Governing the Access to COVID-19 Tools Accelerator: towards greater participation, transparency, and accountability. Issue 10323 (29th January 2022)

• Record Type: Journal Article
• Authors: Moon, Suerie; Armstrong, Jana; Hutler, Brian; Upshur, Ross; Katz, Rachel; Atuire, Caesar; Bhan, Anant; Emanuel, Ezekiel; Faden, Ruth; Ghimire, Prakash; Greco, Dirceu; Ho, Calvin WL; Kochhar, Sonali; Schaefer, G Owen; Shamsi-Gooshki, Ehsan; Singh, Jerome Amir; Smith, Maxwell J; Wolff, Jonathan
• Is Part Of: Lancet. Volume 399:Issue 10323(2022)
• Page Start: 487
• Page End: 494
• Publication Date: 2022-01-29
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(21)02344-8
• Languages: English
• ISSNs: 0140-6736

Abstract

Summary: 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.