Control over most of the production and distribution of countermeasures (vaccines, diagnostics, therapeutics and other critical supplies) related to prevention and mitigation of health impacts in pandemics, as seen with COVID-19, rests with a small number of countries. National security and economic interests, not epidemiology, dominated decision-making leading to shortages in countries lacking the wealth and fiscal capacities to compete in gaining timely access to such goods.

International organizations and mechanisms, including the Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), the Access to COVID-19 Tools Accelerator (ACT-A), launched by WHO and partners with three pillars on Diagnostics, Therapeutics, and Vaccines (COVAX), have made strong contributions to global health, but have limitations that were exposed during the COVID-19 pandemic.  The WHO mRNA vaccine technology transfer hub initiative offers a basis for assessment of possibilities and pitfalls in ensuring global access to pandemic-related health tools, and how limitations of the governance structure of ACT-A should inform WHO’s roles in overseeing future equitable distribution.

The politicization of science leads to people distrusting some health tools, especially vaccines, resulting in poor uptake and increased morbidity and mortality. Moreover, misinformation and disinformation about the safety and efficacy of new vaccines lead to limited acceptance and uptake in many settings, both rich and poor; however, the impact is greater among poor and rural populations.

The Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement of 1995 requires member countries to make patents available for any invention, whether products or processes, in all fields of technology without discrimination, subject to the normal tests of novelty, inventiveness, and industrial applicability. There is growing consensus that the 2022 TRIPS waiver for COVID-19 vaccines failed to remedy long-standing concerns with the role of intellectual property rights (IPR) in access to health innovations (pandemic-related or otherwise) and that governments in their research funding or advance purchase agreements must place conditionalities on private sector IPR and market decision-making to ensure that there is equitable access to such products globally.

The global health governance is often constrained in addressing global health challenges separate from the interests of large donor members.  The broader context is a need to examine the reform of multistakeholder global health governance with reference to more equitable participation from LMICs (particularly LDCs) and civil society organizations. Several major initiatives developed by ACT-A stakeholders, G20, G7, IPPPR, and INB-global treaty, will shed light on the future global health landscape. An important issue to take on is the dilemma between multilateralism underpinning a globalized world and national interest, self-determination; how to integrate into global and national governance.