When contagions don’t discriminate, why should cures? That question encapsulates a bitter irony of global public health. Countries that contribute the most pathogens to medical research are often the last to benefit from the outcomes.

Low- and middle-income countries (LMICs) in Africa, Southeast Asia and Latin America, where new pathogens often emerge, are expected to proactively share biological materials and genomic data with the world through the World Health Organization (WHO). However, countries that develop life-critical vaccines, therapeutics and diagnostics (VTDs) using that material are under no obligation to reciprocate with fair and timely access to these clinical products. Risks are shared; rewards are not.