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BRICS' contributions to the global health agenda.

We are currently witnessing a seminal shift in power between the world's countries. Pascal Lamy, former head of the World Trade Organization (WTO), recently drew attention to the fact that, as Brazil* the Russian Federation, India, China and South Africa--the so-called BRICS group of countries--gain in economic and political influence, they will no longer remain policy takers but will shape the future on their own terms. (1) However, the positions that these five countries will take in future global health issues remain unclear. How closely will they align their health and foreign policies? What alliances will they seek? Will they set agendas that are different from present global health priorities? They may well want to approach global health challenges in new ways. Many analysts want BRICS to be more active in global health. As Sridhar et al. stated, "the fact that the relatively economically stable BRICS have not stepped up their commitments to the Global Fund, the GAVI Alliance, or the World Health Organization has raised questions about their commitment to global health leadership in the long term". (2) BRICS have, however, positioned themselves on a new trajectory for development and as the Chinese foreign minister expressed "participating in world affairs on an equal footing and working actively to build international systems".' They have recently increased their cooperation in the fields of social development, environmental protection and health, institutionalized regular meetings of their health ministers and identified common health priorities --with the stated goal of addressing emerging health threats not only within their own populations but also on a global level. BRICS appear to be less interested in simply providing financial contributions for development assistance than in very political and more structural bilateral and multilateral approaches to global health. They are, for example, jointly promoting access to affordable, safe and efficacious medical products of high quality through the use of the WTO's Agreement on Trade Related Aspects of Intellectual Property Rights. (4) They are also emphasizing the importance of technology transfer as a way to empower developing countries through international cooperation--and have underlined the need to establish a BRICS network of technological cooperation. While a focus on trade agreements could have a beneficial impact on the health of millions of individuals in the developing world, such agreements are vulnerable to political conflicts, international disputes and the often conflicting interests of transnational drivers such as the tobacco and food industries. It has been encouraging to observe Brazil's leadership in the Framework Convention on Tobacco Control and the recent moves by China to increase tobacco regulation at national level. High expectations despite some major problems In 2011, the Director-General of the World Health Organization commented that "... BRICS represent a block of countries with a ... great potential to move global public health in the right direction ... towards reducing the current vast gaps in health outcomes and introducing greater fairness in the way the benefits of medical and scientific progress are distributed". (5) BRICS span several continents and important regional groupings and could, in principle, bring their health agendas to all of the high-level policy forums in which they participate, such as those of the United Nations Security Council and the Group of Twenty (G20). Of course, each BRICS country has its own foreign policy goals and astutely uses health as a "soft power" strategy. BRICS have studied the approaches used by the current key players in global health, show great interest in tripartite cooperation--e.g. between a BRICS country, a non-BRICS African country and a European or American donor--and have no interest in being only junior partners in the development of a global health agenda. …