By Nancy S. Jecker, Caesar A. Atuire

With rare exceptions, many people around the world have gleefully shed masks and with them, any lingering concerns about catching the novel coronavirus. Maskless and nonchalant, we are boarding planes, shopping, showing up at parties, enjoying entertainment, and going to in-person classes. Proof of vaccination has also fallen by the wayside as has the effort to ‘vaccinate the world.’ While scientists debate the latest move, the public message is loud and clear: we are done with this pandemic.

But is it done with us?  More to the point: can the world stop worrying about pandemics? Can we move on to slaying other beasts? It’s tempting. There is no shortage of global catastrophes to choose from –the war in Europe, the planetary devastation wrought by climate change, and mounting threats to democratic governance. What makes moving-on from pandemics all the more tempting is we have no clear path ahead.  How do you stop the next pandemic?

While promising discussion is underway to harness the powers of international law to forge a pandemic treaty among WHO member states, it remains to be seen whether this will materialize. Even if it does, a treaty is not enough. The kernel of the problem is this: when it comes to global health governance, a purely statist framing fails.

During the COVID-19 pandemic, the limits of a state-based model became painfully clear. First, multiple non-state parties wielded power, such as for-profit pharmaceutical companies, multinational philanthropic foundations, and civil society groups. Second, the sheer scale of human disaster overwhelmed a statist approach and required all-hands-on-deck.  Third, as the pandemic raged, distinctions blurred between protecting ‘our own’ and ‘everyone.’  With twenty-first century globalization, we are more interconnected than ever before.

Consider vaccines.  They are still the best way to end the pandemic phase of COVID-19 and curb severe disease and death. Many decry their unequal global distribution: as of April 27, 2022, just 12% of people in low-income countries have completed an initial vaccine protocol, compared with 74% in high-income countries. What led to the current predicament was the result of actions taken by multiple parties up and down the vaccine supply chain.  Academic researchers and Universities sold the rights to vaccines to for-profit companies. Companies stuck bilateral advance purchase deals with high-income governments, who hoarded vaccines. COVAX was formed to equitably deliver 2 billion doses of vaccines in 2021, but fell short for many reasons, including the disruption of global vaccine supply as COVID surged in vaccine-producing countries, halting exports. Intellectual property protections, established by the World Trade Organization, protected drug company profits, effectively stalling efforts to expand vaccine manufacturing. Even as shortages eased, the logistics of getting shots in arms overwhelmed countries that lacked a public health infrastructure to take this on, reflecting upstream structural injustices. Vaccines also appeared with minimal advance notice and looming expiration dates.

What can we do? Loosening the grip of a state-based model of global health governance is a good place to start.  In tandem, we must contain the outsize role played by a few for-profit companies and international philanthropies. As the vaccine case shows, global health justice must be re-imagined as a multilateral task engaging many groups at various levels, each of whom must coordinate to realize common long-range goals.

Among the bioethics principles that should guide global health governance are subsidiarity and the responsibility to protect (R2P).  Subsidiarity is a tactic for allocating powers and responsibilities at multiple levels in the absence of a unitary sovereign. It requires larger groups to stand behind and support smaller ones, with power dispersed among many hands.  R2P articulates cross-border responsibilities in instances when a state is unwilling or unable to halt or avert serious harms its people are suffering and requires states to protect citizens of another state.

Lessons learnt from the COVID-19 pandemic should invigorate everyone to forge ahead in better ways than before. Bioethicists can contribute by articulating new values and principles for facing down global health threats.

Paper title: Toward a New Model of Global Health Justice: The Case of COVID-19 Vaccines  OPEN ACCESS

Author: Nancy S. Jecker, Caesar A. Atuire, Susan D. Bull

Affiliations:  Dr. Jecker is affiliated with the University of Washington School of Medicine, Department of Bioethics and Humanities and the University of Johannesburg, Department of Philosophy. Dr. Atuire is affiliated with the University of Ghana, Department of Philosophy and Classics. Dr. Bull is affiliated with The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford

Competing interests: None

Social media accounts of post author(s): Twitter: @profjecker @atuire