The concept of a ‘global public good’ is an economic idea that at its simplest, refers to products, ideas, policies or issues with effects that could extend to everyone, everywhere. Despite its name, this actually has nothing to do with good or bad effects, as the word “good” here refers to products, rather than something that is beneficial or positive. In the context of health, this usually means programmes, policies and services that have a truly global impact on health, usually positive impacts, even though those benefits or costs may not be equitable across the world. Show So slightly confusingly perhaps, a global public good can involve something that is good or bad – it is something that can have benefits or costs that reach the entire world. Global warming is a useful example of an issue that is a global public good that has disastrously negative effects for the entire world. Global public goods must be non-rivalrous – meaning that using it doesn’t reduce the amount for anyone else, although activities or interventions concerning it may well be. They must also be non-excludable, meaning that it should be impossible to prevent anyone else from getting the benefits. Films are an example of a good that is non-rivalrous – one person enjoying a film doesn’t affect how someone else enjoys it – but it can be excludable from someone who doesn’t pay to access the film. Global public goods in healthcareOrganisations such as the World Health Organization (WHO) provide a range of global public goods, in the form of open access publications, standards (e.g. the International Classification of Disease), guidelines (e.g. for HIV treatment in resource-poor settings), assessments (e.g. pre-qualification of drugs and vaccines), coordinating frameworks (e.g. Global Action Plan on Antimicrobial Resistance), voluntary normative guidance (e.g. Code of Conduct on Marketing of Breastmilk Substitute) or binding international law (e.g. the International Health Regulations and the Framework Convention on Tobacco Control). Disease eradication meets the criteria of both being non-rivalrous and non-excludable. The eradication of a vaccine-preventable disease, such as smallpox, qualifies since everyone benefits, whether or not they contributed to the eradication effort. Read more: Gavi's Vaccine supportWho governs and finances global public goods?Clearly, unlike non-health-related global public goods, such as sunlight, which exists without human intervention, the provision of some health-related ones need sustained planning and financing. Their provision is not automatically assured. Financing brings issues both of coordination and of governance – who is in charge of a global public good, who decides the priorities, and who decides where the money goes? In some instances, where sovereign interests can’t be coordinated easily for a global goal that is much needed, international agencies have taken the reins, often along with philanthropic funding. Gavi’s mission is a good example of this, in which a core group of partners decided to innovate ways to ensure that childhood vaccination would be available to anyone who needs it. It is also a prime example of a public-private partnership taking a private good (a vaccine) and making it public. To ensure sustainable financing, some global health academics like Suerie Moon at Harvard, and others, have suggested a Global Fund for Public Goods (GFPG), in to which all countries would contribute to fund, for instance, R&D with a global reach. Ensuring all countries contribute to such a fund can be challenging because global public goods can be undermined by “free riders”, who essentially want to reap the benefits without contributing as much as might be needed – free-riding off the goodwill and contributions of others. Read more: Gavi's Innovative financingVaccines as a global public goodWhile disease eradication as a whole is a global public good, it becomes more complex when you look specifically at health products. Drugs and vaccines are often both rivalrous and excludable – for example, if prices are set so high that low- and middle-income countries can’t afford to buy them, or if there are supply issues. However, as Moon and colleagues point out: “excludability is not immutable”, and societal and political decisions can influence whether or not a good is made non-excludable. Researchers, for example, could publish their work in a journal that has a paywall or one that has open-access, and similarly, scientists could decide to patent a technology or make it free to use, depending on the circumstances. This ability to make private goods or products public, when the right to health demands it, was reflected in the lead up to this year’s World Health Assembly (WHA). Countries debated whether there should be a reference to global public goods in a UN resolution, the “International cooperation to ensure global access to medicines, vaccines and medical equipment to face COVID-19”. UNAIDS called for a “People’s vaccine” against COVID-19 that would be available to everyone, in all countries, free of charge. The UN General Assembly resolution ended up including global public goods as a concept in this way: “the role of extensive immunisation against COVID-19 as a global public good for health in preventing, containing and stopping transmission in order to bring the pandemic to an end, once safe, quality, efficacious, effective, accessible and affordable vaccines are available…” Read more: COVAXTo enact this resolution and ensure mandatory worldwide sharing of all COVID-19-related knowledge, data and technologies, countries will most likely need to make full use of agreed safeguards and flexibilities in the World Trade Organization Doha Declaration on the TRIPS and Public Health, to protect access to medicines for all. These are agreements that allow countries to lift patents on medicines if it is in the public interest, as Brazil did with antiretrovirals in 2007, although this was not an easy process for the country and brought a significant backlash from pharmaceutical companies. When it comes to vaccines, the call to make them affordable and available to everyone, everywhere – essentially, to make vaccines a global public good – is embedded in the idea of universal health coverage. In a world living with concurrent severe epidemics of cholera and measles, and now dealing with the COVID-19 pandemic, the need for affordable and available vaccines is more urgent than ever.
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