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TABLE A4-1 Overview of Resource Mobilization (millions)





Vaccines (doses)








Safety boxes




US$ for global operations




US$ for in-country operations




aIs equal to the difference between needs and pledges.

SOURCE: WHO (2009d).

Getting Beyond Global Clichés: Global Access Framework Components

A key political and diplomatic factor that will affect whether countries might answer the call for creating a global access framework will be the content of the framework. Proponents of creating this framework have to articulate what would be required in order to achieve the goals of equity, solidarity, and justice. Many arguments that have been made in favor of greater vaccine and antiviral access in the context of 2009-H1N1 influenza A provide no details about what the global framework should contain and how countries should negotiate such a framework. The task of filling out those details has to take into account the thus-far- unsuccessful negotiations on virus and benefit sharing concerning HPAI-H5N1—negotiations which are grappling with the central issues facing the access challenge for 2009-H1N1 influenza A. In others words, building a global access framework would take place under the dark cloud that the HPAI-H5N1 controversy and failed negotiations have produced in global health.

In addition, a simple list of possible components of a global access framework reveals the potential enormity, complexity, and difficulty of any negotiations on creating such a framework (see Box A4-1). The negotiations for a global access framework would likely be long and complicated. New international health governance mechanisms can take long periods of time to negotiate. For example, the IHR 2005 took a decade to reach an agreement, 12 years from the start of the revision process to the IHR 2005’s entry into force, and 17 years before state parties have to be in full compliance with the IHR 2005. In addition, most experts acknowledge that WHO member states would not have adopted the IHR 2005 without the painful shock administered by the 2003 outbreak of severe acute respiratory syndrome (SARS). The experience with the IHR 2005 does not, of course, mean that every other global health negotiation will take as long to be completed, but it stands as a warning that expectations of a quickly negotiated, agreed upon, and implemented global access framework are unrealistic.

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