Despite heavy pressure from the WHO and European Union in yet another meeting, in Geneva, Switzerland, a large bloc of African states are refusing to sign on to what they consider a clear colonialist agenda. Which of course it is, aimed at putting Covid-era wealth transfers on a more permanent footing.

The WHO, for reasons explained below, is doing what it is paid to do. Major financial sponsors of the WHO have much to gain from getting this Agreement through. It has fallen on African leaders, attuned to the model of rich countries and their corporations imposing rules designed for wealth extraction, to protect the rest of us from the farce that the current public health approach to pandemics has become.

The fact that the agency tasked with building capacity and promoting sustainability of low-income health systems is instead doing the opposite now needs to become the center issue of this whole shabby episode. It is time for the international public health community to face itself and decide on which side, people or profit, it should stand.

The Modern Basis of Multilateral Health Cooperation

There are obvious reasons for countries to cooperate in matters of health, as there are for neighbors on a suburban street. Mutual interest in facing common threats where action by neighboring States, or access to their resources, helps protect your own. Moral reasons based on the generally accepted 'good' of helping neighbors when they are in difficulty or lack resources through no fault of their own. Or because a stable and more prosperous neighborhood (world) is good for business, and a sick one may not be.

Cooperation is not submission, and few self-respecting people would opt for that. Mutual interests and morality all dissolve fairly quickly when cooperation becomes coercion, and the interests of the most powerful player then become the goal. Health is well-defined in the WHO's constitution as physical, mental, and social well-being. Accordingly, it rests on economics and social capital and is degraded by poverty and inequality. Neither aspect of well-being – mental, social, or physical – is supported by forced compliance or slavery.

The basis of modern medical ethics hinges on Hippocrates' assertions on physician conduct from around 400BC, commonly summarized as to do good rather than harm and respect a patient's privacy (confidentiality). As a counter to fascism since the Second World War, we added voluntary informed consent (i.e. absence of coercion). This means the final decision in any aspect of medical care or intervention must rest with the individual concerned.