During the final months of 2025, the global health community got to know about the America First Global Health Strategy. A complete analysis of all the problem areas of this policy would take us too far: allow me to focus here on the implications for the ongoing negotiations on a Pathogen Access and Benefit Sharing (PABS) agreement.

During the Covid-19 pandemic, low- and middle-income countries (and even some high-income countries) became aware (again) that genuine and well-intended international cooperation is not always a two-way street. While most countries shared all available information on how Covid-19 evolved at home, the COVAX initiative developed by WHO and others, although intended to “guarantee fair and equitable access [to Covid-19 vaccines] for every country in the world”, had to work with the left-overs, after high-income countries finished their shopping. “Never again”, is what some leaders of low and middle-income countries thought: from now on it will be a two-way street. That is what PABS is about: basic fairness and reciprocity. At least if they reach an agreement in the coming months.

The Trump administration did not wait for the outcome, however. It pulled the USA out of the WHO (and the PABS negotiations), closed USAID, thus creating a deadly situation of financial scarcity, and then came with “an offer they cannot refuse”: financial support can resume, but only to those countries who are willing to give the USA more than what PABS could ever have provided, and for a lower return.

We do not know enough about the content of the 15 bilateral agreements  signed so far between African countries and the USA to evaluate their long-term consequences. We do know, however, from the negotiations with Kenya, that the USA wanted “a specimen-sharing agreement”, which Kenya refused.

And suddenly European countries (and other high-income countries) are facing the prospect of vaccines to counter the next pandemic being developed and produced in the USA only. If tariffs do not convince pharmaceutical companies to move their vaccine development capacity to the USA, access to necessary information may. (‘Fortunately’, we may still rely on the Trump administration’s antivax stance to keep some of that capacity in places where vaccines are more appreciated.)

So, Europe may be getting a taste of its own medicine? We’re not there yet, but could be there sooner than we’d like. European countries’ vaccine hoarding behaviour during the pandemic may not have been a blatant violation of  international law – although the commitment to international collaboration and assistance of article 44 of the International Health Regulations would have justified more generous behaviour – but it certainly was an example of (economic) ‘might is right’. As long as the USA was part of Team West, ‘might is right’ was a bearable – albeit somewhat unbecoming – way of running global affairs, at least from a European perspective. But suddenly, it looks a lot less enticing.

Since about a decade, forcing myself to look for silver linings – always – is my first new year’s resolution. Year after year, it becomes harder, though. This year, I hope for the emergence of a ‘coalition of the unwilling’: people, and countries, unwilling to trade in the (previous) unipolar ‘might is right’ regime for a multipolar ‘might is right’ regime.

And now I hope that the people who represent me in the PABS negotiations will take, in the near future, less of a ‘might is right’ position than currently seems to be the case…