Responsibility – In Public Health 133Hence, even if many goals were achieved, river blindness as a health
problem has not yet been resolved. New strategies and new research are
pending. But we should also note that all this progress would not have
been possible had we only targeted one particular agent (be it the na-
tional state, the pharmaceutical companies, the wealthy countries, or the
actions of international agencies).
8.4 Conclusion
Global health presents itself as an immutable debt and as a moving
target with a cluster of different challenges. Following ethics and politi-
cal philosophy proposals, the states and the international human rights
architecture are ideal agents of justice. However, because global health
presents a combination of very little compliance by ‘ideal’ responsible
agents and manifold obstacles exist, I argued for a joint effort appealing
to the responsibility of multiple agents and actors aiming for a transi-
tional strategy. Within this strategy, secondary agents of justice—in
O’Neill’s proposal—can be identified as responsible agents. This im-
plies holding various institutions, pharmaceutical companies, and even
transnational corporations responsible. Finally, I presented a real case
where many different agents (intergovernmental agencies, states, inter-
national corporations, among others) interacted to fight onchocerciasis
in Africa. Instead of defending a simple monistic answer, I consider a
pluralistic and diversified view to be far richer and more constructive.