COVID-19: international power structures and global health policy. focus on who and international solidarity

For decades, virtually all parties with political or medical responsibility for pandemic issues have stressed the need for more intensive inter-national cooperation. COVID-19 is only the latest epidemic for the time being to demonstrate the massive discrepancy between rhetoric and reality in this regard. A global health policy worthy of the name still does not exist. The WHO and its sub-organizations have neither the competencies nor the financial resources to live up to their claim proclaimed by the community of states. Against the backdrop of the crisis created by the spread of SARS-CoV-2, this article asks what the pre-conditions and determinants of this failure are. First, it illuminates the ideological and political patterns that shape the strategic thinking and actions of those major powers that command global health policy and other aspects of global governance. The following section discusses the resulting (malfunctioning) structures for addressing epidemics and diseases, which are also barriers to the development of comprehensive health systems. Thirdly, the implications for the possibilities of addressing the COVID pandemic and also helping those countries and regions of the Global South that have neither the financial resources nor the tools of the rich North are discussed. In this context, we will take a look at the role of the EU and Germany and their programs and practice of global health policy. Germany, after all, held the presidency of the Union in the second half of 2020 — amid the pandemic. The last part deals with the role and influence of an increasing «neoliberalization» of the health care system, especially since the 1990s, and the impacts for research and development, as well as with a pharmaceutical industry that primarily follows market laws and only secondarily health maxims. Under this aspect, the «vaccination race» between and within the EU and other actors is considered. Simultaneously, the question is raised whether and to what extent there are chances to steer the unsatisfactory state of affairs in a direction that enables better disease control on a regional and global scale through international cooperation and strengthened institution building.