This chapter explores the gap between technology’s promise and our ability to realize the global public goods of vaccines and medicines. This gap stems from significant market disincentives in the R&D process, along with clinical trial challenges and regulatory hurdles. Yet a range of innovative financing strategies to delink R&D costs from vaccine and drug prices, along with well-designed and ethically run clinical trials, can fill this gap, facilitating development of urgently needed medical countermeasures.

This chapter critically evaluates, from the standpoint of the capability approach and the human development paradigm, the reliance on market-driven forces and mechanisms in the vaccine development and distribution pillar of ACT-A (COVAX), and the significance of complementary (or supplementary) developments such as the establishment of mRNA technology transfer hubs and the waiver of certain provisions of the international intellectual property (IP) regime. In hope of regaining some ground lost in global health equity, this chapter highlights the need to appropriately situate IP rights, not by maintaining the status quo but to advance deeper relationality in terms of the technological capability of health systems, particularly those of the "Global South."

The protection of intellectual property (IP) is a question of life and death. COVID-19 vaccines, partially incentivized by IP, are estimated to have saved nearly 20 million lives worldwide during the first year of their availability in 2021. The vast majority of the benefit of this lifesaving technology, however, went to high- and upper-middle-income countries. Despite 10 billion vaccines having been produced by the end of 2021, only 4 percent of people in low-income countries were fully vaccinated. Paradoxically, IP may also be partly responsible for hundreds of thousands of lives lost in 2021, due to insufficient supply of vaccines and inequitable access during the critical first year of vaccine rollout, most notably in low-income countries that lacked the ability to buy or manufacture vaccines to save their populations. The contributors to this book diagnose a number of causes for the inequitable distribution of life-saving COVID-19 vaccines, from misguided reliance on intellectual property rights and voluntary mechanisms to share knowledge and vaccines, to the rise of vaccine nationalism and vaccine diplomacy, to unequal global intellectual property institutions that disenfranchise low-income countries and continue to reproduce colonial era dependency by poor countries on high income nations for life-saving technologies. Global experts herein suggest several reforms to prevent such inequity in the next pandemic, including delinking vaccine development from monopoly rights in technology, enhanced legal requirements to share publicly-funded technologies in pandemic times, and investment in technology transfer hubs and local vaccine manufacturing capacity in low and middle-income countries.

For many years, some lawmakers, scholars, and activists have argued that firms located in each developing country (or each regional set of developing countries) should produce more of the drugs that the residents there need. They contend that local production would benefit the residents of those countries in two ways. The chapter first discusses some recent developments that have altered the relative strength of these competing considerations, sharply increasing the likelihood that fostering local production in developing countries would be socially beneficial.It then proposes five legal reforms and economic initiatives that could help build local pharmaceutical production capacity and thereby save lives.

Authors in this volume make a wide range of important proposals on intellectual property, innovation, and access. The question this chapter asks is: which of these might work in an actual pandemic? By tracing the first year of COVID-19 vaccine distribution, it shows the critical importance of aligning choice of policy mechanisms with political forces. Indeed, it argues that an openness paradigm may have been more effective not only for reasons of justice, but because it could accommodate populist politics and vaccine nationalism.

This chapter is concerned with coordinating the immediate global response to future pandemics – on which there has been very little focus – as opposed to long-term arrangements on prevention and preparedness where recent efforts by the WHO, the Coalition for Epidemic Preparedness Innovations (CEPI), and the Pandemic Fund seem to be moving in the right direction, even if a lot more needs to be done. This chapter does not purport to provide all the answers on global governance on pandemic response but attempts to at least raise the right questions that the international community needs to ask itself.

In the years following FDA approval of direct-to-consumer, genetic-health-risk/DTCGHR testing, millions of people in the US have sent their DNA to companies to receive personal genome health risk information without physician or other learned medical professional involvement. In Personal Genome Medicine, Michael J. Malinowski examines the ethical, legal, and social implications of this development. Drawing from the past and present of medicine in the US, Malinowski applies law, policy, public and private sector practices, and governing norms to analyze the commercial personal genome sequencing and testing sectors and to assess their impact on the future of US medicine. Written in relatable and accessible language, the book also proposes regulatory reforms for government and medical professionals that will enable technological advancements while maintaining personal and public health standards.

An isolated approach to climate action hinged on nationalism and built on the superiority complexes of countries in the Minority World will not be enough to address the climate emergency. Climate multilateralism, despite its imperfections, remains a potent tool for addressing the tragedies of our commons.

Chapter 5 examines some of the rationales for pharmaceutical interventions, especially vaccines, and resistance to them. Vaccine-hesitant and anti-vaccine activists have questioned different aspects of the Covid-19 vaccination programme, and some have even argued that the whole virus is a scam and part of a plot to profit from selling vaccines. The discussion regarding vaccines and other potential pharmaceutical treatments quickly became highly politicized, especially after Donald Trump’s official endorsement of the malaria drug hydroxychloroquine. The debate about vaccines and treatments does not only reflect tensions between science and politics and expert and non-expert discourses. It also highlights the fact that there are divergent views within the scientific community itself on when new evidence may be ready to be put into political action. This chapter explores the divergent arguments used in this debate as well as their various and complex value-laden underpinnings.