by Katrina Perehudoff, Veronika J Wirtz, Anna Wong, Violet Rusu, Jillian Kohler
BMJ Global Health 2022;7:e010057 (Open access)
In July 2020, UN Secretary-General António Guterres called for a ‘New Social Contract and a New Global Deal’ in response to exacerbated international inequalities made glaringly apparent during the Covid-19 pandemic. We argue that the Covid-19 pandemic and its economic, political and social crises illuminate the need for a revamped social contract on access to essential medicines and health technologies (including, e.g. vaccines and diagnostics). The current social contract, which focuses on the nation-state’s responsibility for its population’s access to essential medicines and health technologies, struggles to sufficiently address the global provision of pharmaceutical products during an international health crisis.
The Covid-19 pandemic is this generation’s canary in the coal mine, underscoring the ongoing and far-reaching global inequities that have been known to the access to medicines community since before the 2000s HIV/AIDS epidemic. Addressing this profound global injustice will require embracing a global model of the social contract, based on a set of principles grounded in global cooperation. Here, we present the shortcomings of the current social contract model for the transnational governance of essential medicines and health technologies, and we argue for a global social contract rooted in the health security and sustainable development agendas.
- The Covid-19 pandemic illuminates the need to move away from the current social contract, which focuses on the nation-state’s responsibility for protecting the health of its own population, including by providing essential medicines and health technologies.
- We argue for embracing a global social contract, which is a governance concept that lays the foundation for how states should act as members of the international community, as regulators of the private pharmaceutical industry, and as guarantors of public goods benefiting people worldwide.
- A global social contract should be based on a set of four principles: collective state stewardship of the pharmaceutical and health technology; equity and the protection of health as a human right; an effective global polity; and governmental transparency and democratic accountability.
- This foundation can serve as a basis for a future pandemic treaty and as a model to address the much broader global crisis of inequitable access to medicines and health technologies for infectious and non-communicable diseases.