The adoption of the World Health Organization Pandemic Agreement in May 2025 marked a political commitment to stronger global pandemic preparedness. Its credibility, however, depends on the successful negotiation and implementation of the Pathogen Access and Benefit Sharing annex under Article 12, to be finalized by April 2026. The COVID 19 pandemic exposed the failures of voluntary global health mechanisms, as African countries rapidly shared pathogen samples and sequence data yet faced severe delays in access to vaccines, diagnostics, and therapeutics. The PABS annex therefore represents the core test of whether the Agreement can move beyond symbolic equity toward enforceable obligations. This commentary argues that African countries enter the PABS negotiations with an unusual convergence of leverage: early scientific contributions, expanding regulatory and manufacturing capacity, and coordinated diplomacy through the African Union and Africa CDC. In a fragmented multilateral environment dominated by high income state interests, the central challenge is not recognition but conversion of capacity into binding rules. African negotiators have responded by pushing for standardized contracts, traceability of pathogen materials and sequence information, and compliance mechanisms that condition access on enforceable benefit sharing. Drawing on Africa’s institutional readiness, the paper contends that the continent is positioned not merely to influence the PABS annex, but to co-design its operational architecture. Whether this potential is realized will determine if the Pandemic Agreement corrects past inequities or reproduces them under a new legal form.

Rising interest in solidarity in global health reflects a growing need to understand why and how it can shape global health policy, practice, and research. This study seeks to review existing studies on solidarity in relation to global health and to identify gaps in current knowledge. We conducted a scoping review of papers published between 2007 and 2024 to explore how solidarity is conceptualised and practised in the context of global health. Our search, guided by the key concepts of solidarity and global health, identified 752 studies across four databases: SCOPUS, PubMed, Global Health, and Google Scholar. Following a rigorous screening and full-text review process, 83 peer-reviewed journal articles meeting the inclusion criteria were selected for thematic review. This analysis focused on examining the relationships between solidarity and global health problems, norms, and practices. The majority of the 83 reviewed articles were theoretical or conceptual in nature (63.9%) and predominantly authored by individuals affiliated with institutions in high-income countries (65.1%). The articles spanned multiple disciplines, with philosophy and applied ethics, including bioethics, being the most prominent (34.9%). Our findings indicate a growing interest in incorporating non-Western perspectives on solidarity and health into recent scholarship. The literature at the intersection of solidarity and global health showed that solidarity is often broadly defined–frequently without explicit reference to global health–and conceptualised in diverse ways, although some agreement exists on its core components. Solidarity’s focus on relationality and interdependence was found to align well with decolonial, feminist or ecological approaches. However, this review also identified a significant gap between the conceptualisation of solidarity and its practical implementation, largely due to structural barriers that impede its translation into action, often leading to undesirable outcomes. This review underscores the conceptual and practical potential of solidarity to reshape some of the foundational assumptions, objectives, and processes of global health. However, substantial work is still needed to clarify more nuanced understandings of solidarity within the global health context, to establish a comprehensive and prescriptive framework that guides an understanding of genuine solidarity and its applications while avoiding merely rhetorical uses and adverse outcomes, and to address the structural barriers that hinder their practical application. Not applicable.

The COVID-19 pandemic exposed weaknesses in health systems globally, highlighting chronic underinvestment, fragmentation, and a lack of preparedness with catastrophic impact on public health, economies and societies. Lessons learned reconfirmed the necessity to build health systems resilience, integrating efforts to achieve Universal Health Coverage (UHC) and health security in tandem. This study identified 63 global and regional policies, collaborations, and investments (collectively termed “initiatives”) that came out post-COVID-19 and reviewed them in reference to their focus on integration of UHC and health security through the lens of WHO’s seven policy recommendations for building resilient health systems. The findings indicate that while efforts to align UHC and health security are evident at global and regional levels, they vary in depth and coherence. 81% of initiatives align with at least four of the seven WHO policy recommendations. While there is emphasis for health security preparedness, focus on primary care and health promotion is less pronounced. Policy initiatives show stronger alignment with WHO policy recommendations compared to Collaborations or Investments, indicating synergies between policies, while apparently a gap between policy and practice. Multilateral groups, including UN agencies, and government-affiliated organizations show greater alignment with the WHO policy recommendations too, while there is less alignment with those from non-governmental and other entities. This review shows that while post COVID-19 policies increasingly articulate visions for integrated health systems strengthening, existing collaborations and investments have not demonstrated comparable commitment to the implementation of these visions. This underscores a prevailing disconnect among global health actors and the mostly reactive and short-term nature of external investments and partnerships. In low-income and fragile health system contexts, this misalignment risks the inefficient use of global support and may perpetuate foundational weaknesses in health systems. Moreover, this is particularly problematic given worsening fiscal constraints from reductions in overseas development assistance and country-level economic contractions. By (re)orienting global health policies, collaborations, and investments toward more unified approaches to achieving UHC and health security, the international community can more effectively support countries in building health systems capable of withstanding future crises, maintaining essential health services and safeguarding gains in health equity.

BackgroundSupporting service delivery through the private sector is a policy priority for improving maternal and child health service delivery for UHC. Despite the increased attention, it is not clear how pay-for-performance interventions within the private sector perform post-donor transition. This study aimed to examine the impact of donor transition on private service providers’ ability to deliver maternal and newborn health in Uganda.MethodsAn exploratory qualitative study was conducted in Uganda’s Rwenzori and Lango sub-regions, which benefited from a USAID project to reduce maternal and newborn deaths from 2012 to 2016 in Rwenzori and 2015–2020 in the Lango sub-region. A purposive sample of 52 respondents (Rwenzori = 26, Lango = 16, National = 10) took part in the study. A thematic analysis technique was followed, guided by the components of the health systems dynamics framework, with data management supported by Atlas. ti a qualitative data management software.ResultsOverall, results reflect a mix of progress and setbacks following the cessation of donor funding to the participating private health service providers. The subnational governance to provide oversight to the private sector was strengthened, which extended into the post-transition period. Despite setbacks in the provision of a comprehensive MNCH package, such as a drastic reduction in patient volumes, reduced scope of services offered and inconsistent supply of emergency medicines, the popularisation of MNCH services among the private sector players created awareness of the same post-transition. The information systems built with donor support contributed to improved data reporting from the private sector, which was sustained post-transition. Human resources for health among private sector players were greatly affected post-transition, although the same benefited the public sector with an experienced pool of health workers from which they recruited into public service. Despite the continued use of equipment procured during donor support, the medicines and supplies were greatly affected by funding cessation. Equally affected was the financing following donor cessation to the private sector players post-transition.ConclusionDespite the mixed results following donor cessation of funding to the private sector, these results have important implications for supporting private sector players to improve MNCH services in low-resource settings. The governance, health information systems, and service delivery experiences are critical aspects worth emulating for better engagement of the private sector in strengthening MNCH service delivery.Clinical trial numberNot applicable.

Poor authorship practices in global health research may be a sign of unequal partnerships. Previous studies have shown that authors from low- and middle-income countries (LMICs) are frequently underrepresented in publications from global research collaborations between LMICs and high-income countries (HICs). To the best of our knowledge, the patterns of authorship from LMICs in international industry-sponsored clinical research on breast, lung and colon cancer have not yet been investigated. Therefore, as a spin-off to broader research on globalization of commercial clinical trials in oncology, we conducted an analysis of authorship in the publications from completed industry-sponsored therapeutic trials in breast, lung and colon cancer (from phase I to IV) that involved LMICs. Only articles published in a peer-reviewed journal in English by March 30, 2024 were included. A total of 302 publications from 173 trials were analysed. 63% (n = 191) of them have at least one author from a middle-income country (MIC); 14% (n = 42) articles have the first author from a MIC; and 13% (n = 39) articles have the last author from a MIC. Conversely, 37% (n = 111) of articles had no author from MIC, including two trials conducted only in MICs. In conclusion, our study found an imbalance in authorship, suggestive of significant inequalities, in collaborative research in industry-sponsored clinical trials for breast, lung and colon cancer. Industry sponsors need to work towards greater equity in authorship when collaborating with researchers in (L)MICs, and oncology researchers and opinion leaders in HICs should actively advocate for greater fairness to their colleagues in (L)MICs.

Professional health associations increasingly serve as vital transnational actors in responding to global public health emergencies and shaping health system resilience. Their cross-border collaboration becomes especially critical in conflict-affected settings, where local infrastructure is overwhelmed, and international expertise, advocacy, and solidarity can bridge urgent gaps. In Ukraine, the intersection of war, health system disruption, and infectious disease threats has underscored the role of organizations such as the All-Ukrainian Association of Public Health Specialists (UPHA), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the American Society for Microbiology (ASM), and the American Public Health Association (APHA). These associations contribute technical assistance, policy guidance, and emergency response and cultivate a shared professional culture and knowledge base that transcends national borders. While the role of professional health associations in routine healthcare delivery and advocacy has been previously explored in the literature, few publications have addressed their mobilization during acute crises—particularly in lower-resource or conflict settings. This comment responds to that gap by examining how professional associations act as platforms for coordinated response, capacity building, and health diplomacy during complex emergencies, with a specific focus on addressing infectious diseases in Ukraine. It draws on desk reviews, organizational reports, and authors’ insights to inform how these associations support infection prevention, biosafety, antimicrobial resistance surveillance, and the development of a resilient public health workforce—issues of global relevance that demand collaborative solutions.