The coronavirus disease (Covid-19) has made it apparent that states have different capacities to detect, effectively respond to, and manage highly infectious diseases. Concomitantly, the resources necessary to support robust health systems are distributed inequitably, which inevitably places greater stress on societies with the most vulnerable health infrastructure. In 2005, the World Health Organization (WHO) found that health capacities were nowhere near “a path to timely implementation worldwide.” By 2013, well before the current Covid-19 pandemic, studies found that no African state had fully implemented their core health capacity requirements under the International Health Regulations of 2005. Indeed, many of the countries listed in the Global Health Security Index ranked as “least prepared” are in Africa, with Somalia and Equatorial Guinea appearing at the very bottom. The lack of capacity especially visible in African countries and elsewhere in the Global South is in part due to historical vulnerability from slavery, colonialism, neocolonialism, political instability, and conflict, as well as neoliberal reform policies like structural adjustment. This chapter analyzes the international obligations of capacity-building and cooperation in light of Covid-19.