The COVID-19 pandemic exposed a brutal truth about the global health order: when faced with a shared threat, the world’s wealthiest nations chose to protect their own interests before protecting human lives. Masks, ventilators, vaccines, diagnostics, and medicines were treated not as global public goods, but as commodities to be bought, stockpiled, and controlled by those with the deepest pockets. As governments across Africa, Latin America, the Caribbean, Asia, and Eastern Europe scrambled for access to life-saving technologies, richer countries secured supplies far beyond their immediate needs, leaving millions to wait. The result was not merely an inequitable response. It was a profound moral failure that turned survival into a privilege of wealth and geography and contributed to unnecessary suffering and loss of life across much of the Global South.
Six years later, the world has an opportunity to decide whether it has learned from that experience. Yet as negotiations continue around the World Health Organization’s Pathogen Access and Benefit-Sharing (PABS) system, there is a real risk that some of the same dynamics that defined the COVID-19 response could be embedded into the framework intended to prevent them.
Recently, AIDS Healthcare Foundation joined other civil society organizations in submitting a complaint to the United Nations Special Rapporteur on the Right to Health. The concern is straightforward: positions advanced by some high-income countries in the PABS negotiations risk undermining principles that are already firmly grounded in international human rights law, including the right to health.
Human rights do not become optional when governments enter international negotiations. Countries do not leave their obligations behind when they walk into the World Health Organization. The right to health, recognized under international law, carries responsibilities that extend beyond national borders. It requires cooperation, solidarity, and a recognition that decisions taken in one country can directly affect the health and lives of people in another.
These principles are not abstract legal concepts. They become matters of life and death during a public health emergency.
Scientific progress only has value if its benefits reach people in time. A breakthrough vaccine provides little comfort to a patient who cannot access it. A life-saving medicine means little if it is unaffordable. Cutting-edge diagnostics cannot stop an outbreak if they arrive only after the worst has already happened. The true measure of scientific innovation is not what is discovered in a laboratory, but whether those discoveries are available to the people who need them most.
That reality raises a fundamental question at the heart of the PABS negotiations: who benefits from science, and when?
During a pandemic, access to vaccines, diagnostics, and treatments should be determined by public health need, not purchasing power. The countries facing the greatest risk, the highest disease burden, and the most vulnerable populations should not find themselves at the back of the queue simply because they cannot outbid wealthier nations. Yet that is precisely what happened during COVID-19.
The principle underpinning PABS should be simple. Countries share pathogen samples and genetic sequence information so that researchers and manufacturers can rapidly develop the tools needed to respond to emerging health threats. In return, the benefits generated from that research should be shared fairly and predictably.
Reciprocity is not a radical concept. It is the foundation upon which trust is built.
Yet many civil society organizations are deeply concerned that the system currently under discussion provides greater certainty around access to pathogen information than it does around access to the products developed from that information. In other words, countries may be expected to share samples quickly and transparently while receiving no meaningful assurance that they will have access to the vaccines, medicines, diagnostics, technologies, or knowledge that result from those contributions.
That is neither sustainable nor fair.
It is difficult to justify a system in which countries fulfill their responsibilities immediately, yet must rely on goodwill, political considerations, or charity when it comes to receiving the benefits generated from their contributions. If pathogen sharing is an obligation, then benefit sharing must also be an obligation. Certainty must exist on both sides of the equation.
Timing matters as much as access itself.
One of the lessons of COVID-19 is that delays cost lives. Waiting until an outbreak has escalated into a full-scale pandemic before stronger access mechanisms come into effect defeats the purpose of preparedness. The most critical window is often the earliest phase of an outbreak, when rapid intervention can contain transmission, prevent escalation, and save lives. Access to health technologies must be built into the response from the start, not offered after the crisis has already deepened.
The experience of Southern Africa during COVID-19 illustrates this challenge vividly.
Scientists in South Africa and Botswana played a critical role in identifying and reporting the Omicron variant to the world. Their transparency and scientific excellence allowed the global community to better understand the emerging threat. Yet the immediate response was not solidarity. Instead, several countries imposed travel restrictions targeting Southern Africa, with significant economic consequences for the region.
At the same time, many African countries continued struggling to access vaccines already widely available elsewhere.
Former Botswana President Mokgweetsi Masisi captured the frustration felt across much of the developing world when he questioned a system in which countries are encouraged to contribute scientific information for the benefit of all, yet see the resulting technologies concentrated in the hands of a few.
His criticism speaks to a deeper concern that extends beyond COVID-19. Why should countries continue to share the information that makes scientific discovery possible if they have no assurance that the benefits of that science will return to them when they are needed most?
This question is particularly relevant given the enormous contributions countries in the Global South make to global health security. They contribute surveillance systems, research institutions, healthcare workers, clinical trial participants, pathogen samples, and genetic data. Their contributions help drive scientific advances that protect the world. But contribution alone does not guarantee access.
That imbalance must change.
Benefit sharing cannot be reduced to last-minute donations of surplus products after wealthier countries have met their own needs. Donations may have a role, but they are not a substitute for equity. By the time vaccines or medicines arrive months late, opportunities to prevent deaths and control outbreaks may already have been lost.
Furthermore, true benefit sharing involves more than distributing finished products. It requires expanding access to manufacturing capacity, technology transfer, voluntary licensing, scientific knowledge, and regional production capabilities. Countries should not remain permanently dependent on a handful of suppliers located thousands of kilometers away. Building resilient and geographically diverse manufacturing systems is not only fair, it is strategically necessary for global health security.
What PABS ultimately needs is accountability.
There must be transparency regarding who accesses pathogen information, how that information is used, and whether agreed benefits are actually delivered. There must be mechanisms that support affordability, expand production when demand surges, and ensure that commitments are enforceable rather than aspirational.
None of this should be interpreted as an argument against rapid information sharing. On the contrary, the rapid exchange of scientific information remains essential to managing future outbreaks. But a system that is crystal clear about the obligations of countries contributing pathogen information while remaining vague about the obligations of those benefiting from that information is neither balanced nor sustainable.
Infectious diseases do not respect borders, ideologies, or economic status. An outbreak left uncontrolled anywhere can quickly become a threat everywhere. Ensuring that life-saving technologies reach the places where they are most needed is not an act of charity. It is an act of collective self-interest and sound public health policy.
The world will be judged not only by how quickly it can detect the next pandemic threat, but also by how fairly it responds to it.
If countries are expected to share the information that makes scientific breakthroughs possible, then the benefits of those breakthroughs must also be shared fairly, rapidly, and predictably. The lessons of COVID-19 are too painful and too recent to ignore.
The next pandemic cannot be determined by who can pay first and who is left waiting. Human lives must never again be auctioned to the highest bidder. The international community now has an opportunity to build a system rooted in fairness, reciprocity, and shared responsibility. It must not waste it.
By Dr. Jorge Saavedra, Executive Director, AHF Global Public Health Institute
