Global Health security, multi-stakeholder collaboration, and pathogen sharing: Building a New Microbial Commons

In the first quarter of the 21th century, epidemics and pandemics of emerging infectious diseases are more present and concerning than ever. Due to the globalized and zoonotic nature of such outbreak events, collaboration and sharing across disciplines, sectors, domains, organizations and countries are essential. Nevertheless, there are stakeholder concerns and countervailing mechanisms for open and timely sharing of pathogen and outbreak-related resources guided by data protection and appropriation, as well as the establishment of reciprocity and the fair sharing of benefits; which are threatening efficient and collaborative Global Health action. This thesis aims to contribute to Global Health security by providing insights on how to foster multi-stakeholder collaboration and enhance the sharing of pathogen resources. This thesis is subdivided into three sections. The first section has as the main focus to explore and understand in-depth contextual factors related to the physical and institutional characteristics of pathogen resources, the attribute of the communities involved; and the governing rules. It finally reflects on how these factors influenced collaboration and sharing for Global Health security, either by generating barriers or by creating opportunities. The chapters composing this section are Chapter 4 that explores multi-country collaboration for Global Health security by assessing timeliness in out-break response; Chapter 5 that explores the sharing of pathogen materials and data through biobanks and databases considering the Nagoya Protocol; and Chapter 6 that explores the sharing of acid lactic bacteria considering the Nagoya Protocol and its impact on probiotics innovation. The second part of this thesis explores barriers to multi-stakeholder collaboration and the sharing of pathogen resources within the Global Health security environment, allowing the identification of the most common and relevant challenges in the field, how they influence the patterns of interaction of stakeholders, and which negative outcomes they generate. It includes Chapter 7 that focuses on barriers to the sharing of pathogen resources to support outbreak management; Chapter 8 that investigates barriers in multi-domain One Health collaboration; and Chapter 9 that focuses on barriers in multi-sectorial collaboration for vaccine development in the context of infectious diseases research and development. The last section of this thesis focuses on exploring existing and potential solutions to address the barriers for collaboration and sharing in the Global Health security environment. It is com-posed by five chapters where Chapter 10 analyses in-depth the sharing of pathogen genomic sequence data in the context of the Nagoya Protocol and the related challenges and opportunities; Chapter 11 proposes solutions for the sharing of pathogen resources through a biobank model to support timely response to epidemics; Chapter 12 proposes a blockchain-based model to support the timely and open sharing of pathogen resources and efficient infectious diseases research and development; and Chapter 13 that evaluates existing solutions for collaborating and sharing in the Global Health security environment and propose improvements and new opportunities for future investments and efforts. This thesis shows that the development of a multilateral global system for pathogen sharing, with standardized access and benefit sharing measures and following a One Health approach, is urgent to balance the Global Health security needs of open and timely sharing of resources while guaranteeing fairness and reciprocity in the sharing of benefits to the communities involved. In a globalized world, where diseases know no borders and we are constantly threatened by emerging diseases, we need to work towards rebuilding the Microbial Commons. In this new Microbial Commons, the lessons learned about how to establish and maintain fairness, equality and transparency in collaboration have to be the stepping stones in order to enable wide-spread adoption, inclusion, sustainability, and lastly but not least, enable Global Health security.