The Access to COVID-19 Tools Accelerator (ACT-A) is a multistakeholder initiative quickly constructed in the early months of the COVID-19 pandemic to respond to the breakdown in global cooperation.

ACT-A is now the largest international effort to achieve equitable access to COVID-19 health technologies, and its governance is a matter of broad public importance. 

In this paper, the authors trace the evolution of ACT-A's governance, identify the governance challenges that arise from the structure of the group and make some recommendations for strengthening its governance.

All authors are members of the WHO-led ACT-A Ethics and Governance Working Group set up to advise WHO on ethics and governance issues related to its role as a partner in the ACT-A. Jonathan Wolff, Alfred Landecker Professor of Values and Public Policy, is co-chair of the working group.