The big idea: No single body runs global health. Instead, a crowded field of actors shapes who gets treated.
The actors
- The WHO
- States
- pharmaceutical companies
- NGOs
- philanthropic foundations
Global health governance: This is global health governance: powerful, but full of gaps and power imbalances. The central problem it must solve is vaccine equity — and it often fails.
- The WHO — the UN agency that coordinates, sets standards and declares emergencies, but has limited money and no power to compel states.
- States — the biggest funders and decision-makers, who can cooperate or pursue narrow self-interest.
- Pharmaceutical companies — develop and own the medicines and vaccines, and set prices and access through patents.
- NGOs, foundations & partnerships — e.g. Médecins Sans Frontières (delivering care), the Gates Foundation (funding), and GAVI/COVAX (vaccine access).
Power is unequal — and there are gaps: Global health governance is powerful but uneven. The system has real power imbalances and gaps — most visible when the world fails to deliver vaccine equity in a crisis.
Who holds what power
- The WHO sets the agenda but depends on member funding and cannot force states to act.
- Pharmaceutical companies hold enormous power because they own the medicines and set the prices, which can put life-saving drugs out of reach for the poor.
- Rich states and big foundations can steer global priorities toward their own concerns.
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Each actor brings something essential — and something problematic. The result is a system that can achieve great things (eradicating diseases, funding vaccines) yet repeatedly fails the poorest when powerful interests and narrow self-interest pull the other way.
The WHO and states — coordination without control
The WHO is the closest thing to a global health authority: it sets standards, runs surveillance, declares emergencies and coordinates responses. But it relies on states for funding and cannot compel them to act, so its power is soft. States, meanwhile, are the biggest funders and ultimate decision-makers — they can drive cooperation or, as in a pandemic, retreat into self-interest. The gap: real authority sits with sovereign states, not the coordinating body, so global action depends on states' willingness.
Pharma, NGOs and foundations — private power in a public field
Pharmaceutical companies develop the medicines and vaccines the world needs, but own them through patents and set prices, so they hold huge power over access — profit can clash with equity. NGOs like Médecins Sans Frontières deliver care where states can't and advocate for the poor, but can't fix the system alone. Foundations like the Gates Foundation and partnerships like GAVI/COVAX fund and distribute vaccines at scale — a huge good — yet concentrate power in a few private, unelected hands that can shape global priorities.
Case study — vaccine equity and the COVAX gap: During the COVID-19 pandemic, the whole cast appeared.
Who did what
- Pharmaceutical companies developed vaccines fast but controlled supply and price through patents.
- Rich states pre-bought most of the early doses.
- COVAX (backed by the WHO, GAVI and the Gates Foundation) was created to pool funding and buy vaccines for poorer countries — a genuine attempt at vaccine equity.
- But COVAX was under-funded and out-competed by wealthy states buying directly, so poorer countries still waited far longer for doses.
- NGOs like Médecins Sans Frontières pushed for patents to be waived so more producers could make vaccines — resisted by pharma.
What the episode shows: The episode shows global health governance at work AND its limits: many capable actors, but power imbalances (pharma's control, rich states' buying power) meant the system still failed the poorest. It captures the HL lesson: global health is governed by a crowded field, and its gaps are where the poorest fall through.
The key point: Global health is governed by a crowded field. Each actor brings capacity but also power imbalances. The system's gaps show most in the repeated failure to deliver vaccine equity.
The field
- The WHO — coordination without control.
- States — the real power and funding.
- Pharmaceutical companies — own the medicines and set prices.
- NGOs, foundations and partnerships like MSF, the Gates Foundation and GAVI/COVAX.
The imbalances
- Pharma's control over access.
- Rich states' buying power.
- Unelected private influence.
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Is this crowded, imbalanced system good enough — or does it need reform? Should we curb pharma's power and strengthen the WHO, or does private and philanthropic power get things done? Weigh it — and recommend.
The case that the system works well enough
The crowded field brings vast resources and expertise: pharmaceutical innovation produces the medicines and vaccines in the first place, foundations and partnerships fund immunisation at enormous scale, NGOs reach the hardest places, and the WHO coordinates. Diseases have been driven back and hundreds of millions immunised. On this view, private and philanthropic power, alongside states, gets real results that no single public body could — so the system's diversity is a strength.
The case that it fails the poorest
But the same system repeatedly leaves the poor behind: pharma's patents and pricing put life-saving drugs out of reach, rich states out-buy everyone in a crisis, and unelected foundations and companies wield outsized power over global priorities with little accountability. The WHO — the one body meant to serve everyone — is under-funded and cannot compel action. So the gaps are structural: when profit or national self-interest clash with equity, the poorest lose, as vaccine inequity shows.
One view: it works
- Private innovation, philanthropic funding and NGO delivery achieve results no single body could.
Another view: it fails the poorest
- Pharma's pricing, rich states' buying power and unelected influence create structural gaps.
Two perspectives — weigh them: Strong HL answers judge that the system has real capacity but structural imbalances. So reform should keep what works (innovation, funding, delivery) while fixing the gaps — without destroying the innovation and resources the field provides.
Fixing the gaps
- Strengthen the WHO's authority and funding.
- Guarantee vaccine equity in advance.
- Curb pharma's control over access.
How global health actors come up in Paper 3: Paper 3 stimulus might show a governance failure, a pricing dispute, or a foundation's role.
What to do with the stimulus
Who does what
Analyse WHO does what.
Where the gaps are
Find WHERE the power imbalances and gaps are: pharma, rich states, unelected influence, weak WHO.
Recommend
Recommend — usually strengthen the WHO + guarantee equity in advance + curb access barriers, keeping what works.
Who, where, what to fix.
How Paper 3 rewards you (HL)
Understand
Show you understand the challenge and the stimulus material accurately.
base
Analyse
Break the challenge down — causes, actors, perspectives — using the material.
analyse
Recommend
Propose and justify a course of action — the Paper-3-specific skill.
recommend
Synthesise
Pull the material together into a judged, evaluated response.
top
Recommend how global health governance could be reformed to deliver fairer access to vaccines and medicines.
Model answer plan
See the mark-by-mark plan — for / against / judgement, with marking guidance — in study mode.
Common mistakes (Paper 3): 1. Treating the WHO as an all-powerful world government. It coordinates but can't compel.
2. Ignoring pharma's power over access. Patents and pricing shape who gets medicines.
3. Forgetting foundations' unelected influence. Great funding, but concentrated power.
4. Only describing the actors. Analyse the gaps + recommend.
5. Reform that kills innovation. Keep what works while fixing the gaps.