During the Covid-19 pandemic the idea of “solidarity” was frequently invoked by the Word Health Organisation (WHO). In March 2020 it launched the Solidarity Trials, a randomized control trial aimed at evaluating the efficacy of specific therapeutics in reducing mortality in hospitalised Covid-19 patients. The trials involved 14,200 patients, 52 countries, 600 hospitals and 2000 researchers. WHO also established the Covid-19 Solidarity Response Fund for WHO to finance its pandemic response efforts.
In May 2020 the establishment of the Covid-19 technology access pool was animated by a “Solidarity Call to Action”. C-TAP proposed using voluntary pooling of intellectual property, knowledge and data to make the Covid-19 response effort “a public common good”. By October 2023, five months after the declared an end to the Covid-19 public health emergency of international concern (PHEIC), only two institutions (both public) had entered into licensing agreements with C-TAP.
Solidarity was also referenced in a December 2021 decision taken by a special session of the World Health Assembly. In that decision, WHO Member States established an intergovernmental negotiating body with a view to creating a new legal instrument that would “frame practical actions to deal with both causes and consequences of pandemics and other health emergencies”. The text specified that the negotiations for this instrument should be informed by “the principle of solidarity with all people and countries”.
Despite its promiscuous rhetorical use, solidarity was clearly never enacted by WHO Member States with the wealth, political influence, knowledge, regulatory power and production capabilities to secure the equitable distribution of Covid-19 health products. Vaccine apartheid and unequal access to diagnostics and therapeutics defined the pandemic. This led Dr. Jean Kaseya, head of the Africa CDC, to liken the development of vaccine manufacturing capabilities on the continent to “the second independence of Africa” because even though “[m]any African countries got their independence [from colonisers] in the 1960s, … we saw in COVID that we are not independent.”
What would meaningful enactments of solidarity look like in the field of health? Samora Machel - who worked as a nurse in Maputo, and later became the first president of an independent Mozambique – argued that “solidarity is not an act of charity, but mutual aid between forces fighting for the same objective”. In 1971, reflecting on the Frelimo’s health services contribution to the ongoing armed liberation struggle in Mozambique, he states
"Our hospitals exist because sacrifices have been made… The surgical instruments, drugs and equipment are a result of the sacrifices made by the people, the sacrifices made by our friends. Because blood is flowing in Mozambique, a powerful tide of solidarity has built up in many countries to help us. People voluntarily deprive themselves to help us… A further example and encouragement to us should be the internationalist spirit of the foreign comrades who, out of revolutionary solidarity, have left their own countries and the comfort created through their labor to come and work with us."
In the contemporary moment, where international cooperation has been saturated with language about “win-win” propositions, it is striking to encounter a definition of solidarity as – in some senses – a “losing” proposition for those with power. Machel acknowledges that solidarity involves the loss of comfort and certainty. Solidarity on his view entails “sacrifice”, i.e. leaving behind the “comforts of home” to pursue a political project alongside strangers. Machel argues that this is spurred by the recognition of a common humanity, respect for the agency of the “weaker” party (rather than supplanting it through charitable acts), and the intention to bring about a more just and equitable world through concerted action.
Why does this matter for global health? When negotiations on a new Pandemic Accord started, it offered the hope that countries would commit to a version of solidarity close to Machel’s. Many in the global south hoped that the Accord would challenge the “solidarity for sale” model during the pandemic. Under this model market-based mechanisms such as pooled procurement, differential pricing, and avoiding the use of compulsory licenses allow pharmaceutical corporations to remain profitable and to retain control over their intellectual property (and thus market dominance). Any concessions they make are discretionary and on their own terms – a show of charity that might limit their profitability in the short term, but that ultimately preserves their market share and legal autonomy vis-à-vis regulatory authorities. Covax is one example of such a model, where (ostensibly) solidaristic intentions were tempered by market rationalities.
An optimistic perspective would point to the fact that the Pandemic Accord is still being negotiated, and therefore hope remains that a truly solidaristic agreement could emerge. Such an agreement would require that global north countries commit to the discomfort of entering into legally binding agreements to proactively support technology transfer, unhindered use of TRIPS flexibilities to promote the right to health, research and development ecosystems that prioritise public health needs and institutionalise access and benefit sharing provisions, and concessionary financing for developing geographically diversified and sustainable pharmaceutical manufacturing infrastructure in the global south. In the short term this would surely not feel like a “win-win” proposition for the global north.
International cooperation of this sort might be considered utopian, but it is not. It is captured in the legal notion of common but differentiated responsibilities – a principle that recognise the obligations and capabilities of all parties, strong and weak, to contribute what they can to address systemic problems. Unfortunately, it seems that this established principle of solidarity in international relations is being ignored – and perhaps is at risk of being undone – in the context of Pandemic Accord negotiations that seem more informed by trade considerations than a commitment to more just and equitable PPR efforts.
You can learn more about Lauren's work on solidarity in global health at the upcoming Collective Conversation on 16 September 2025.
About the author
Lauren Paremoer is a staff member of the Political Studies Department at the University of Cape Town and a member of People’s Health Movement (PHM) South Africa. She also serves as PHM's Global Steering Council representative for the Democratising Global Health Governance programme. Her research focuses on health activism, global governance for health, and political mobilisation aimed at realising social citizenship in societies of the Global South. She has explored these themes in relation to the struggle for the right to HIV/AIDS treatment in South Africa, the social reproduction work undertaken by community health workers and women more generally, and the use of for-profit markets and philanthrocapitalism to ameliorate the worst effects of deteriorating public health systems.
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