The counterplan solves future pandemics best through establishing a GHS framework

5. The search for an effective GHS The second most relevant reason why the theorization of a Commons for the Covid-19 vaccine and other life-saving treatments should be pursued is the achievement of a GHS system. GHS has not a proper definition, but it has always been approached from two opposite perspectives: on the one hand, state and national security which prioritizes national safety, and on the other hand, through a more holistic point of view, security of the entire humanity, beyond national borders.87 This lack of clarity is evidenced in how the world was highly unprepared to face the Covid-19 virus and all the consequences that derived from it.88 Therefore, there is the need to take a position on what GHS really means. This can be done by critically assessing two aspects of the pandemic that amplified issues of inequality, nationalism and private interests: the restrictive measures commonly defined as lockdowns (including stay-at-home orders, shelter-in-place orders, economic shutdown),89 and, more relevant for the purposes of this paper, the vaccine’s development and distribution. With regard to the first phenomenon, the impact of the restrictive measures, although consistent across the world, has been highly dependent on the country involved. The most drastic effects can be found in low- and middle-income countries (LMICs) where the lockdown led to a limitation of access to essential public health services, such as the treatment of the Human Immunodefciency Virus.90 Moreover, considering that all the health facilities were deeply focused on testing, treating and preventing Covid-19, in LMICs there was a 10 per cent decline of sexual and reproductive health services only in 2020, specifically in relation to the use of contraceptives, services for pregnancy-related and new-born care and abortions.91 Other than these serious health-related issues, there is evidence that state authorities started to implement intimidation, violence and imprisonment against part of the population, not due to violations of the restrictive measures, but only because they were political opponents and marginalized communities.92

The only instrument that could put an end to all the restrictive measures and their devastating consequences is the vaccine, which was finally introduced at the end of 2020. However, the real success of this pharmaceutical depended (and still depends) only on its equitable access and rapid distribution on a global scale, and unfortunately this was not the case. A sense of vaccine nationalism took over at the end of 2020, with all the wealthy countries that started to pre-order vaccine quantities beyond their own needs, arriving to cover 300 per cent of the population.93 Developing countries, despite the fact that their own citizens were part to the trials for Covid-19 vaccines, were being excluded from this massive distribution.94 This naturally resulted in missing the target set by the World Health Organization (WHO) to fully vaccinate 40 per cent of the population in every country by the end of 2021.95 Therefore, as it can be easily noticed, the goal of ensuring a GHS that is human security-centric and equity-based, especially in terms of equitable access and distribution of vaccines, is far from being accomplished.

Unfortunately, the activism from the international community, that should ensure, if not the total accomplishment, at least a contribution in reaching a GHS for the vaccines, proved to be not particularly sensitive in this regard. The reference is not only to the limited IP waiver and its complicated history analysed in Section 3 but also to another international instrument through which, if implemented properly, developing nations would have obtained access to vaccines. The reference is to the facility called COVAX at the WHO, funded in a (failed) attempt of showing multilateral solidarity. COVAX was committed to ensure a vaccine contingent of 20 per cent cover of each country’s population, which is a threshold extremely lower than the one (around 60 per cent) required to reach herd immunity and protect the entire world from the virus.96 Moreover, similar to what was discussed in Section 3 with regard to the TRIPS compulsory licensing, bilateral agreements and Memorandum of Understanding, between developed countries, LMICs and vaccine manufacturers, allowed the latter to overcome the legal guarantees and requirements of COVAX, also considering that the facility was consistently underfunded.97 Considering all these aspects, it can be noticed how this pandemic showed the controversial links between global health, GHS and global inequities, and how such inequities must be reduced in order to achieve this GHS that is more human and equity-oriented.98

There are different interventions that can be done to pursue this perspective of GHS. The first one could be prioritizing Covid-19 in health programming.99 The prevention and vaccine programs against the virus require the implementation of efficient and strong universal systems, in terms of primary health care-oriented services.100 Interestingly, practical hints to create such a system can be taken from LMICs that implemented efficient public health strategies, such as integrated programming, contact tracing, and door to door health care, for instance during the epidemic response to Ebola in West Africa.101 Second, there is the need of implementing human rights instruments,102 especially the International Covenant on Economic, Social and Cultural Rights103 and International Covenant on Civil and Political Rights.104 These international treaties can in fact enforce important rights and state obligations related to the access of lifesaving drugs.105 For instance, other than adopting only a ‘negative’ IP waiver and/or IP exception, it would be important that countries ‘positively’ comply with their international obligations of promoting the right to health and the extension of fnancial and technical resources to LMICs.106 Third intervention that can be made to pursue GHS is the adoption of an equity focus in the International Health Regulations (IHR) of the WHO.107 This legal instrument would require each country to prepare and adhere to pandemic guidelines. However, its core requirements have never received a consistent implementation in most countries, especially LMICs.108 Therefore, the implementation of the IHR framework, that can allocate global and local accountability, would be central to deal with the inequities of the world. Lastly, there is probably the most relevant intervention for this paper and its argument, which is technology and knowledge transfer.109 In particular, there is the need to address vaccines and other life-saving treatments as shareable and accessible Commons, through the implementation of an inclusive right which, as mentioned above, would not only guarantee the open access but also enforce it. This is the focus of the following sections.