The following text is based on our letter that was published in Nature Medicine today – one year after COVID-19 was declared a pandemic. What we ask for in this letter is a revamping of our global governance system. Nothing less. We argue that COVID-19 has unveiled serious dysfunctions of global governance, epitomized by the battle for COVID-19 vaccines. Time for a new Bretton Woods conference?
A few years ago I got an eye opener when I chaired a Lancet commission addressing inequities in global health. I learned that these inequities are profound and that they to a large extent can be attributed to fissures and flaws in global governance. Simply put – the global governance system has not been sufficiently flexible and malleable to keep pace with the development of the society at large – and has not adapted to a world that faces not only the scourge of war but also the scourge of pandemics.
A new world order
Bretton Woods was where the blueprint was laid out for the post-WWII world order. The meeting was held in 1944, close to eight decades ago. Now is the time to meet again, to flesh out a new world order that is better equipped to handle crises like the one at hand – with due attention to the fact that we are all interconnected and that the current inequities in health must be remedied in order to be better prepared when the next crisis hits.
What strikes me is that current debates on vaccine distribution largely focus on the national perspective rather than the global one. It should be quite obvious that a fair and equitable distribution of vaccines would be in everyone´s interest. Amassing vaccines in rich countries at the expense of poor countries is the closest that we could possibly come to a Pyrrhic victory. Delaying vaccination in low-income countries would allow the virus to mutate further, threatening all of us and hindering a reopening of international travel and interaction.
Safeguard the health
I am the first to acknowledge the dilemma that we face in this respect. One of the primary obligations of the modern nation state is to safeguard the health of its population – today translated into an adequate access to vaccines. But values are global and so are our responsibilities. A pandemic like the one at hand is the very epitome of our interconnectedness. Let it encourage us to take the global view and to consider vaccines as a common good that should be distributed equitably and justly.
Let me conclude by quoting from our letter to Nature Medicine:
….as shown by COVID-19, updated global governance mechanisms are needed that better reflect the contemporary geopolitical order and truly encourage international collaboration across sectors, through political and legal solutions rooted in commitments to justice and shared global responsibility. We call for a 21st-century Bretton Woods–type conference, similar to that of 1944, when states met to improve global economic interaction, secure peace and provide assistance to countries devastated by World War II, which resulted in new global governance structures such as the International Monetary Fund and the World Bank.
One year on, this is a timely request.