Equitable access to pandemic products demands stronger public governance

The absence of global arrangements to ensure access to health products during emergencies is a gap that governments are seeking to fill through recently agreed amendments to the International Health Regulations (IHR) and continuing negotiations towards a Pandemic Agreement. ACT-A supplied nearly 2 billion vaccine doses to countries in need and secured substantial volumes of diagnostics, oxygen, and therapeutics by the end of 2023.1 However, ACT-A was unable to deliver equitable access for low-income and middle-income countries (LMICs), ensure the meaningful representation of these countries in governance, nor permit public scrutiny of decision making.2,3 The absence of a clearly designated global public forum meant that crucial decisions on sharing of knowledge and access to health products were made outside public scrutiny. Neither the amended IHR nor the draft Pandemic Agreement guarantee sufficient and sustainable funding, and history casts doubts on governments' readiness to funnel substantial new funding through WHO.11,12 Moreover, WHO's ethical guidance is not legally binding for governments or companies, and they might choose not to follow it on sensitive issues, such as which citizens or countries should receive priority for scarce health products.13 Finally, new international rules will not provide WHO with hierarchical authority over the many other actors that influence access to pandemic products, such as research and development funders, global health initiatives, or foundations.