Over a short period of time, access to medicines has ceased to be understood solely as a public health issue. Increasingly, medicines are being discussed in terms of security, strategic autonomy, and preparedness for future threats. The COVID-19 pandemic and recent geopolitical crises have accelerated this shift, bringing to the forefront ideas such as industrial resilience and so-called medical countermeasures—that is, medicines and vaccines designed to respond to emergencies. This change in framing is not neutral: it raises fundamental questions about the place of rights, equity, and transparency in health policy.
To reflect on these issues, Salud por Derecho hosted a few days ago the online event From Shields to Pills: Access to Medicines in an Age of Securitization, the first session this year in our Transparency Series. At the heart of the discussion was a question that is becoming increasingly present in public policy: what happens when medicines begin to be managed as strategic assets rather than, first and foremost, as essential public health goods?
For decades, access-to-medicines policies have been grounded in principles such as affordability, solidarity, and states’ obligation to guarantee the right to health. The new approach, by contrast, places the emphasis on crisis response capacity, stockpiling, logistics, and supply continuity in exceptional governance arrangements. This is not only a shift in language; it also changes who decides and how those decisions are made. A security lens tends to concentrate power, justify accelerated decision-making, and shrink the space for public debate.
This approach is often accompanied by what was described in the discussion as a “capability logic”: the idea that security and defence actors are better equipped to manage crisis situations, given their experience with logistics, command-and-control structures, and decision-making under pressure. This narrative, however, tends to portray civilian health systems as insufficient and helps legitimise the expansion of security actors into domains traditionally governed by public health criteria.
In the European context, these dynamics are particularly visible. As Laëtitia Sédou, from the European Network Against Arms Trade, explained, many European Union defence policies have shifted in just a few years from pilot programmes to a consolidated, stable model. What was initially presented as a temporary exception has become normalised, with a progressive weakening of parliamentary oversight and of ethical assessments, increasingly delegated to the very companies benefiting from the funds.
Sédou also stressed that this process—accelerated after Russia’s invasion of Ukraine—is not confined to the military sphere. As it extends into civilian sectors, it introduces ways of deciding with less public debate and reduced access to information. In the webinar, participants shared the concern that if these schemes are transferred into medicines policy, they may shape decisions that directly affect people’s daily lives without sufficient transparency or democratic oversight.
One of the most troubling effects of this shift is opacity. In the name of national interest, access is restricted to key information on contracts, prices, or allocation criteria. This is often achieved through so-called ‘security carve-outs’—legal exemptions that justify withholding information for security reasons. Practices that are justified in the military domain on the basis of urgency or confidentiality become especially problematic when applied to health. Without sufficient public information, the tools to demand accountability are weakened—and it becomes harder to assess whether public money is truly being used in the public interest.
Looking at other contexts reinforces this concern. As Heba Wanis, a researcher at the Third World Network, explained, Egypt illustrates how centralising the purchasing and production of medicines under state security-linked structures has been presented as a pathway to greater control and efficiency. In practice, however, this model has been accompanied by major lack of transparency, supply problems, and rising prices. When health governance is insulated from societal scrutiny, failures become harder to detect and correct.
Despite the differences between Europe and Egypt, a common pattern emerges. The boundaries between civil and military spheres become blurred, and security-linked actors gain weight in areas traditionally managed from a public health perspective. This not only shifts priorities; it also changes who has a voice in decision-making. Civil society and rights-based perspectives find less and less space when security becomes the dominant argument.
This debate is especially relevant at a time when new initiatives on critical medicines and pandemic preparedness are being discussed, both at European and global levels, including within the framework of the World Health Organization. The question is not whether we need to be better prepared, but how. This question is particularly pressing in a global context marked by deep inequalities. When medicines are conceived as strategic assets tied to national security, commitments to international solidarity and equitable access between countries are weakened.
There is a risk that instruments designed for pandemic preparedness prioritise self-sufficiency and stockpiling, pushing global obligations related to the right to health into the background. If preparedness is built through a logic of permanent exception and follows defence-industrial logics, there is a danger of consolidating opaque models that prioritise industrial or strategic interests over population health needs.
At Salud por Derecho, we argue that resilience does not have to be at odds with democracy or equity. Preparing for future crises is essential, but it should not mean giving up transparency, public oversight, and a rights-based approach. Medicines cannot become mere pieces on a geopolitical chessboard. They remain, above all, tools for safeguarding life.
You can read the report we have produced on the session here. You can also download it at this link.
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