Abstract

Our initial response to COVID-19 has been plagued by a series of failures—many of which have extended inequity within and across populations, especially in low- and middle-income countries. The global health governance of pandemic preparedness and response needs to move further away from the advocacy of a one-size-fits-all approach that tends to prioritize the interests of high-income countries towards a context-sensitive approach that gives equity a central role in guiding our pandemic preparedness and response strategies.

While the global governance of pandemic preparedness and response often touts the importance of equity as a moral value and policy goal, our reaction to the COVID-19 pandemic should lead us to call this into question. On the one hand, we find the failure of omission—the progression of the COVID-19 crisis threatens to disproportionately impact low- and middle-income countries (LMICs) with vulnerable healthcare systems. On the other hand, we find the failure of commission—high-income countries (HICs) battle to buy out ventilators, personal protective equipment, and diagnostic tests on the global market, which freezes out any real possibility of LMICs getting these resources. This lack of collective action is a moral failure that risks losing the gains made in promoting health and health equity globally, and risks calling into question the usefulness of equity-based arguments for responsible governance that were used to justify actions to achieve these gains. We argue that much of pandemic preparedness and response remains focused on the interests, resources, and capacities of HICs and, in the case of COVID-19, requires more than a one-size-fits-all approach. The practicality of any proposed pandemic response measures needs to be strongly reconsidered in light of the flawed expectations surrounding the context, capacity, and governance arrangements in LMICs. We maintain that this requires us to rethink how we can strengthen the role equity plays in guiding the global governance of pandemic preparedness and response, and its wider potential impact for global health governance more generally.

Citation

Eyawo, O., Viens, A.M. Rethinking the Central Role of Equity in the Global Governance of Pandemic Response. Bioethical Inquiry (2020). https://doi.org/10.1007/s11673-020-10001-2

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