I have sought to demonstrate why politically and economically powerful countries should care about the world’s least healthy people. It may be a matter of national interest, so that helping poor States makes everyone safer and more secure. Or, global health assistance simply may be ethically the right thing to do to avert an unfolding humanitarian catastrophe. Or, there may be a growing sense of legal obligation, whether through WHO treaties and regulations or the international right to health. Although no single argument may be definitive in itself, the cumulative weight of the evidence is now overwhelmingly persuasive. Whatever the reasons, perhaps we are coming to a tipping point where the status quo is no longer acceptable and it is time to take bold action. Global health, like global climate change, may soon become a matter so important to the world’s future that it demands international attention, and no State can escape the responsibility to act.

If that were the case, States would need an innovative international mechanism to bind themselves, and others, to take an effective course of action. Amelioration of the enduring and complex problems of global health is virtually impossible without a collective response. No State or stakeholder, acting alone, can avert the ubiquitous threats of pathogens as they rapidly migrate and change forms. If all States and stakeholders voluntarily accepted fair terms of cooperation through a FCGH, then it could dramatically improve life prospects for millions of people. But it would do more than that. Cooperative action for global health, like global warming, benefits everyone by diminishing collective vulnerabilities.

The alternative to fair terms of cooperation through a Framework Convention is that everyone would be worse off, particularly those who suffer compounding disadvantages. Absent a binding commitment to help, rich States might find it politically or economically easier to withhold their fair share of global health assistance, hoping that others will take up the slack. Major outbreaks of infectious disease, including extensively drug resistant forms, would become increasingly more likely. Even if the economically and politically powerful escaped major health hazards, they would still have to avert their eyes from the mounting suffering among the poor. And they would have to live with their consciences knowing that much of this anguish is preventable.

What is most important is that if the global community does not accept fair terms of cooperation on global health soon, there is every reason to believe that affluent States, philanthropists, and celebrities simply will move on to another cause. And when they do, the vicious cycle of poverty and endemic disease among the world’s least healthy people will continue unabated.

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