Actions speak louder than words

Achieving equitable access to medical countermeasures requires a transformation that can only be attained through clear, concerted action

Ending the Covid-19 crisis for everyone everywhere and creating frameworks and mechanisms for equitable access to all medical countermeasures must be priorities for every person on the planet. Covid-19 demonstrated the stark reality of what ‘we are not safe until we are all safe’ really means in this interconnected world. The challenges brought by a lack of equity have been well articulated. It is now time to go beyond articulating challenges to designing and implementing solutions. I was on a panel at the 2021 World Health Summit that identified the need for Global South leadership and civil society voices to be heard. A solution to hold a dialogue was proposed. Ports to Arms – a Global South–led dialogue – was created and implemented within five months. It can be done. We must continue pushing for action.

Global health leaders, activists, heads of institutions, civil society and others have been articulating, debating and discussing the challenges to achieving equitable access to medical countermeasures since long before the Covid-19 outbreak. Yet most of these discussions have been located in and led by the Global North. We have already identified the need for the following ingredients to achieve authentic health equity, such as genuine participation and engagement from the Global South, with equity in power dynamics; reformed global institutions with solidarity and outcomes for communities at their heart; alternative financial models and incentives for getting innovations for medical countermeasures from bench to bedside; and enlightened, collaborative – not competitive – leadership at sub-national, national and global levels.

The work required

Much work is needed to achieve equitable access to medical countermeasures for pandemics for all. We must work towards achieving a dynamic state of readiness for the next pandemic, wherever it might occur. While many populations are still dealing with the societal and economic impacts of Covid-19, some countries and populations are now also dealing with monkeypox. On top of global health threats, the effects of climate change and war all coalesce to affect equitable decisions on financing and resourcing. We cannot afford to continue to make siloed decisions. If we all agree that health is a global priority for our collective future, then collective commitments to support equitable access must be made now.

Health For All must truly deliver health for all – not health for some at the expense of the rest of us. We must overcome systemic and internal biases so that the value of a life in Tigray is considered the same as a life in Ukraine. In the news we see pets in high-income countries valued more in conflict situations than Black people. This is wrong and must be addressed – in action, not just words.

More than two years after the start of the Covid-19 pandemic, populations in low- and middle-income countries still cannot access the medical countermeasures afforded populations in high-income countries. A Nigerian friend of mine with Covid-19 was unable to access antivirals when she was very ill because she was told the drugs were not available in the country. Were she in a hospital in London or elsewhere in the Global North, the story would be different. We must address the bottlenecks in the system locally and globally. 

I took up the call to action last year for a whole-of-society discussion hosted by the Global South. The Emergency Coordination Centre in Nigeria, with support from Wilton Park and UNICEF, designed and hosted Ports to Arms in Abuja in February this year. The dialogue focused on finding solutions and creative alternative approaches to achieve access to medical countermeasures where equity and solidarity are at the heart of all decision-making and where people do not feel disadvantaged either in the process of making decisions or implementing decisions, or in the impact and outcome.

Just the beginning

The Ports to Arms Summit was just the start. We need enlightened leadership and commitment from leaders in the Global South and the Global North to invest funding, resources and time to achieve equitable access to medical countermeasures. It is not enough for leaders of the Global North to acknowledge that equitable outcomes require changing power dynamics and moving away from traditional donor relationships. Leaders of the Global South must also step up, become masters of their own destiny, be proactive in their approaches and transform the ‘aid recipient’ mentality. Leaders must come together for global solidarity for equitable health outcomes.

To achieve equity, we must speak to the unconscious bias and the blindness of leadership that so many people have experienced when proposing alternatives to the status quo to achieve equitable access. I have personally experienced the unconscious bias of global health leaders who purport to stand for equity yet, behind closed doors, undermine and fail to support views that differ from their own, with little appreciation of the inequitable power dynamics at play. Peer-to-peer awareness raising is needed to address this unconscious bias, which continues to reinforce the status quo.

Leaders must be bold and courageous and take risks. They must move beyond pandering to financial markets and industry risks and dare to try other models to accelerate access to medical countermeasures to low- and middle-income countries. National leaders must go beyond nationalism and test collective, collaborative approaches. Global structures must be reformed to deliver because they are no longer global in reach or impact. Rather, they enhance the power of some and exclude those who are not part of the inner circle.

The Access to COVID-19 Tools Accelerator and COVAX as the vaccine pillar were originally conceived with the notion of equitable access and solidarity at their heart. National interests quickly undermined these principles. We still need a framework to address how we enable the development and delivery of all medical countermeasures for future outbreaks. But now is the time to agree on the reform and governance changes necessary to meet the originally intended impacts.

Our collective survival can no longer be based on the principle of competition and survival of the fittest or richest. This is an antiquated approach with no moral basis.

We must leave our egos behind if we are to collaboratively design and deliver global mechanisms for global public good. We know this can be done. We must continue our momentum with greater engagement with the Global South on global mechanisms that authentically listen to their challenges and potential solutions, and work collectively to design inclusive solutions.