On November 6, the day after the US presidential elections, in the train from Paris to Brussels, I’m looking hard for a silver lining. (That is a mental health lifestyle choice of me, always look for silver linings.) The only one I can come up with is: clarity. Under president Trump, international cooperation in health will serve the interests of the USA, or it won’t be.

That is, in my opinion, merely a clarification: under previous US presidents too, global health efforts have always been driven by the interests of the USA, which explains why global efforts to control infectious diseases (aka ‘global health security’) have always been the USA’s priority – more than universal health coverage, for example. And if we’re honest about it, the global health practice of the member states of the European Union is not all that different, once you scratch away the thin layer narratives of ‘equity’ and ‘health systems strengthening’. So that’s what it would be: a clarification, not even a radical change.

How would that be a silver lining? First, a partnership that is based on pursuing common interests could be more balanced, in terms of power, and more reliable, than a partnership based on charity – albeit labelled as solidarity. We could get rid of terminology like ‘donors’ and ‘recipients’ and ‘aid’, because none of these are appropriate for partnerships pursuing common interests. Who is the ‘donor’ and who is the ‘recipient’ of a polio vaccination campaign in Pakistan? Are the countries providing the money for the sake of protecting their own future generations of children from polio the donors? Is Pakistan, doing all the hard work, providing the health workforce it trained and hired, the recipient?

That brings me to my second silver lining point. If done seriously, and somewhat fairly, a global partnership focused on infectious disease control would probably generate bigger financial transfers (not aid) than global health currently does. All the billions channelled through the Global Fund and GAVI obscure the reality that the ‘recipients’ are making the biggest contributions – especially if expressed as percentages of their wealth.

Of course, such a partnership would only truly improve the present imbalance of power if all partners involved were willing, at some point, to step out of it. The power to say no costs no money, even the poorest countries can do that, and that is what could make all high-income countries accept that they are now negotiating with equal partners – not ‘recipients’. It would result in a kind of game of chicken: the first one who gets scared of the consequences of holding their position is the loser. In practice: the countries willing to say no to an unfair global infectious diseases control partnership may also be the ones facing the most serious hardship from uncontrolled infectious diseases.

But isn’t that exactly what is happening in the ongoing Pandemic Treaty negotiations ? The low- and middle income countries who are standing their ground and refusing to provide ‘pathogen access’ as long as there is no fair ‘benefit sharing’ are playing a game of chicken with the high-income countries. Let’s see who blinks first.