Deepening Accountability: The Fair Pharma Scorecard and Access to Medicines in a Fragmented Global Health Law Landscape.

The international legal landscape governing global health is characterized by regime complexity and legal fragmentation, with overlapping and sometimes conflicting legal norms. This fragmentation can blur lines of accountability, particularly in the context of access to medicines, where responsibility is dispersed across multiple stakeholders. Traditional frameworks of accountability in human rights law emphasize a vertical relationship between states as duty bearers and individuals as rights holders- failing to capture the multifaceted reality of global pharmaceutical governance, where access to medicines is shaped not only by the relevant state but also by a range of nonstate actors. Among these, pharmaceutical corporations play a pivotal role in shaping a state's capabilities to ensure access to medicines for its population. In this context, we argue that the development and deployment of a pharmaceutical accountability scorecard offers an innovative tool to address some of the existing accountability gaps. This paper presents the Fair Pharma Scorecard - Cancer Edition, developed by the Dutch nonprofit Pharmaceutical Accountability Foundation, as an innovative tool to address some of the existing gaps. Grounded in a normative framework that draws on various international legal and health- related instruments, this scorecard evaluates the extent to which multinational pharmaceutical companies fulfill or neglect their responsibilities to ensure equitable access to medicines.