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Abstract
Global public–private partnerships (PPPs) have become prominent in efforts to address global challenges, particularly in the health field. In the scholarly literature, global PPPs have been conceptualized as arenas for voluntary public–private cooperation rather than agents of global governance. This paper challenges this approach, arguing that a sub-class of highly institutionalized partnerships have developed into transnational bureaucracies that, much like international organizations, can draw from their administrative capacities to exercise agency and gain and consolidate authority over time. To substantiate this argument, I present an in-depth analysis of five global health partnerships that played a leading role in the Access to Covid-19 Tools Accelerator (ACT-A), the initiative that sought to coordinate the global response to covid-19. Based on extensive document review and analysis of the ACT-A PPPs —Gavi, the Vaccine Alliance, The Global Fund to Fight AIDS, Tuberculosis and Malaria, The Coalition for Epidemic Preparedness Innovation, Unitaid, and The Foundation for Innovative New Diagnostics — I show how these partnerships' leadership role during the pandemic emerged from a decade long build-up of PPP agency. These organizations gained administrative capacities that enabled them to increase their authority vis-à-vis their donors, boards, and other external actors through three interlinked strategies: (a) developing greater financial autonomy; (b) expanding their mandates (including toward pandemic preparedness and response); and (c) establishing inter-partnership cooperation and mutual representation to other forums. My analysis suggests the need for future research to consider highly institutionalized PPPs as agents of global governance and to explore empirically and theoretically the consequences of their rising authority.

This article explores the motivations behind Norway's contributions to the global response to Ebola (2014). Unpacking the interests, norms and context at play, it finds that the repatriation of an Ebola-infected volunteer triggered a strong governmental response. Humanitarian in nature but partially securitized, this response was driven by altruistic and security concerns: a desire to provide assistance and the ambition to contain the epidemic at its source, while managing domestic fears. This analysis concurs with publications highlighting the centrality of security considerations in the global Ebola response, while suggesting that humanitarian motivations should not be overlooked. Finally, it argues that the theoretical divide between a "statist" and "globalist" approach to global health security does not fully capture the complexity at play in the operationalisation of the concept. Therefore, the analysis introduces the idea of a "universalist" understanding of global health security, using the global level as referent for security and allowing for a balance between realpolitik and idealpolitik. ; Norges reaksjon på ebola: en sammenblanding av altruistiske og sikkerhetsmessige interesser

BACKGROUND: In 2021, donor countries, the pharmaceutical industry, and the COVAX initiative promoted vaccine donation or "dose-sharing" as a main solution to the inequitable global distribution of Covid-19 vaccines. COVAX positioned itself as a global vaccine-sharing hub that promised to share doses "equitably, effectively and transparently," according to rational criteria overseen by independent scientists. This article provides a critical analysis of the principles and practice of "dose-sharing," showing how it reveals the politics at play within COVAX. RESULTS: Donated doses were an important source of COVAX's vaccine supply in 2021, accounting for 60% of the doses the initiative delivered (543 million out of 910 million). However, donations could not compensate fully for COVAX's persistent procurement struggles: it delivered less than half of the two billion doses it originally projected for 2021, a fraction of the 9.25 billion doses that were administered globally in 2021. Donor countries and vaccine manufacturers systematically broke COVAX's principles for maximizing the impact of dose-sharing, delivering doses late, in smaller quantities than promised, and in ad hoc ways that made roll-out in recipient countries difficult. Some donors even earmarked doses for specific recipients, complicating and potentially undermining COVAX's equitable allocation mechanism. CONCLUSIONS: COVAX's pivot from global vaccine procurement mechanism to dose-sharing hub can be seen as a "win-win-win" solution for COVAX itself (who could claim success by having access to more doses), for donor countries (who could rebrand themselves as charitable donors rather than "vaccine hoarders"), and for the pharmaceutical industry (maintaining the status quo on intellectual property rights and protecting their commercial interests). Although dose-sharing helped COVAX's vaccine delivery, its impact was undermined by donors' and industry's pursuit of national security, diplomatic and commercial interests, which COVAX largely accommodated. ...

Background In 2021, donor countries, the pharmaceutical industry, and the COVAX initiative promoted vaccine donation or "dose-sharing" as a main solution to the inequitable global distribution of Covid-19 vaccines. COVAX positioned itself as a global vaccine-sharing hub that promised to share doses "equitably, effectively and transparently," according to rational criteria overseen by independent scientists. This article provides a critical analysis of the principles and practice of "dose-sharing," showing how it reveals the politics at play within COVAX. Results Donated doses were an important source of COVAX's vaccine supply in 2021, accounting for 60% of the doses the initiative delivered (543 million out of 910 million). However, donations could not compensate fully for COVAX's persistent procurement struggles: it delivered less than half of the two billion doses it originally projected for 2021, a fraction of the 9.25 billion doses that were administered globally in 2021. Donor countries and vaccine manufacturers systematically broke COVAX's principles for maximizing the impact of dose-sharing, delivering doses late, in smaller quantities than promised, and in ad hoc ways that made roll-out in recipient countries difficult. Some donors even earmarked doses for specific recipients, complicating and potentially undermining COVAX's equitable allocation mechanism. Conclusions COVAX's pivot from global vaccine procurement mechanism to dose-sharing hub can be seen as a "win-win-win" solution for COVAX itself (who could claim success by having access to more doses), for donor countries (who could rebrand themselves as charitable donors rather than "vaccine hoarders"), and for the pharmaceutical industry (maintaining the status quo on intellectual property rights and protecting their commercial interests). Although dose-sharing helped COVAX's vaccine delivery, its impact was undermined by donors' and industry's pursuit of national security, diplomatic and commercial interests, which COVAX largely accommodated. The lack of transparency and accountability mechanisms within COVAX's overly complex governance structure as a global public-private partnership enabled these practices.

AbstractOver a third of the world's countries have launched contact‐tracing apps in response to the COVID‐19 pandemic, generating much hype about the prospect of automating contact‐tracing to manage outbreaks and to alleviate costly and labour‐intensive 'manual' contact tracing. Despite the stringent scientific criteria applied to the development of vaccines and other 'biomedical countermeasures' in responding to the pandemic, digital contact tracing has been widely recommended despite being an unproven public health intervention. Evidence for its effectiveness is thin, based on theoretical mathematical modelling and unsystematic observations across diverse country contexts. Establishing evidence of effectiveness is complicated by the fact that two private corporations, Apple and Google, own the technology upon which most government contact‐tracing apps are based and which, by design, restricts access to needed data on privacy grounds. In this policy insight, we make the case for why public health authorities urgently need to establish the effectiveness and societal implications of this big digital contact‐tracing experiment.

Abstract The growth of global public-private partnerships for health has opened up new spaces for civil society participation in global health governance. Such participation is often justified by the claim that civil society organizations, because of their independence and links to communities, can help address democratic deficits in global-level decision-making processes. This article examines the notion of 'civil society engagement' within major public–private partnerships for health, where civil society is often said to play a particularly important role in mediating between public and private spheres. How do major global health partnerships actually define 'civil society', who represents civil society within their global-level decision-making bodies, and what formal power do civil society representatives hold relative to other public and private-sector partners? Based on a structured analysis of publicly available documents of 18 of the largest global public–private partnerships for health, we show that many of them make laudatory claims about the value of their 'civil society engagement'. Most use the term 'civil society' to refer to non-governmental organizations and communities affected by particular health issues, and state that they expect these actors to represent the needs and interests of specific populations in global-level decisions about strategies, funding models and policies. Yet, such civil society actors have a relatively low level of representation within the partnerships' boards and steering committees, especially compared with private-sector actors (10.3 vs 23.7%). Moreover, there is little evidence of civil society representatives' direct and substantial influence within the partnerships' global-level governing bodies, where many decisions affecting country-level programmes are made. Rather, their main role within these partnerships seems to be to implement projects and advocate and raise funds, despite common discourses that emphasise civil society's watchdog function and transformative power. The findings suggest the need for in-depth research into the formal and informal power of civil society within global health governance processes. ; Civil society participation in global public-private partnerships for health

COVAX, the vaccines pillar of the Access to Covid-19 Tools Accelerator (ACT-A), has been promoted as 'the only global solution' to vaccine equity and ending the Covid-19 pandemic. ACT-A and COVAX build on the public-private partnership (PPP) model that dominates global health governance, but take it to a new level, constituting an experimental form that we call the 'super-PPP'. Based on an analysis of COVAX's governance structure and its difficulties in achieving its aims, we identify several features of the super-PPP model. First, it aims to coordinate the fragmented global health field by bringing together existing PPPs in an extraordinarily complex Russian Matryoshka doll-like structure. Second, it attempts to scale up a governance model designed for donor-dependent countries to tackle a health crisis affecting the entire world, pitting it against the self-interest of its wealthiest government partners. Third, the super-PPP's structural complexity obscures the vast differences between constituent partners, giving pharmaceutical corporations substantial power and making public representation, transparency, and accountability elusive. As a super-PPP, COVAX reproduces and amplifies challenges associated with the established PPPs it incorporates. COVAX's limited success has sparked a crisis of legitimacy for the voluntary, charity-based partnership model in global health, raising questions about its future.