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or allow organizations, such as WHO, to guide a realistic and appropriate approach.
- Plotkin S
- Robinson JM
- Cunningham G
- Iqbal R
- Larsen S
which makes low- and middle-income countries dependent on research and development from more powerful economies. In addition, the research highlights the challenges to achieving population-level effectiveness with a vaccine, regardless of production capacity, due to weak delivery infrastructures and access barriers that determine acceptance.
- Smith J
- Lipsitch M
- Almond JW
Many countries still do not have universal health coverage; therefore, existing delivery gaps must be addressed in distribution strategies and networks. Private business could support the search for a vaccine, but because COVID-19 can spread rapidly across countries and disrupt entire communities, transportation systems, economic sectors and geographic regions, the COVID-19 vaccine should be treated as a global public good. This global need for equitable access to a vaccine is why returning to WHO’s so-called Health for All agenda could bring new meaning to the organization and help plan future steps for managing COVID-19.
Notes to assist in nominating representatives.
Selection mechanisms may be reinforcing traditional participation structures, in which many countries and stakeholders are under-represented, while privileging those who live or work in high-income countries or organizations. Additionally, public-private partnerships that are similar to COVAX have previously withheld data from WHO.
It is proposed to provide impartial advice to transform and re-legitimize the organization. At least two instances of civil society participation (WHO Watch and Global Health Watch)
- Tree F
- Sanders D
- Narayan R
have shown the value of vigilance. The inclusion of a mechanism similar to WHO Watch and Global Health Watch in current and planned WHO initiatives, especially in the aftermath of the COVID-19 pandemic, could also help build the trust necessary for effective global health governance.
- Moon S
- Sridhar D
- Pate MA
- et al.
With insufficient capacity for decisive management of global health, mainly because its budget is too small to meet the stated goals, WHO runs the risk of becoming irrelevant and further weakened. Its financing scheme makes it dependent on large economies that are heavily influenced by powerful corporations, many of which work in the health sector and are connected to philanthropic organizations that lead international collaborations. The power of the WHO is based on the understanding that it truly represents the best interests of all its member countries and is committed to providing a COVID-19 vaccine for all.
Given the challenges for WHO to be reactive, responsive and trustworthy during the COVID-19 pandemic, structural reform will be slow and difficult. First, an example could be set by evaluating initial steps, where necessary, to ensure the meaningful inclusion of countries and voices that have traditionally been excluded in the WHO Scientific Council and in COVAX. Second, formal conditions must be established for organizations to directly supervise the Scientific Council and COVAX. Finally, we cannot expect a different outcome than what we have already experienced with the response to COVID-19 in many parts of the world without global inclusion and transparency.
We declare that there are no competing interests.
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Posted: September 25, 2020
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DOI: https://doi.org/10.1016/S2214-109X(20)30415-0
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