This month, Cordaid marks a remarkable milestone: our international health work has reached its 100th anniversary. A fitting moment to pause and reflect. What have we learned? Which approaches truly work? And which do not? And above all: what does the future demand of us?
Against this backdrop, we read with deep concern the details of the United States’ new bilateral strategy to fight infectious diseases. The draft agreement with PEPFAR (the US President’s Emergency Plan for AIDS Relief) that low- and middle-income countries are expected to sign introduces new conditions: any country seeking US assistance must provide genetic material of potentially dangerous pathogens within 5 days, not to the WHO, but directly to the US.
Immoral and Politically Explosive
This may all sound very technical, but it is fundamentally about ethics. Morally, it is indefensible, and politically, it is explosive.
Because what is at stake here is the very essence of international health cooperation. Is disease control a collective, global effort built on solidarity and mutual trust? Or is it a geopolitical tool, in which powerful nations impose their interests on vulnerable partners?
PEPFAR clearly opts for the latter. Instead of strengthening multilateral agreements, the United States undermines the ‘Pathogen Access and Benefit Sharing’ system, which has been the subject of careful WHO negotiations for years. Meanwhile, countries in the Global South have insisted that sharing crucial information must go hand in hand with fair access to vaccines and treatments.
Aid Based on Barter
The US seeks to sidestep that balance. It offers temporary financial support for surveillance and laboratory capacity, but demands long-term obligations in return; obligations that are grossly disproportionate to the assistance provided.
For instance, after 2026, countries would increasingly have to cover their own transport and salary costs, and by 2030, the entire support package would end, while the obligations would remain in place for another 25 years.
The result is a form of health assistance based on barter rather than on justice. Working on health in fragile contexts requires cooperation, trust and local ownership, not deals that pressure countries to choose between protecting their population and safeguarding their sovereignty. Health must never be used as leverage.
Don’t Look Away
We can choose a different path. By actively advocating for a strong and equitable system within the WHO. By putting solidarity first, even when others do not. And by refusing to look away when international health cooperation is turned into a geopolitical game.
For 100 years, we have known: health is not a commodity, it is a human right. Let us stand firmly by that principle for the next 100 years as well.
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