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Alleged mice infestation at Albuquerque middle school raises health concerns, staff & parent outrage
Staff and parents at James Monroe Middle School in Albuquerque report a recurring mice infestation, with droppings, urine, and dead rodents found throughout the campus, prompting health concerns and grievances against Albuquerque Public Schools.
Hospital workers' union files labor grievance against UF Health amid contract talks
The AFSCME Local 1328 and Local 1781 filed an Unfair Labor Practice grievance against UF Health following stalled contract negotiations.
Treasury says largest U.S. banks let politics influence who received banking services
New Treasury Department findings may lend weight to President Donald Trump’s long-running grievance that major banks have discriminated against conservatives.
September Monthly Review: Health MCP Guy?
For all the time I spend talking about APIs and data exchange, this newsletter has had embarrassingly little interoperability of its own. It’s old-school SaaS, baby - UI or bust. Not all of that is my fault! Substack, for all its popularity, is (as mentioned before) really frustrating as my system of record. The primary user it optimizes towards is the reader, whose attention feeds the app, the Notes feed, and the recommendation network that Substack is actually selling. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe They’re falling into the same trap that Medium once sprinted into, albeit at a much more glacial speed. Younger generations may not remember (or never knew) it, but Medium once lured publications like The Ringer and Signal v. Noise onto its platform, only to lose them as it rebuilt itself around a paywall and an algorithmic feed. Substack’s original pitch circa 2020 was the antidote (you own your list), but every new feed feature chips away at it. I get it: writers are generic supply in the eyes of the Substack product team. Generic supply follows demand, so the consistent pressure on the PMs is to generate demand, which leads to every product cycle going toward discovery (Notes, recommendations, the app, live video). The end result lackluster author tools (laggy and broken analytics are truly crippling) all despite the premium price point. The archive is where it crosses from authorial gripes to actual reader impact, though. Across Substack and LinkedIn, I’ve published 1,218 posts and nearly 900,000 words since 2018. Substack’s native search can see only the 464 posts that live on Substack, and even there it’s woefully inadequate at surfacing relevant content (even for the guy who wrote it)! Readers have the same problem, writ large. Ask the Archive Fixing search (for both my readers and my own use) turned out to be extremely non-trivial, unfortunately: There’s no public API for readers to access content RSS exists for new content notification, but it only carries the 20 most recent posts and cuts paid ones off at the preview The only Substack MCP is an admin tool for analytics The export exists for authors, but it’s painfully awkward and slow. So I built something to work around that: the Health API Guy MCP. It’s a private MCP server holding the full text of everything I’ve written across Substack and LinkedIn. Add it to Claude or ChatGPT as a connector and you can ask things like: It pairs keyword search (for acronyms and case names, of which we have many) with semantic search. Every post is also labeled by topic, form, and court case, so you can pull a lawsuit’s (or multiple cases’) entire docket across Substack and LinkedIn in one query: Hail, Healthapiguyhydra This is also a bit of me eating my own cooking. I’ve spent the year arguing that headless healthcare is arriving and that developers want primitives over abstractions. Last week in Hail, Benihydra, I watched Salesforce plug its platform into Claude and bet that the records underneath outlive whatever interface sits on top: Salesforce must believe that the Hydra’s immortal head is the records, permissions, and business logic (in that they will survive whatever happens to the interface). It felt a bit hypocritical to keep my own archive behind a Substack search bar. The archive is the body. Substack is one head, and now whatever tool you might use is another. Will the EHRs follow my lead? Probably not imminently, but one can hope! Why Founding Members Only The MCP is available to Founding Member subscribers. A few reasons: It costs money and time to run. Hosting, the database, Clerk usage and AI compute for search and labeling are significant operational costs (that increase with usage). Substack gives me no way to automate access. There’s no API to check whether someone is a paid subscriber, so every user is manual operations for now. It’s a beta. We’ll need to improve things and parts will break. I’d rather they break for a small group of dedicated readers who will tell me about it. The Founding tier deserved a real benefit. Until now it was mostly a generous tip. Now it comes with something. If you’re already a Founding Member, reply to this email with the address you’d like provisioned. If you’re not and want in, upgrade here. Larger teams (such as companies) can get access too: group subscriptions at the Founding tier come with the group discount. The admin for the subscription can reply with the list of addresses to provision. Get 20% off a group subscription Pricing Founding membership is now a flat $200 a year, replacing the old suggested $150 that readers could adjust. Existing Founding Members will have access grandfathered in at their previous rate. Month in Review Articles Published Make Networks Dumb Again (Sep 11): AI is making old analog networks cheaper to use and flooding them with machine traffic in the process. A plea for agent-native rails with the intelligence at the endpoints, and for Washington to drag them to ubiquity. Interoperability, Unbuttoned (Sep 29): Interoperability is a series of workflows in a trenchcoat, and this post finally takes the trenchcoat off. A color-coded map shows which provider workflows went digital, which are fragmented, and which still run on fax. Video Content Antitrust’s System of Record Problem (Sep 3): The FTC’s investigation into Epic prompted a ninety-minute webinar, now posted with chapters and a smoothed transcript. We get into why market definition, missing B2B share data, and the SSNIP test leave antitrust poorly suited to systems of record, plus why information blocking may be doing more than any pending lawsuit. The Information Exchange: Cerner Milking Edition (Sep 18): This was so fucking fun. Ryan Tucker, Ryan Brickner, Brad Thorson, and I try an Around the Horn format, complete with points, penalties, and a mute button. We debate whether Oracle Health is dead, who would actually buy Cerner (IBM enters the chat), p(Doom), and why the front desk still hands you a clipboard. Regulatory Ask Not What Your Network Can Do (Sep 23): CDC’s RFI on public health data intermediaries lists use cases already served, unevenly, by eCR, lab reporting, IZ Gateway, and syndromic surveillance. The real opportunity sits in one question about AI: a network that can handle the next emergency without another interface project. Court cases Particle v. Epic: The Naughty Schoolteacher (Sep 4): After a summer-long vigil, the answer on Epic’s early summary judgment bid is two paragraphs and a remedial assignment. Particle advances to the next grade, and market definition gets another year of discovery. The Epic Discovery Files (Sep 8): Texas’s motions to compel arrive with a 251-page appendix of requests, objections, and meet-and-confer letters with Cravath. Inside: Epic using generative AI for document review, denied interoperability requests in scope, and Noerr-Pennington raised against lobbying discovery. Epic v. Health Gorilla: “Working as Designed” (Sep 9): Epic wants nothing to do with the data breach MDL, and explaining why puts fresh discovery on the public docket. The spiciest allegation: Health Gorilla told GuardDog to scrub its law firm business from its website instead of cutting off access. Veeva v. Epic: Legal Bypass Surgery (Sep 15): Veeva asks the Wisconsin Supreme Court to skip the Court of Appeals, while law professors and three policy groups line up as amici. Meanwhile, Epic’s lawyers apologize for another round of citation errors, including a quote that never existed. Texas v. Epic: Behind the Black Bars (Sep 17): The court portal served up Epic’s unredacted filings, revealing a $5 million document review budget and the AI workflow behind it. Also inside: the 200-plus company names Texas wants searched, and one very expensive Zoom invitation. OpenEvidence v. Doximity: Consequences Will Follow (Sep 25): OpenEvidence tells the court it will not comply with a discovery order, and its own lawyers at Quinn Emanuel say they won’t defend the choice. Add years of Slack reported unrecoverable, and Rule 37 sanctions come into view. Health Tech Keeps Choosing Violence (Sep 28): Doximity moves to end OpenEvidence’s case, Epic asks Texas to show its work, and a sleepy Audacious Inquiry patent fight sprouts antitrust and information blocking counterclaims. The main event is a long-sealed Cognizant v. Infosys ruling that hints where system of record antitrust claims can survive. EHRs One Verb for Oracle Health (Sep 14): Oracle’s earnings call quantifies every data center to the decimal point, while Oracle Health gets a single verb: “accelerate.” Panning the few healthcare mentions turns up an agentic care management system, a research-to-care ledger play, and the question of whether healthcare gets Larry’s patience. Epic’s Forretress Under Siege (Sep 30): Judy Faulkner tells a panel Epic paused hundreds of projects to harden its software and calls it a “shame,” while a spokesperson insists the roadmap hasn’t changed. Project Glasswing, a Pokémon-branded QAN sprint, and a trove of Jodel grievances reconcile the two Epics and preview the Jevons paradox coming for all software. Industry Analysis Scanning for a Network (Sep 1): Scan.com raises $220M to build the imaging network labs never got, speedrunning Zocdoc’s consumer-to-B2B pivot. Its wedge to network density may be the most American one available: personal injury litigation. The Front Desk Wants the Damn Whole Building (Sep 16): Hello Patient buys Converse Health, pushing its AI front desk into referrals, chart work, and prior auth. The copilot categories keep blurring, and your distribution partner is still your final boss. Cross-industry Comparisons A Different Patchwork Quilt (Sep 10): Healthcare loves to envy open banking, but the US version has no mandate, a toll booth at Chase, and data quality problems of its own. The grass isn’t greener; it’s another American patchwork quilt, and perhaps a worse one. Hail, Benihydra (Sep 21): Salesforce brings its platform into Claude, Slack, and its own agent, inviting the interfaces that might replace it. Cut off one head and more grow back, so long as the records underneath stay put. Living on A Trade Secret Prayer (Sep 22): Six credit unions are suing Fiserv, the Epic of core banking, by claiming their own member records as trade secrets. Banking has no Cures Act, so its lawyers reach for legal alchemy that healthcare has already tried. Other News None this month External Media Nabla Accelerate NYC: I kicked off fall conference season at Nabla’s Accelerate event in New York, where Delphine Groll opened by asking the room to picture the company it wants to become and the one it doesn’t. I liked her framework of bureaucracy, fear, and ego as the blockers. I also love vendor conferences/events in general - different vibe than industry biggies. Healthcare 101 with Nikhil Krishnan: I briefly guest lectured Out-Of-Pocket’s Healthcare 101 class. Appreciated Nikhil’s takeaways cover whether AI doctors can query HIEs, why healthcare’s data-liberation rules beat most industries’, and the hi-res graphic is in the comments. HCN: Epic Probed by the FTC: I joined the HCN guys to talk through the FTC’s investigation into Epic. Cedric’s new hairdo was an unexpected plot twist. The episode also covers MFN drug pricing, healthcare M&A and Eli Lilly’s acquisition streak. Fall Conferences: At eHealth Exchange’s Annual Meeting in Austin on Oct 27, I’ll moderate a panel on the tensions between AI, HIEs, and timely patient access with Jean Ross (Primary Record), Therasa Bell (Kno2), Byron Crowe (Doctronic), and Michael Marchant (Freenome). Here’s the rest of my schedule if you want to meet up: CommonWell (Redwood Shores, CA): Oct 13-14 Will be participating in a fun Jeopardy event Open@Epic (Madison, WI): Oct 20-23 Will be enjoying Verona, Willy Street, and other local adventures eHealth Exchange and Sequoia Project (Austin, TX): Oct 27-29 Yeehaw HLTH (Vegas): Nov 15-18 Groundhog Day, Venetian Edition RSNA (Chicago): Nov 30-Dec 2 See me at “Governing AI in Breast Imaging: What Health Systems Are Actually Doing” Digital Health Counsel 2026 AI Summit (Seattle): December 2-3 Will likely be speaking to a bunch of lawyers about information blocking Posts I Liked ChatGPT’s Epic integration: game changer or nothing burger?: Joshua Liu, MD offers five thoughts on OpenAI’s Epic launch, starting from the point that it rides the same open APIs available to anyone. He argues read-only access leaves ordering to Art and the ambient startups, and asks why HCA is piloting it alongside Commure. He’s sorta a must-follow at this point - consistently excellent, thought-provoking takes. Epic, Lilly, and the Discovery pass: Seth Chaney reads Epic’s first major Discovery deal (with Eli Lilly), as well as its revised developer terms on commercial displays, as the pipe finally opening between EHRs and pharma. Life sciences and health continue to collide. Scott Rossignol on EHR payer platforms and ePA fees: Scott argues the top ambulatory EHR vendors are turning the prior auth mandate into a per-member-per-year toll on payers, for an API whose operating cost has nothing to do with covered lives. His fix is two lines of regulatory text: put the CRD/DTR/PAS certification criteria in the Base EHR definition, and bring payer-facing ePA connectivity under § 170.404’s cost-based fee rules. It’s a good solution. Health API Guy is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
Aaron Rodgers blasts exes, says Shailene Woodley broke off engagement
As he kicks off his final NFL season, Aaron Rodgers is taking the opportunity to air out his grievances about his past relationships.
Burlington mayor meets with businesses over downtown disorder
A standing-room-only crowd gathered at Burlington’s City Hall to express their grievances.
Is Germany benefitting yet from the crisis in US research?
Science|Business - Table.Media partnershipScience|Business has partnered with Table.Media, a leading source of news about higher education and research in Germany. Each week, we are publishing one of each other’s stories to give readers an even broader range of insight into R&D policy across Europe.Drawing over 500 participants, the German Academic International Network conference in San Francisco brings together researchers, universities, scientific organisations and policymakers in the US as part of an attempt to recruit international talent for Germany. It also serves as an annual barometer for the uncertainty triggered by the Trump administration’s science policies. As was the case last year, Germany’s political presence was unusually strong: federal lawmakers, nine state ministers of science and research, and federal research state secretary Marcus Pleyer all attended. Joybrato Mukherjee, president of the German Academic Exchange Service (DAAD), has observed a marked shift at US universities a year after the Trump administration began sweeping interventions: the initial state of "shock and paralysis" has given way to a strategic approach to the situation. Universities are seeking new funding sources, mounting legal challenges against interventions and opening themselves up more to international collaborations, including with Germany, he said. Early-career international researchers with expiring visas are considered particularly vulnerable. Germany is benefiting from increased demand among this pool of young talent; the country’s 1,000 Minds Plus programme, designed in part to lure German academics back home, has already filled up around one-third of its capacity. Meanwhile, Markus Blume, Bavaria’s science minister and current chair of the federal Conference of Science Ministers, sees an "enormous outflow of talent from the US." An increasing number of international researchers want to leave. Applications to Canada have risen by 42% January, and those to Europe by 32%. Meanwhile, the number of people drawn to the US is plummeting. "In this context, Germany must position itself as a prime destination offering reliable conditions, institutional stability and academic freedom, including through smart collaborations," Blume told Table.Briefings.“Darkest hour”At the get-together in San Francisco, the former president of the US National Academy of Sciences, Marcia McNutt, highlighted the gravity of the situation on the ground in a keynote address. She described the present moment as the "darkest hour for the US scientific system." At the same time, she said that cooperation should be maintained, especially during a crisis. Established researchers in the US are less likely to leave. Ulrike Malmendier, a former member of the German Council of Economic Experts and an economist at Berkeley, explained why established researchers are not packing their bags and leaving the US in droves: working conditions and the concentration of talent at places like Berkeley and Stanford remain unparalleled. According to Peter-André Alt, managing director of the Wübben Foundation, which helps Germany attract international academics, political restrictions are not the only grievance voiced by US-based researchers. "There are evidently still many areas where, fortunately, unfettered research is possible," Alt told Table.Briefings. Instead, the primary complaint concerns the cost of living, which has "skyrocketed” to absurd levels. "Runaway inflation, like that currently seen in the US, is certainly no draw for young scientific talent,” he said. Return homeA growing number of early-career researchers from Germany appear to be considering a return home. Jörn Benzinger, who is responsible for recruiting early-career researchers from abroad at Ruhr University Bochum, reports numerous conversations with researchers who are taking a closer look at the German academic landscape."Germany has definitely moved more into the spotlight,” he said. States, university alliances and research organisations joined forces to recruit talent. Bavaria, Baden-Württemberg and North Rhine-Westphalia were prominently represented, as were alliances such as the Berlin University Alliance and the University Alliance Ruhr. Benzinger sums up Germany’s approach with a new formula: "collaboration is the new competition." He notes that it is becoming increasingly difficult for individual universities to gain international visibility, while regional research ecosystems and collaborations are growing in importance. Afraid to leaveThe crisis in the US academic sector is also straining transatlantic research relations. Benzinger reports that some US-based researchers had to decline brief invitations to Germany because they could not be certain of being allowed to re-enter the US afterward.He considers the simple poaching of researchers to be the wrong approach; what is needed, he says, are "reliable offers and long-term partnerships."However, Green Party politician Ayşe Asar, who also attended the conference, sees a significant need for improvement, particularly regarding career paths in Germany.While lifetime professorships and academic freedom certainly make Germany attractive, young researchers also require predictable career paths, tenure-track positions and flatter hierarchies.
Why Is Hunter Biden on a Media Blitz?
The former president’s son is trading silence for airtime, using podcasts and essays to talk about his past and share grievances.
Fauci Contempt Vote Reflects the Enduring Politics of COVID
Experts say the focus on COVID grievances shows that some wounds it opened were never closed
Trump forced to play good sport at correspondents’ dinner
President’s speech at Friday’s event started well enough but quickly moved to the usual insults, taunts, jokes and grievances
White House report says Trump can usher in a "new golden age" of science
The resulting report is a near-random mixture of real problems and grievances.
Trump heads to NATO as tensions simmer with Europe
President Trump's grievances with several European governments over their refusal to join the U.S. war with Iran have cast a pall over the summit.
Opinion: Grievance, Bewilderment and Ethnic Amnesia: Poland, Ukraine and the Politics of Historical Memory
An explainer from a Ukrainian perspective to warn against a black-and-white approach to historical issues that serves politicians’ purposes but divides neighbors.
In Retrospect: Poland, Russia, Europe
In April I spent a few days with Zryw, a Polish non-profit organization that recruits young people to enter politics and public life. Their aim is to build a new generation of civic leaders in Poland. I’ve followed their evolution from the beginning; my son is one of the founders. (“Zryw” means “impulse” or “burst of speed” in Polish). Julie Chmielewska, one of Zryw’s leaders, interviewed me at the event. Here is the conversation, lightly edited for grammar and context: Julia Chmielewska: Assuming that culture shapes institutions, could we conclude that some cultures are more prone to authoritarianism? Anne Applebaum: I don’t think so. Every culture, every nation, and every country has the potential for change. When we look at history, we can see that nations do change. Poland has changed, for example, from the 1980s to today. There’s a completely different mentality here than the one I encountered when I first visited, in 1988. The current generation sees the world through a different frame. So no, I don’t believe that certain nations are doomed to authoritarianism, or to anything. Of course, there are political and cultural traditions, but they can always be challenged. JC: So do you think there’s something intrinsic in human nature that pushes people to democracy, freedom? AA: I think there is something in human nature, a deep instinct, that pushes people towards freedom, yes. People who live in authoritarian countries – and I’ve heard this from them over and over again – sooner or later find themselves angered by a feeling of helplessness. They can see the unfairness of crooked courts, irrational political decisions. They naturally dislike the fact that somebody has all the power while they have none. In those circumstances, people who have no political background at all sometimes are politicized just by that frustration. I’m thinking of Svetlana Tikhanovskaya, for example, who was a Belarusian housewife, until the circumstances of her husband’s arrest forced her to become a politician. I met a woman who is a Uyghur from China, and who had come to live in Turkey. After several of her family members were arrested, she too was propelled into a political role. These kinds of experiences make people interested in democracy or political reform, even if they thought they didn’t care. I also think that the opposite is true: some people instinctively prefer homogeneity, order, hierarchy. They don’t like the confrontation of opinions or the noise of debate, and they lean towards a single leader or a unified regime. I think that most of modern history is shaped by the clash between those two different sides of human nature. JC: Which force do you find more powerful today? AA: I think they both have a lot of power and there’s no way of predicting who wins. Even in countries that seem very shut off or stuck in an authoritarian system can change. We’ve seen that happen. And vice versa, I think democracies can also begin to fail and slide into authoritarianism. So it’s very important not to be complacent in either direction. JC: I want to go into your history and your experiences. You’ve lived in Russia during a time of incredible change in the late 80s, and then you came back to do research in post-Soviet Russia. AA: I was a student in Russia just before the collapse of the Soviet Union. I then traveled and worked there extensively in the 1990s, and I met people who really were full of hope. They hoped that Russia could become a democracy, or at least a place that guaranteed freedom of speech, freedom of the press. These weren’t ideas that came from Washington. Although now the narrative in the Kremlin is different, I met many people who were working towards exactly that kind of transformation. A friend of mine ran a series of seminars – once a year, and then later several times a year, in cities all over Russia – designed to get people to discuss politics in new ways. She invited young politicians and journalists, as well as foreigners. I went to many of them, in Moscow as well as Volgograd and Novosibirsk. Over two decades, hundreds of people came to these seminars, and all of them wanted Russia to be different. I remain convinced that many Russians still want Russia to be different. It’s just that the old system, in the form of Putin, a representative of that system, returned. The KGB reimposed their power. And this wasn’t because of something to do with culture, this was to do with money and politics, and who was in charge. JC: You’ve partially answered my question... I wanted to ask whether that excitement of the 1990s was an exception from the Russian historical norm which has been rather authoritarian? AA: Of course, if you look at the history of Russia since the 18th century, there have always been liberal groups, reformers and revolutionaries. There were the Decembrists, in the early 19th century, and the rural populists later on, who tried to organize the peasantry. A significant group of liberal Russians appeared at the turn of the 20th century, people like the father of the writer Vladimir Nabokov, who was a Russian politician before the revolution. These groups were small in number, but sometimes had a broader significance. The Russian dissident movement in the 1950s and 1960s actually invented the modern human rights movement. It was their idea to hold the leaders of the Soviet Union accountable for the language they used, to remind them of the treaties they had signed and the promised they had made. They created the Helsinki group, for example, that held Soviet leadership to the language of the Helsinki Treaty, which formally ended the Second World War and which contained guarantees of human rights, at least on paper. That idea spread to Eastern Europe, and similar tactics were used here in Poland. (Benjamin Nathans recently wrote a great book about the Soviet dissidents, To the Success of Our Hopeless Cause) JC: But seemingly, even if they do ever get power, they could never hold on to it. AA: We don’t know, because they have never really had power. But in any case, we also don’t know what will happen in the future. There is no reason to assume that Russia will forever be condemned to totalitarianism. Even during the first fifteen years of Putin’s regime there was some form of democratic politics. Only when the full-scale war began did he bring everything to an end: he shut down all remaining independent organizations and killed his most important opponent, Alexi Navalny. But does that mean he is popular, that he enjoys legitimacy? Even now, we don’t really know what Russians think about him, or about the war. There is no way of doing real polling in Russia because nobody will answer an independent pollster over the phone. JC: Do you think that the flock of young people, especially young men, who fled Russia after the start of the war represent a continuation of liberal movements that refuse to partake in the authoritarian state, or do you think they are moving for the sake of self-preservation – “I don’t want to go to the army, so I leave”? AA: I’m sure it’s both. I actually know many people who left Russia for political reasons either in the very last years before the war, or else just after the war began. JC: And do you see a change in the young generation versus the old one that have fled? AA: It’s hard for me to say because the people who I know were mostly already politicized. I do know some younger people who left, but most of them were already either active in the opposition, or working as journalists. Many of them very self-consciously think of themselves as maintaining Russian culture abroad, just as in the 20th century the Soviet dissidents or the anti-communist White Russians once thought of themselves as people who maintained the true Russian culture, outside of Bolshevik Russia. JC: Let’s move on to Poland. One of your first experiences with Poland was reporting on Margaret Thatcher’s first state visit, in the autumn of 1988. You followed her around the farmers’ market. AA: She was making a symbolic gesture. She wanted to welcome free markets, but the only one she could really visit was the farmers’ market at Hala Mirowska. JC: And I want to talk about this area because today you can look out of any window in that district, Mirów, and see rows and rows of skyscrapers. How does it feel to see a country built from the ground in such a short time, both politically and economically? AA: You know, when you’re living in a period of dramatic change, it’s always hard to know whether the change is positive or negative. The transformation in Poland created winners and losers, as well as new classes of people, new political movements of different kinds. At the time, it sometimes just felt like turbulence. Now, we can look back at the 1990s and early 2000s in Poland and see in retrospect that the country was headed in towards prosperity and European integration. In around 2009 or 2010, I remember speaking to a woman who worked cleaning government offices, and who asked me if her daughter should study in Amsterdam or in London. This seemed to me to be a real transformation, and it happened very fast: within a few years, Poles stopped feeling like second-class Europeans, and a generation of younger Poles appeared who had no qualms about crossing borders. JC: We again live in turbulent times. Do you think we’re heading towards positive outcomes? AA: I can’t make predictions, because everything that happens tomorrow depends on what people do today. Also, history doesn’t have a trajectory. It doesn’t move in a particular direction. You only think it does afterwards. As I said, you can look afterwards at Poland in the 1990s and you could say this was a period of great progress. But not everybody at the time saw that. Sometimes people are very wrong about a given country’s trajectory. I remember people writing about Ukraine in the 1990s, about how dangerous it was that Ukraine was independent, that this was going to be an anti-semitic state, that Ukrainian nationalism was going to come back... and although you can say many bad things about Ukraine, the country made many bad choices, actually it became a pretty tolerant state which now has a Jewish president and until recently a Muslim defense minister. JC: In the 1990s Poland’s and Ukraine’s GDP were roughly similar. Ukraine was even a bit richer. So the starting point was similar for both of these countries, but they’ve turned out very, very differently. Even if we stop in 2014. Why do you think Ukraine “chose East”? Was it external influence? AA: No, I think Ukraine was in a different position. First of all, central and eastern Ukraine had been part of the Soviet Union since the 1920s, and had therefore experienced a longer period of occupation, repression, Sovietization and even Russification. Ukraine did not have, as Poland did, an alternative elite: a large cadre of economists and politicians, who already had some experience in opposition politics and in independent thinking. In Poland, the transformative finance minister, Leszek Balcerowicz, had already thought about how an economy might be decentralized before he took office. We can argue about how successful he was, but at least he was prepared to try something new. In Ukraine, people weren’t prepared. For one, there hadn’t been much space even for an illegal opposition in the previous couple of decades. Ukraine was also in many ways still emerging from colonial occupation. For the previous couple of centuries, many of the most capable Ukrainians had moved to Russia, and the first generation of leaders in independent Ukraine tended to be former Soviet apparatchiks. They didn’t immediately seek to become closer to western Europe. Instead, they looked for some kind of economic and political “third way” and an accomodation with Russia. Ukraine became stuck in this position, half-in, half-out and became pretty profoundly corrupt. JC: The Polish alternative elite had a vision of where they wanted the country to go. I think the general perception now is that this vision ends with the next election, right? Is this a natural process of gaining power? AA: Their vision, and it was shared by the time by politicians who now call themselves both left and right, was that Poland should join the EU and NATO, as fast as possible. My husband (Radek Sikorski) was in the very first government that said it wanted to join NATO. At the time this was taken very badly in Washington: the demand for NATO membership absolutely came from Poland, not from the US. But even then, in the early 1990s, many Poles already understood that the Russian sphere of influence would grow once again, that it was important to become part of the transatlantic alliance and an integrated Europe as fast as possible: NATO, the EU, the Council of Europe, all of the trading and security alliances. That consensus lasted through several different governments and over many years, even governments containing former communists. For twenty years, right, left and center disagreed about many things, but they all agreed on the direction that the country should go. In retrospect, that consensus created the basis for prosperity in Poland. JC: And regarding the Polish-Ukrainian relations. We know that antagonisms, e.g. the myth of Wołyń [a massacre of Poles that took place in what is now Western Ukraine, in 1943] are increasingly used in Polish political discourse today. In Ukraine, nationalist historians make heroes out of UPA, the Ukrainian revolutionary army, which is held responsible for this tragedy. Where do you see a start for burying the hatchet? Is the reconciliation of our nations possible? AA: So here’s a strange thing: For more than a decade after they both gained independence, Poland and Ukraine participated in a number of projects that were designed to solve exactly these kinds of Polish-Ukrainian differences. Books were published that were jointly written by Polish and Ukrainian historians, monuments were built. These projects were successful: If you’d asked me this question in 2010, I would have said that there are no real historical issues between Poland and Ukraine, that the two countries had mostly reconciled. For a number of reasons, this began to shift. In Poland, children and grandchildren of victims of the Wołyń massacre felt their tragedy hadn’t been fully recognized. In Ukraine, nationalist groups wanted the UPA partisans who had fought against the Soviet Union recognized for their heroism, despite the fact that some in this broad and not well-defined group were also linked to Wołyń. In both eastern Poland and western Ukraine, the memory of the ethnic cleansing that took place there in the late 1940s - Poles were moved West, Ukrainians East - to accomodate new borders has left feelings of displacement and bitterness. The wave of Ukrainian immigration, which started before the war, may have provoked some of this. But don’t underestimate the role played by Russia, which has always wanted to create discord between Poland and Ukraine, and pumps out propaganda to that effect in both countries. Vandalism on both sides of the border, damage done to cemeteries and monuments, is sometimes carried out by provacateurs working for Russia, just to create bad feelings. The Polish-Ukrainian conflict also hides a different reality: although there are real grievances and bad memories, the truth is that the biggest tragedies both nations experienced in the twentieth century were inflicted by the Soviet Union and Nazi Germany. That should unite these two countries, not divide them. JC: This week (19.04.2026 – Ed.) in Hungary we saw that using historical narratives to create grievance has no longer worked. Are you optimistic about the direction after Orban’s loss? AA: The Hungarian election was really important because it shows that people can actually resist powerful, dominant propaganda. The ruling party Fidesz controlled all of the TV, 90% of the newspapers, the constitutional court, the bureaucracy... and yet people had the nerve to vote against it and resist it. It’s also an important election because Hungary created a huge network of well-funded think tanks and foundations that were funding other far right groups and projects. So that loss is going to have a knock-on effect in other places too, maybe even in Poland. JC: What you’ve said about resisting propaganda reminds me of one of the interviews you did about talking to Russians in the post-Soviet era who claimed that people knew that the system was lying. Why do people choose to believe in these regimes anyway? AA: Because it’s useful. Stephen Kotkin, an American historian, once described how people would learn how to “speak Bolshevik”: It was just a language that you needed to use in order to get by in society. If you didn’t talk the way the regime wanted you to talk, then you might have problems, or lose your job, or your kids would not get into university. It was a way of getting along. Communist Poland was similar, at least in the early years. When I was writing a book about the Sovietization of Eastern Europe after World War II, I met a lot of people who wanted to talk a lot about the war, when many of them had done really heroic things. But almost nobody wanted to talk about the decade afterwards, between 1945 and 1956. This was when you had the short period of terror, violence and Polish Stalinism. To stay safe, people felt the need to just go along with what others were saying, or stay out of politics, or use communist jargon without necessarily believing it. I don’t judge them for it, and I wouldn’t describe all of those people as collaborators. It’s easy to feel moral certainty in retrospect, because we know that communism ended. But if you were living in 1949, it might not have been clear to you that communism was going to end. In very repressive societies, maybe about 10% of people who are really evil – collaborators, torturers. Maybe 10% of people are really brave and who find ways to resist. And then around 80% of people have kids, they have parents, they have to have jobs and they’ve had to get through it somehow. Strange though it may sound, I’ve found that the work I did on that book is now very useful in explaining some of what’s going on in the United States today. There are plenty of members of the Republican Party in Congress who know perfectly well that Donald Trump says many things that aren’t true. But they avoid criticizing him because it’s inconvenient, because they would get in trouble, because someone would attack them on the internet. So actually you don’t even need mass terror to get people to conform. JC: Is Gen Z reinventing agency? AA: We’ll see. In any generation you can find groups of people who want agency. If you live in a society that’s unfair, for example where a tiny number of people have captured most of the wealth, then at a certain point people rebel. This is always easier for younger people, who have you have less to lose. The question now is how the internet will affect the relationships between citizens and the state, and how it will change organizations. The “Twitter revolutions” people spoke about as early as 2008-9, mass protests organized online, have often proved to be very superficial. Although you can easily join something just by clicking, the work of creating a real movement requires physical participation. Successful mass movements of the past, for example the Civil Rights movement in the United States, were built by people who had spent many years together. They had participated in non-violent workshops together. They practiced and prepared. Just using the you can get everybody to show up at a certain moment, but then when the protest is broken up, nothing happens. It’s also true that the repressive regimes have more recently learned how to use the internet to undermine leaders and movements. Most of all, they now understand how to make people cynical. The form of propaganda that most modern authoritarians use - and I think the Russians really pioneered this - deploys sneering cynicism. Instead of praising the rulers, the regime propagandists mock the opposition movement leadership for being supposedly corrupt or sexually degenerate, with the goal of undermining any kind of idealism. JC: MAGA grew on the internet? AA: MAGA is a real grassroots movement. They had symbols, red hats, they showed up at rallies. But you’re right that the cynicism, the sarcasm and the distrust that the movement embodies came originally from the internet, and this is different. Fifty years ago, most European political parties had a social base in real organizations, in trade unions for Social Democrats, in church groups for Christian Democrats. As people stopped going to church and as the trade unions became smaller, the social base of these parties disappeared. Now people who wouldn’t have known one another in the past meet on the internet and create new movements, many of which don’t last. JC: Is history ending? Going in stale circles? AA: History never ends. In truth, human beings want contradictory things at the same time: order and freedom, stability and change. These things are never resolved, and when a society swings too far in one direction, people always push it the other way. But each time that happens, the result is different. Certainly it is true that we are now in a period when old philosophers and ideas from the 1930s are undergoing a revival. Carl Schmitt, who was a philosopher who was very influential on the Nazis, is back as an influence on both the far left and the far right, once again inspiring people to think that all politics has to be existential, that all politics is about defining and defeating enemies. In the US, some are also bringing back dominionism, the idea that we need a Christian and not a secular state. It’s also true that we are living through a more fundamental shift. The old left-right divide, which was mostly about the size of the state, is much less important now. Instead, we are arguing about more fundamental things: what are our rights, what protects our freedom. Or how much power do we want to give small elites, versus how much power to give ordinary people. In America a small group of very wealthy people now control information, because they control the social media platforms and AI, which means they determine what people will read and learn. Finding a way to preserve preserve zones of autonomy and independent thinking, this is going to be the main task for the next generation. JC: What is the one book that a person interested in Central Europe should read? AA: You could read my book “Iron Curtain: the Crushing of Eastern Europe” which tells the story of how the Soviet Union imposed its culture on the region. Or read Tim Snyder’s history of the region, “The Reconstruction of Nations: Poland, Ukraine, Lithuania, Belarus 1569-1999.” And everyone should read “The Captive Mind” by Czesław Miłosz, which describes exactly the phenomenon we were talking about: why do people collaborate? I joined Scott Galloway and the brilliant Fiona Hill in a discussion about the wars in Ukraine and Iran, the future of global power, and what these conflicts reveal about America's role in the world. Scott told us that this was the 400th edition of his podcast, which is quite a number: My friend Francesco Chiamulera runs a brilliant series of literary events, Una Colline di Libri, A Hill of Books, in the Prosecco Hills, a region of vineyards and elegant hill towns in the Veneto, north of Venice. We did an event in Vittorio Veneto and also drove and biked around the countryside. Buy Autocracy Inc Buy Iron Curtain Open Letters, from Anne Applebaum is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Subscribe
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The New WHO Pandemic Treaty and Global Health Governance: Incorporating Common but Differentiated Responsibilities into PABS - Georgetown Journal of International Affairs
On May 20, 2025, the World Health Assembly unanimously adopted the World Health Organization (WHO) Pandemic Agreement, an international treaty designed to strengthen pandemic prevention, preparedness, and response. The product of three years of arduous negotiations, the treaty marks a new era of global cooperation in public health. However, core aspects of the agreement remain unresolved—notably the Pathogen Access and Benefit-Sharing (PABS) System, which is intended to ensure equitable access to pandemic-related materials and benefits. To support the successful implementation of the WHO Pandemic Agreement, the principle of “common but differentiated responsibilities” should be formally incorporated into the negotiating agenda of the PABS annex. Introduction For the first time, an international treaty has enshrined the principle of “One Health,” the compelling idea that the health of animals, humans, and the environment all contribute to pandemic risks. SARS (2003), H1N1 (2009–10), Ebola (2014–16), and COVID-19 all emerged through zoonotic spillover from animal hosts—respectively, civets, hogs, and bats. Together, they underscore the need for a coordinated, cross-sectoral approach. The Pandemic Agreement responds to this call, requiring state parties to acknowledge the ecological interplay and commit to a comprehensive “One Health” strategy. Specifically, Article 5 charges governments to address “the drivers of pandemics and the emergence and re-emergence of infectious disease at the human-animal-environment interface,” including wild animal markets, deforestation, and antibiotic overuse. Yet the effectiveness of this “One Health” vision depends equally on the free flow of scientific information and data among countries and institutions. Just as environmental and animal health factors have been neglected in past global frameworks, so too has data sharing been marginalized, despite its centrality to timely detection and response. The Pandemic Agreement takes an important step by requiring governments to enhance data collection and cooperate with the World Health Organization (WHO). However, these provisions will remain aspirational without a robust Pathogen Access and Benefit-Sharing (PABS) annex. The PABS system will determine whether countries and researchers can rapidly exchange pathogen samples and genetic data while ensuring equitable access to resulting research and development, including diagnostics, therapeutics, and vaccines. Without such mechanisms, the treaty’s promise to operationalize “One Health” and strengthen global preparedness will risk becoming largely symbolic, echoing earlier failures to translate shared principles into coordinated action. Equity Concerns When the 2025 Health Assembly adopted the Pandemic Agreement, it left the difficult question of access to pathogens and the sharing of resulting benefits to be addressed in a separate agreement. Negotiations on this separate agreement, PABS, are now underway in Geneva. Yet governments remain divided over fundamental questions of equity between the countries that primarily contribute to the system and those that primarily draw from it—and consequently benefit. For example, wildlife in countries bordering the equator is likely to produce PABS materials, but companies in Europe are likely to use them to develop lucrative products. The most likely contributor countries are likely to be those biodiverse countries around the equator, such as Brazil, the Democratic Republic of the Congo, and Indonesia, where the number of human-mammalian viral host interactions is large. Conversely, countries most likely to benefit from this material are those with the technology, investors, and infrastructure to capitalize on genomic data, such as the United States, EU member states, and Japan. This imbalance reflects a broader pattern seen in prior international frameworks. Now, as in the past, the wealthiest countries in the world (a useful heuristic is membership of the Organisation for Economic Co-operation and Development (OECD)) disproportionately benefit from systems in which pathogens and genomic sequencing data are contributed to a common source. Under the International Agreement on Plant Genetic Resources for Food and Agriculture (the “Plant Treaty” or “Seed Treaty”) and the Pandemic Influenza Preparedness (PIP) Framework, companies from Europe and North America disproportionately withdraw biological samples and data for development into lucrative medical products. Their governments and companies have both statutory and contractual claims to the products that those companies correspondingly produce. PABS appears poised to follow the same pattern. The text calls for strong language on access to pathogens and associated data, but the corresponding benefits that should flow to poorer countries are couched in equivocal or non-binding language. Common but Differentiated Responsibilities To address these inequities, the principle of “common but differentiated responsibilities” should be formally incorporated into the negotiating agenda of the PABS annex. Common but differentiated responsibilities are often a feature of climate change negotiations. The basic principle is that, even though all countries should reduce carbon emissions, governments that became rich and powerful through massive carbon emissions (e.g., France, the United Kingdom, the United States) should have a greater obligation to address the resulting crises. Applied to PABS, it would require that governments hosting and supporting companies developing lucrative products carry greater obligations toward the cost of running the PABS system; share benefits or final medical products; and transfer technology to help countries worldwide develop their own capacities to innovate and manufacture vaccines during an emergency. For example, an annex could mandate that any company based in an OECD country that withdraws PABS material would be obligated to donate the resulting diagnostics, therapeutics, or vaccines to the WHO during a public health emergency or pandemic. Questions remain about how robust those donations would be, but the principle is that they should deliver highly significant lifesaving benefits to be equitably shared. Theoretically, this approach mirrors the PIP Framework, in which companies withdrawing influenza samples are required to pay half of the operating costs. In practice, however, the framework has fallen short. The PIP Framework Secretariat has struggled to secure payments from companies, with companies often disagreeing over how much is owed. Additionally, without another pandemic influenza to test the strength of the agreement during a public health emergency, corporate compliance with sharing mechanisms remains unknown. Even if these limitations did not characterize the PIP Framework, partially paying for operating expenses does not address the inequity in access to genetic data and pathogen samples that left less developed countries last in line for COVID-19 vaccines (and, before them, H1N1). Common but differentiated responsibilities would go further, addressing governments’ legitimate grievances regarding information sharing. It would make withdrawals of PABS material and resulting products more transparent, building trust across the board. Enforcement and Enduring Success A key implication of this approach is that the governing mechanism of the PABS must have real enforcement authority. The WHO Pandemic Agreement delegates its core governance responsibilities to a Conference of the Parties (COP)—a governing body composed of one representative from each participating government, similar to those established under the UN Framework Convention on Climate Change and the WHO Framework Convention on Tobacco Control. The proposed WHO Pandemic Agreement COP is charged with oversight functions but ultimately possesses no real authority to compel a government to take any action it does not wish to take. The text does not give the COP the ability to, for example, sanction a party that does not comply with either textual obligations or PABS provisions. In other words, there are no effective mechanisms in place to ensure compliance. Perhaps just as significant, establishing a meaningful enforcement mechanism within the PABS system would strengthen the WHO’s credibility and its ability to ensure compliance across global health governance. By setting a precedent for accountability, such a mechanism could enhance the organization’s authority not only within the Pandemic Agreement but also in enforcing the revised International Health Regulations and other frameworks for public health emergencies. Conclusion The PABS annex can—and should—be different. It should establish clear responsibilities for funding as well as for sharing the diagnostics, therapeutics, and vaccines that result from contributions to the system. The system, in turn, must include a dedicated body empowered to hold governments and the corporations they sponsor accountable for their responsibilities before, during, and after pandemics. Doing so would restore trust in the broader agreement, which was eroded as commitments were repeatedly diluted while parties scrambled to meet their own self-imposed deadlines during the Pandemic Agreement negotiations. A robust PABS Annex would cement a grand social bargain. Wealthier countries and their corporations would gain unimpeded access to scientific information essential for developing and manufacturing lifesaving medical products. As such, they would stand to gain considerable economic benefit. Yet that privilege must be matched with responsibility. The grand bargain must include not only the right to innovate, but also the duty to ensure that innovation serves all. As medical products are developed and produced through collective contributions, every person must have equal access. All human beings deserve an equitable chance to survive—to save their own life, the lives of their families, and the well-being of their communities. … Sam Halabi, JD, MPhil, is the Bette Jacobs Endowed Professor at Georgetown University’s School of Health and the Director of the Center for Transformational Health Law at Georgetown Law. He serves as the co-lead for the WHO’s Working Group on Regulatory Consideration on AI and Health’s training workstream. He earned his JD from Harvard, his MPhil from Oxford, and undergraduate degrees from Kansas State University. Lawrence Gostin, LLD (Hon.), JD, BA, is University Distinguished Professor and Founding Director and Timothy and Linda O’Neill Professor of the O’Neill Institute for National and Global Health Law. He is the author of Global Health Security: A Blueprint for the Future (Harvard University Press, 2021); Global Health Law (Harvard University Press, 2014); Public Health Law: Power, Duty, Restraint (University of California Press, 3rd ed., 2016); Public Health Law and Ethics: A Reader (University of California Press, 3rd ed., 2018); Law and the Health System (Foundation Press, 2014); Principles of Mental Health Law & Practice (Oxford University Press, 2010). He also directs the WHO Collaborating Center at Georgetown University. Image Credit: United States Mission Geneva, CC BY 2.0, via Wikimedia Commons
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