Rethinking solidarity towards equity in global health: African views.

When the COVID-19 pandemic first took the world by storm, the World Health Organization (WHO) issued a Solidarity Call to Action to realize equitable global access to COVID-19 health technologies through pooling of knowledge, intellectual property and data. At the dawn of 2022, 70% of rich countries' populations were vaccinated but only 4.6% of poor countries (Our World In Data, Coronavirus (COVID-19) vaccinations, 2022). Vaccine nationalism and rampant self-interest grew and our ineffective global response led to new variants of concern - like Omicron - emerging. Rather than abandon the idea of solidarity in global health, we believe that the international community must embrace it. Solidarity, with its emphasis on relationality and recognition of similarities, could offer fertile ground for building an ethical framework for an interconnected and interdependent world. Such a framework would be better than a framework that focuses principally on individual entitlements. To defend this view, we draw on African relational views of personhood and morality. When humans are conceived of as essentially relational beings, solidarity occupies a central role in moral behaviour. We argue that part of the reason appeals to solidarity have failed may be traced to an inadequate conceptualization of solidarity. For as long as solidarity remains a beautiful notion, practiced voluntarily by generous and kindhearted persons, in a transient manner to respond to specific challenges, it will never be able to offer an adequate framework for addressing inequities in global health in a systematic and permanent way. Drawing on this understanding of solidarity, we propose pathways to respond creatively to the risks we face to ensure equitable access to essential health for all.

Pandemic preparedness and response: beyond the Access to COVID-19 Tools Accelerator.

Nationalism has trumped solidarity, resulting in unnecessary loss of life and inequitable access to vaccines and therapeutics. Existing intellectual property (IP) regimens, trade secrets and data rights, under which pharmaceutical firms operate, have also posed obstacles to increasing manufacturing capacity, and ensuring adequate supply, affordable pricing, and equitable access to COVID-19 vaccines and other health products in low-income and middle- income countries. We propose: (1) Implementing alternative incentive and funding mechanisms to develop new scientific innovations to address infectious diseases with pandemic potential; (2) Voluntary and involuntary initiatives to overcome IP barriers including pooling IP, sharing data and vesting licences for resulting products in a globally agreed entity; (3) Transparent and accountable collective procurement to enable equitable distribution; (4) Investments in regionally distributed research and development (R&D) capacity and manufacturing, basic health systems to expand equitable access to essential health technologies, and non-discriminatory national distribution; (5) Commitment to strengthen national (and regional) initiatives in the areas of health system development, health research, drug and vaccine manufacturing and regulatory oversight and (6) Good governance of the pandemic prevention, preparedness and response accord. It is important to articulate principles for deals that include reasonable access conditions and transparency in negotiations. We argue for an equitable, transparent, accountable new global agreement to provide rewards for R&D but only on the condition that pharmaceutical companies share the IP rights necessary to produce and distribute them globally. Moreover, if countries commit to collective procurement and fair pricing of resulting products, we argue that we can greatly improve our ability to prepare for and respond to pandemic threats.

A framework for assessing the impact of disease treatment.

OBJECTIVES: To address ongoing pandemics and epidemics, policy makers need good data not only on the need for treatments but also on new interventions' impacts. We present a mathematical model of medicines' health consequences using disease surveillance data to inform health policy and scientific research that can be extended to address the current public health crisis. METHODS: The Global Health Impact index calculates the amount of mortality and morbidity averted by key medicines for malaria, TB, HIV/AIDS and several Neglected Tropical Diseases (NTDs) using data on outcomes in the absence of treatment, treatment effectiveness and access to needed treatment. Country-level data were extracted from data repositories maintained by the Global Burden of Disease study, Global Health Observatory, WHO, UNICEF and a review of the scientific literature. RESULTS: The index aggregates drug impact by country, disease, company and treatment regimen to identify the spatial and temporal patterns of treatment impact and can be extended across multiple diseases. Approximately 62 million life-years were saved by key drugs that target malaria, TB, HIV/AIDS and NTDs in our latest model year. Malaria and TB medicines together were responsible for alleviating 95% of this burden, while HIV/AIDS and NTD medicines contribute 4% and 1%, respectively. However, the burden of disease in the absence of treatment was nearly evenly distributed among malaria, TB and HIV/AIDS. CONCLUSIONS: A common framework that standardises health impact across diseases and their interventions can aid in identifying current shortcomings on a global scale.