Poor countries already spend significantly less money on health care than wealthy nations. Historically, long-term economic growth has been the way to increase health expenditures.
If developed nations want developing ones to make new investments now, the middle and low-income countries argue that the rich countries should be willing to help pay for it.
But at the same time they are demanding One Health investments, those rich nations are balking at a proposal that would help the world identify and fight potentially dangerous pathogens.
I wrote about this issue in late February. It's called pathogen access and benefit sharing (PABS).
The idea is that rich countries or the pharma manufacturers should pay for access to pathogens of concern that are identified in developing countries and commit to sharing the benefits derived from that access — i.e., diagnostics and vaccines that are ultimately produced — with those poorer countries. That provision has been a priority for the developing world after the pandemic, when Covid-19 vaccines were slow to reach low-income nations in Africa and the rest of the world.
But the rich countries don't like it. They, along with the pharmaceutical companies they represent, argue such a system would be too bureaucratic and risk slowing down innovation in a future public health emergency.
Some experts have noted the irony of the US and Europe insisting on unfettered access to pathogens from low-income countries at the same time the US government is facing criticism for being slow to share data about H5N1.
"The situation with avian influenza across the United States exemplifies the inherent hypocrisy and vested economic interests around Pandemic Prevention, Preparedness, and Response," Dr. Christian Walzer, executive director of health at the Wildlife Conservation Society, said in a statement.
"While the Global North is demanding transparent and rapid access to pathogen data from the Global South … it seems unwilling to share such information with the world."
The two issues have become entwined in last-minute horse-trading. Based on the latest reporting, developed countries are trying to force a compromise by dangling PABS in exchange for the One Health provisions.
But as of now, the most likely outcome appears to be, at best, a symbolic commitment to One Health principles and a directive to reach an agreement on more specific provisions in the next two years.
Such a disappointing resolution, even as concerns about bird flu grow, is symptomatic of the world's struggles to apply the lessons of Covid-19. As the urgency with which the negotiations began continues to fade, self-interest and geopolitical rivalries are standing in the way of making the world safer from pandemics.
Let's hope we don't pay the price for that shortsightedness.
—Dylan Scott, senior correspondent and editor
