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Governing the Access to Covid-19 Tools Accelerator: Towards Greater Participation, Transparency, and Accountability Publisher Pubmed



Moon S1 ; Armstrong J2 ; Hutler B3 ; Upshur R4 ; Katz R5 ; Atuire C6 ; Bhan A7 ; Emanuel E8 ; Faden R3 ; Ghimire P9 ; Greco D10 ; Ho CW11 ; Kochhar S12 ; Schaefer GO13 Show All Authors
Authors
  1. Moon S1
  2. Armstrong J2
  3. Hutler B3
  4. Upshur R4
  5. Katz R5
  6. Atuire C6
  7. Bhan A7
  8. Emanuel E8
  9. Faden R3
  10. Ghimire P9
  11. Greco D10
  12. Ho CW11
  13. Kochhar S12
  14. Schaefer GO13
  15. Shamsigooshki E14
  16. Singh JA15
  17. Smith MJ5
  18. Wolff J16
Show Affiliations
Authors Affiliations
  1. 1. International Relations and Political Science Department & Interdisciplinary Programmes, Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
  2. 2. Independent Global Health Consultant, Geneva, Switzerland
  3. 3. Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MA, United States
  4. 4. Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  5. 5. Faculty of Health Sciences, Western University, London, ON, Canada
  6. 6. Department of Philosophy and Classics, University of Ghana, Accra, Ghana
  7. 7. Department of Community Medicine and Centre for Ethics, Yenepoya University, Mangalore, India
  8. 8. Global Initiatives and Healthcare Transformation Institute, University of Pennsylvania, Philadelphia, PA, United States
  9. 9. Tribhuvan University, Kirtipur, Nepal
  10. 10. School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
  11. 11. Faculty of Law and Centre for Medical Ethics, University of Hong Kong, Hong Kong Special Administrative Region, China
  12. 12. Department of Global Health, University of Washington, Seattle, WA, United States
  13. 13. Centre for Biomedical Ethics, National University of Singapore, Singapore
  14. 14. Department of Medical Ethics, Tehran University of Medical Sciences, Tehran, Iran
  15. 15. University of KwaZulu-Natal, Durban, South Africa
  16. 16. Blavatnik School of Government, University of Oxford, Oxford, UK, United Kingdom

Source: The Lancet Published:2022


Abstract

The Access to COVID-19 Tools Accelerator (ACT-A) is a multistakeholder initiative quickly constructed in the early months of the COVID-19 pandemic to respond to a catastrophic breakdown in global cooperation. ACT-A is now the largest international effort to achieve equitable access to COVID-19 health technologies, and its governance is a matter of broad public importance. We traced the evolution of ACT-A's governance through publicly available documents and analysed it against three principles embedded in the founding mission statement of ACT-A: participation, transparency, and accountability. We found three challenges to realising these principles. First, the roles of the various organisations in ACT-A decision making are unclear, obscuring who might be accountable to whom and for what. Second, the absence of a clearly defined decision making body; ACT-A instead has multiple centres of legally binding decision making and uneven arrangements for information transparency, inhibiting meaningful participation. Third, the nearly indiscernible role of governments in ACT-A, raising key questions about political legitimacy and channels for public accountability. With global public health and billions in public funding at stake, short-term improvements to governance arrangements can and should now be made. Efforts to strengthen pandemic preparedness for the future require attention to ethical, legitimate arrangements for governance. © 2022 Elsevier Ltd