For a global public policy on health, a universal right and a global common public good

1. The mobilisation of social movements on the right to health and health as a common public good (and service), is widespread and varied. 

There is a need to multiply the occasions for joint action to break down the blocking factors and make room for concrete, long-term commitments to global solutions.

Among the mobilisations underway at international level are those relating to the G20 (October), the COP26 (November) and, at a European level, among others, the European Citizens’ Initiative Right2Cure: No Profit on Pandemics. The aim of this ECI is to obtain by the EU the adoption of the necessary provisions to make the right to health a reality and health a common public good.

The social and economic devastation caused by the pandemic has accentuated the scale and seriousness of the structural crises facing all the world’s countries, not just the ‘most impoverished’ and marginalised. The situation in the United States, France, the United Kingdom and Italy is dramatic. 

There are two major consequences:

1. the worsening of inequalities and gaps between social groups and territories within each country and between countries worldwide; and
2. the growing inability of the international community to devise and implement a common, agreed, planetary response policy to any of the structural crises, not even the most urgent one, the fight against the Covid-19 pandemic.

The two consequences are closely linked. According to the large majority of scientists, they are due to the devastation of the Earth’s life system by human beings. This, in turn, has led to climatic and environmental disasters and, above all, to the breaking down of frontiers between living species, making possible passages that had hitherto remained rare or non-existent. The Covid-19 pandemic is a dramatic confirmation of the disruptive effects of anthropogenic action on the life of the planet. Hence the awareness of the irrationalities and convulsions of the economic and financial system, the technocratic leaps forward, the dismantling of the ‘res publica’… All this has made human beings unprepared to react quickly and well and incapable of doing so together.

The enriched and powerful social groups in the technologically and economically ‘advanced’ countries still believe that ‘they will make it’, that ‘the system will go back to working as before’. Therefore, they are imposing on the world solutions based on global economic and technological competitiveness for survival, which they elegantly call "resilience". In doing so, the more the strongest impose their solutions, the more inequalities grow and the inability to adopt solutions in the interest of all the inhabitants of the Earth increases.

This is what is happening in the field of health and particularly in the context of the fight against the pandemic. Hence the urgent need for a concrete global health policy in the interests of all the Earth’s inhabitants, now. In the absence of this, the UN, anecdotally, risks not reaching the centenary of its existence in 2045. The UN’s 2015 and 2030 agendas have shown that the current UN model is inadequate. Changing it does not mean eliminating the UN and leaving the power of "governance" to the world’s strongest groups, old and new, and to oligarchic clubs such as the G20, the World Economic Forum (WEF), the GAFAM (Google, Apple, Facebook, Amazon, and Microsoft), and Big Pharma… Changing it requires the construction of a new political architecture – a new "UN" – more consistent with the globalisation of the human condition and the life of the planet.

2. The shackles to be undone and the commitments to be made, in order to move from the inability to act together to the will to rebuild an Earth that is habitable by and for all. 

2.1 Deadbolts 

The shackles are obstacles of various kinds, mostly constructed by the dominant social groups over the last few decades, especially since the 1970s. The following six aspects can be considered among the most important.

1. The imposed feelings of fear and insecurity
2. The ideology of inequality in rights
3. The political principle of the absolute sovereignty of states over the planet’s natural resources and ‘national security’
4. The reduction of every form of life to a commodity
5. The privatisation and financialisation of all the common public goods (and services), essential and irreplaceable for life
6. military spending

1. The imposed feelings of fear and insecurity among the "middle" and "lower" social classes of the richer and stronger countries – see the United States, the European Union… – which foment xenophobia, classism and racism.
Major changes with regard to migrants and, on a more general level, to fraternity (instead of competitiveness) between all human beings would be factors in the unhinging of this first cultural and behavioural blockade.

2. The ideology of inequality in rights, whereby the ‘upper’, dominant classes in all countries feed the culture of the inevitability of impoverishment and inequality in rights between individuals and peoples, and hence the culture of the permanence of the dualism of the rich/impoverished, dominant/dominated.
This is a return to a retrograde and classist conception, which predates the rule of law and the welfare state. This explains why, today, financial and technological aid from the rich to the impoverished is once again seen as the most effective solution for ‘fair’ (not just !) but fee-paying access to medicines against the pandemic.
Moving from a ‘charitable’ aid plan (cf. the COVAX mechanism for global access to Covid-19 vaccines) to a common world plan of real cooperation would be a major blow to the tightness of this blockade. 

3. The political principle of the absolute sovereignty of states over the planet’s natural resources and ‘national security’. This sovereignty is now rather fictitious, nominal (with a few significant exceptions) following the almost general privatisation on a worldwide scale of all the common and public goods and services essential to life, in particular health, water, seeds… But it remains a powerful instrument of domination, division and conflicts/war between peoples because it maintains the political, legal and institutional legitimacy of the power of the "nation" and of "national security". In the name of the latter it is possible to carry out abuses against « foreigners », the predation of nature, crimes against humanity. One thinks of the "vaccines nationalisms"!
The application of a spirit of mutualistic cooperation and solidarity between states in the field of health would be sufficient to start a process of breaking the chain.

4. The reduction of every form of life to a commodity, to a commercial commodity, to an industrial product, and even to a "private financial asset" (the case of water after its very recent listing on the stock exchange on 7 December 2020). The most significant commodification is that of knowledge codified in the regime of private intellectual property (explosion of private for-profit patents on living species and artificial intelligence). Patents are at the root of a serious distortion of knowledge, favouring the subordination of the development and use of technologies to the ‘laws’ of the market and to short-term financial returns, and thus the growth of inequalities and "divides".
Life and the right to life for all must count more than the market and the enrichment of the rich. 

5. The privatisation and financialisation of all the common public goods (and services), natural and artificial, tangible and intangible, essential and irreplaceable for life, such as water, air, forests, seeds, health, housing, solar energy, knowledge, constitute the strongest economic blockade consolidated on a global scale in the last 50 years. Even money has been privatised. The future of humanity has been enslaved. The life of the Earth has again been colonised in its essence. Patents on living beings and artificial intelligence are the most sophisticated mechanism.
Undoing this bolt requires a great deal of courage on the part of citizens because the rulers have stolen the spirit of living together. The first urgent moves to be made are to dismantle the large financial concentrations and the great multi-billion-dollar personal wealth and to restore the power of decision and control of private finance by the public authorities. 

6. Military spending is the most significant "existential" obstacle because it expresses a vision and practice of human life that is profoundly opposed to living together and respecting the rights to life of others. Military spending is ‘culturally’ and socially linked to the concept of ‘Me first’, ‘America First’,… In an armed world there is no freedom, no justice, no fraternity.
Fortunately, the entry into force on 22 January of the Treaty on the Prohibition of Nuclear Weapons shows that even this bolt can be broken. 

2.2 Commitments

In the light of the above, it is possible to identify the paths that the world’s community and representative leaders under pressure from citizens and their direct and indirect participation in the decision-making and control processes, must take to develop a new ‘world social contract’ and, within this perspective, a world health policy. 

To this end, four fundamental changes must inspire the choice of the commitments:

1. Eradicate the structural factors of impoverishment
2. Stop the environmental disaster by encouraging the restoration of the planet’s life systems 
3. Outlaw finance, the predator of life, today.
4. Make peace, banning war.

At the top of the priority actions must be the realisation of universal human rights and the right to life of all living species on the planet. This is a fundamental ethical, social and political imperative for humanity. It implies a collective, public, direct and non-transferable responsibility, which must once again become the primary function of democratically elected public institutions. 

Nine commitments for a global public health policy emerge in this context.

1. The universal rights to life of all the Earth’s inhabitants (future generations and all living species included) must guide the future of life.
2. Take research and development (R&D), certification, production, distribution and use of diagnostics, treatments and vaccines out of the market, out of competition and out of the short-term imperatives of financial gain.
3. The processes of re-publicisation of R&D (fundamental and applied) worldwide is essential for health and safety of life.
4. Launch of the design and implementation of a "Global Science Pact for the life and security of all the Earth’s inhabitants".
5. Public authorities must commit to pooling scientific and technological knowledge in the medical field (health protocols, drugs, vaccines, etc.) by creating the first "World House of Health Knowledge".
6. Vaccines must be developed, produced and distributed to all peoples of the world as global public goods in accordance with the fundamental principle of the universal right to life, health, in equality, justice and dignity.
7. Restore and enhance the fundamental link between universal rights and world common public goods (and services) and, among other means, take major steps towards the recognition of humanity as a new key institutional actor in the yet-to-be-built new political architecture of the world regulatory system.
8. The monetary system and the government of global finance must be put at the service of the global community of life on Earth, in particular of the global common public goods and services.
9. Establish a Citizens’ Security Council on Global Common and Public Goods.

Commitment 1. The universal right to life of all the Earth’s inhabitants (future generations and all living species included) must guide the future of life. No longer put the ‘logic’ of the market and private property patents in the driving seat of health policy. The ‘politics’ of the ‘res publica’ must be in the hands of people, humanity, communities and democratic and responsible public authorities. Re-inventing the role of the state in a perspective of the promotion and development of the "global res publica".
An important step in this direction would be for instance: establish that, in health matters, the objectives and rules set at the level of the WHO, a UN body, take precedence over the provisions adopted by the WTO, a body independent of the UN.

Commitment 2. Take research and development (R&D), certification, production, distribution and use of diagnostics, treatments and vaccines out of the market, out of competition and out of the short-term imperatives of financial gain.
Establish the principle that the funding of fundamental research in the field of living species and AI must be public (public universities, public laboratories, etc.), free from any obligation to patent. The same principle applies to public funding of applied research programmes (aimed at promoting and disseminating innovation). The public-private partnership (PPP) model has been shown to be nothing more than a way of privatising public powers.

Commitment 3. The processes of re-publicisation of R&D (fundamental and applied) worldwide is essential for health and the safety of life. We need to start with some "cooperative global common programmes" centred on the links between water, food and health. Universal health coverage depends on this commitment.

Commitment 4: Launch the design and implementation of a "Global Science Pact for the life and security of all the Earth’s inhabitants". Participation in this work should be free and spontaneous, with the participation of States and interested non-profit organisations (e.g. foundations, universities, associations, etc.).

Commitment 5. Independently of the aforementioned pact, public authorities must commit to pooling scientific and technological knowledge in the medical field (health protocols, drugs, vaccines, etc.) by creating the first "World House of Health Knowledge" to facilitate transparency and common accessibility and usability throughout the world.

Commitment 6. Vaccines must be developed, produced and distributed to all peoples of the world as global public goods in accordance with the fundamental principle of the universal right to life, health, in equality, justice and dignity. With regard to recent vaccines against the Covid-19 pandemic, there is an urgent need to a) immediately suspend the application of WTO rules on patents until 2023, b) approve their abolition from 2024 as part of a reform of the current intellectual property regime, which is clearly no longer adapted to the globalisation of the human condition and the collective responsibility of humanity in the Anthropocene era, c) review the agreements agreed in the contracts signed in recent months between the public authorities and the companies holding the patents, annulling the principle of secrecy and confidentiality on crucial aspects of transparency in terms of liability and financial burdens. It is a scandal that the public authorities agree not to allow the elected representatives of the citizens to have access to knowledge of the contents of contracts.

Commitment 7. Restore and enhance the fundamental link between universal rights and world common public goods (and services) and, among other means, take major steps towards the recognition of humanity as a new key institutional actor in the yet-to-be-built new political architecture of the world regulatory system.
Without newly established democratic world institutions, representatives authorities and shared and diffused jurisprudential and control power system, there will be no effective, just, mutualistic and accountable health policy for all at a world level. 

Commitment 8. The monetary system and the government of global finance must be put at the service of the global community of life on Earth, in particular of the global common public goods and services, starting from the local communities/collectivities. The Earth is a diverse world of living territories. The global is variety, the local is multiplicity. The identity of the Earth’s inhabitants is common and multi-territorial.
An effective way to start the implementation of this commitment is to set up a world plan for "Finance for Global Public Goods" on top of the COP26 political agenda.

Commitment 9. Establish a Citizens’ Security Council on Global Common and Public Goods (CiSeCo-PG) focusing, to begin with, on water, seeds, health and knowledge.

3. What and how to identify actions to be carried out in the coming months and beyond? A proposal : Action 2021 "The Citizens’ Memorandum. Towards a common global public health policy".

The objective of Action 2021 "The Citizens’ Memorandum. Towards a common global public health policy" is to contribute to raising public awareness and mobilising citizens in favour of a global health policy during 2021.

This year will be dominated by the fight against the Covid-19 pandemic and marked by major international events such as COP26 (co-chaired by the UK and Italy), the G20 and, at European level, the ECI ‘Right2Cure’ and the ‘New European Deal’. 

At the end of 2021, legislative proposals and economic and social measures will be published and disseminated with the aim of breaking the deadlock in our societies’ ability to make adequate and urgent concrete commitments to achieve the goal of the universal right to health and to treat health as a global common public good. 

The 2021 action will take place around two key moments:

• The Day of Citizen’s Spirit of Revolt: 18 (or 19) May, on the eve of the G20 Global Health Summit. A "convention" day, partly present and mostly remote, when the co-sponsors of Action 2021 will make public The Citizens’ Memorandum.
• The Day of Commitment: 29 October (before the G2O Summit and COP26 in November), a worldwide media event during which (a) a series of artistic acts (musical, scenic, pictorial, graphic, sculptural, etc.) created by some 40 artists from all over the world will be broadcast, and (b) the final proposals regarding "Health and safety of life, a universal right and a global public good. For a world policy". The Citizens’ Memorandum will be made public.

The essential work will be carried out in social and citizen networks through information notes, advocacy documents, articles, videos, webinars, and will be led by the associations that have formed the coordination committee. The month of February will allow the completion of the work on convergence and cooperation between the associations concerned. 

Peoples are in revolt in Latin America. The black and Latino populations of the United States have won a major victory with the election of Biden and, among others measures taken by the new Biden Administration, the halting of the construction of the wall with Mexico. 

The populations tormented by wars and religious conflicts, such as in the Middle East and Asia Minor; the populations damned by misery in Africa, India or Brazil or in the "peripheries" of Europe and Asia, are trying to free themselves from the domination of the dominant, their finance, their technology, their powers, their markets, their companies… They do not want violence; They refuse the violence imposed on them.

The fight against the pandemic is a great opportunity to create opportunities and choices. Health is not one "field" among others. The universal right to life is not an option reserved for the strong social groups of peoples who have become rich at the expense of the Earth’s resources, nor is it a crumb for the peoples of colonised and impoverished countries. 

Brussels, 22 January 2021. 

Riccardo Petrella. Agora of the Inhabitants of the Earth

We recommend:

Małgorzata Kulbaczewska-Figat, "The covid vaccine was created thanks to public money – let it be a public property!" Interview with MEP Marc Botenga

#Right2Cure: No profit on pandemics

Roberto Musacchio, The Virus Hits an Ill-Prepared Europe