 Perhaps most foundationally, the self-interest reason for nations to engage globally in public health cannot be separated from questions of global structural injustice in international relations more broadly. Many threats to public health, including the threats from climate change, cannot be effectively addressed absent collective global action. However, in today’s global order in which nations differ greatly in wealth and other forms of power, the likelihood that agreements and coordinated action will fairly represent and fairly protect the interests of people living in poorer nations is not good. In the case of climate change, although the hottest, poorest, most agriculturally dependent countries have contributed the least to greenhouse gas emissions, they are being hurt “first and worst” by global warming (Powers and Faden 2019, 172–178). And yet enforceable requirements to reduce emissions continue to be blocked by high emission countries. In infectious disease as well, it is typically the poorest countries and the poorest people who are hit hardest in outbreaks and epidemics, but their power to influence global preparedness and response does not match their outsized vulnerability.