Actors and governance in global health

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The WHO, states, pharmaceutical companies, NGOs (e.g. Médecins Sans Frontières), foundations (e.g. the Gates Foundation) and partnerships (e.g. GAVI/COVAX).

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The patchwork of actors, rules and funding that together direct the world's response to health problems.

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It coordinates, sets standards, runs surveillance and declares emergencies — but relies on states for funding and cannot compel them, so its power is soft.

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They develop and own the medicines and vaccines and, through patents, control who can produce them and at what price — so access depends on their choices.

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Fair access to vaccines for all countries, not just the richest — a central goal that global health governance often fails to deliver.

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Global partnerships that pool funding to buy and distribute vaccines to poorer countries — COVAX aimed at vaccine equity but was out-competed by rich states buying directly.

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They deliver care where states can't and advocate for the poor — e.g. pushing to waive patents so more producers could make vaccines — but can't fix the system alone.

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They fund health programmes and vaccines at enormous scale — a huge good — but concentrate power in a few private, unelected hands that can shape global priorities.

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Because of structural power imbalances — pharma's pricing, rich states' buying power, unelected influence and a weak WHO — so when profit or self-interest clash with equity, the poor lose.

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It brings vast resources and expertise — pharma innovation, foundation funding, NGO delivery, WHO coordination — achieving results no single public body could.

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It has real capacity but structural gaps, so reform should keep what works (innovation, funding, delivery) while fixing the gaps — strengthen the WHO, guarantee equity, ease access.