At the meeting of the Institute of Medicine’s Forum on Microbial Threats on 2009-H1N1 influenza A held in September 2009, WHO’s Fukuda repeatedly mentioned the need for a global framework to prevent access crises from occurring in the future (Fukuda, 2009). Fukuda noted the ineffectiveness and inefficiency of the reactionary, ad hoc attempts to increase vaccine access for 2009-H1N1 influenza A. Fukuda’s reasons why a global framework is necessary echo those given in other analyses of this issue: (1) developing this global access framework would achieve global equity, solidarity, and justice; and (2) creating and operating the global framework is in the enlightened self-interest of all countries, including developed countries, with respect to handling the challenges pandemics pose. These calls for a global access framework represent arguments in favor of the negotiation and implementation of a new kind of global health governance mechanism.

Although the calls for a global access framework to produce more equity, solidarity, justice, and enlightened self-interest generally resonate well in the global health community, foreign policy makers present a more skeptical audience, and understanding this skepticism is important to grasping the difficulty of creating a global access framework. Proponents for such a framework often assert that it is needed because access to vaccine for pandemic influenza (or other dangerous viral pathogens) should not be allocated according to the ability to pay (Chan, 2009a; Gostin, 2009; Yamada, 2009). However, as the foreign policy skeptic might point out, virtually all health-related resources—vaccines, antibiotics, potable water, sanitation, health care, prenatal services, and education—reflect access disparities between rich and poor within and among countries. What makes the access concerns with respect to 2009-H1N1 influenza A so special that the international community must create a global access response to this global health problem?

Public health experts have raised concerns on these grounds, which would reinforce the foreign policy skeptic’s view of the matter. In response to the appeal by the United Nations (UN) and WHO at the end of September 2009 for $1.5 billion to buy vaccines and antivirals for low-income countries, Christopher Murray, Director of the Institute for Health Metrics and Evaluation at the University of Washington, argued that “[g]iven that the world spends about $22 billion on all global health problems, is it really wise to spend $1.5 billion only on swine flu? I would prioritize other areas like maternal and child health, where the need is urgent and huge” (Cheng, 2009). Similarly, Philip Stevens of the London-based International Policy Network asserted that “WHO is peddling an alarmist, unscientific agenda to raise funds. The U.N. is operating on pure conjecture that we will face anarchy and chaos in the developing world should the virus mutate” (Cheng, 2009).