The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic Global Challenges, Global Solutions: Workshop Summary (2010) / Chapter Skim
Currently Skimming:
A4 I nternational Law and Equitable Access to Vaccines and Antivirals in the Context of 2009-H1N1 Influenza
A4 I nternational Law and Equitable Access to Vaccines and Antivirals in the Context of 2009-H1N1 Influenza
Pages 137-154
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 137... ...
(HPAI-H5N1) and the access problems sparked by the 2009-H1N1 influenza A virus, the challenge of access to knowledge products related to influenza has become a major issue of global health governance.
|
From page 138... ...
The analysis reveals that the path to creation of such a global framework is strewn with significant obstacles that are not overcome by incantations of the need for "equity, justice, and solidarity." Legally, international law specific to global health and generally on the allocation and creation of resources provides few, if any, precedents for establishing a global access framework. Politically, the self-interested calculations of developed states with respect to supplies of influenza vaccines and antivirals do not create a firm basis for an international agreement on sharing.
|
From page 139... ...
creating and operating the global framework is in the enlightened self-interest of all countries, including developed countries, with respect to handling the challenges pandemics pose. These calls for a global access framework represent arguments in favor of the negotiation and implementation of a new kind of global health governance mechanism.
|
From page 140... ...
One such doubt arises from confusing messages communicated by global health experts, who argue, on the one hand, that low-income countries must get vaccine access for equity, solidarity, and justice reasons, but, on the other hand, who often argue for more international health aid because such countries suffer from inadequate domestic capacities to execute health programs because of shortages of healthcare workers, weak or nonexistent response capacities, and fragile or broken health systems. For example, Sangeeta Shashikant, a legal advisor to the Third World Network, argued in connection with access to vaccine for 2009-H1N1 influenza A that "[t]
|
From page 141... ...
. In the case of resistant strains, the global health damage of ineffective use or misuse of antivirals might overshadow public health benefits procured through greater access in low-income countries.
|
From page 142... ...
Thus, this section looks at three important issues concerning international law's potential role in the creation of a global access framework: (1) what existing international health agreements contribute to the goal of a global access framework; (2)
|
From page 143... ...
Third, other existing international legal regimes for global health also provide no rules or norms that could provide deep anchor points for creation of a global access framework. For example, although the International Vaccine Institute (IVI)
|
From page 144... ...
. Although they represent diverse strategies, these examples share common features that raise questions about the feasibility of a global access framework.
|
From page 145... ...
In short, does the movement to increase access to ARVs provide a model for advancing the objective of a global access framework? Analysis of the global ARV access campaign reveals that this campaign is not a good model for a global access framework, especially with respect to the close association of the framework idea and the threat posed by pandemic influenza.
|
From page 146... ...
International Law and the Allocation of Resources Given the lack of traction that health-specific international agreements and access-specific efforts in global health provide for the global access framework idea, perhaps general international law related to the allocation of valuable resources might provide some insights to inform the desire to craft such a framework. Unfortunately, this approach does not provide a pathway to progress.
|
From page 147... ...
The common thread across the history of "technology transfer" efforts to create and distribute resources is that equity, solidarity, and justice only provide weak incentives for states to create cooperative governance mechanisms. This longstanding pattern in international politics poses problems for the desire to create a global access framework because this framework will have to address the problem of unequal access to valuable technological resources for health, as has been seen in the "difficult and divisive" (Chan, 2009a)
|
From page 148... ...
This reasoning helps explain why some public health experts, as noted earlier, question the expenditure of large sums of money on vaccine for the mild 2009-H1N1 influenza A pandemic when other, more pressing global health problems remain neglected. In the context of a severe pandemic, developed countries will know that the virulent influenza virus will infect their populations, probably in multiple waves, even if low-income countries use donated vaccine supplies properly.
|
From page 149... ...
Epidemiological Uncertainties, Political Dilemmas The call for a global access framework faces other obstacles as well, such as the political dilemmas created by epidemiological uncertainties associated with pandemic influenza viruses. These epidemiological uncertainties create incentives for developed countries not to want to develop a global access framework.
|
From page 150... ...
The nature and timing of these donation decisions suggests that the incentives for developed countries to agree in advance to a global access framework are not significant, especially if developed countries can continue to use their superior power and resources to get priority access to vaccines and drugs, protect their entire populations, minimize political costs, and -- if the epidemiological circumstances are favorable -- appear generous. The next declared influenza pandemic will be more severe because WHO has indicated that it will change its pandemic alert system to reflect virus severity, so the political and public health risks will be higher the next time.
|
From page 151... ...
. The experience with the IHR 2005 does not, of course, mean that every other global health negotiation will take as long to be completed, but it stands as a warning that expectations of a quickly negotiated, agreed upon, and implemented global access framework are unrealistic.
|
From page 152... ...
In the context of the current "mild" H1N1 pandemic, the rhetoric of "equity, solidarity, and justice" is not necessarily very convincing with respect to this public health problem, especially when compared to other, more serious global health problems also plagued by health resources being allocated on the basis of ability to pay. Unfortunately, no good models, templates, or precedents for a global access framework exist in international law specific to health or in general international law on allocation and creation of resources.
|
From page 153... ...
2008. Influenza virus samples, international law, and global health diplomacy.
|
From page 154... ...
2009. Poverty, wealth, and access to pandemic influenza vaccines.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.