During the COVID-19 pandemic the rate of technology acceleration was remarkable, and many communities across the globe were able to benefit from this. However, this rapid development was often exclusive to resource-rich areas. A 2023 paper in Health and Place explores the global inequities in access to COVID-19 health interventions through a political economy analysis. Through four “interconnected layers” the paper suggests that there is a “profoundly unequal playing field”. The conclusion calls for “shifting longstanding power imbalances and the institutions and processes that entrench and enable them”.  

In January 2021 WHO Director-General Dr Tedros Adhanom Ghebreyesus stated that the world was on the “brink of a catastrophic moral failure”, the price of which would be “paid with lives and livelihoods in the world’s poorest countries” 

“Vaccine equity is not just a moral imperative; it is a strategic and economic imperative.” 

The authors admit that, although more than 39 million doses of COVID-19 vaccines had been administered at that stage, the inequities that the Director-General was warning of “persisted”. These inequities spread across diagnostic tests and therapeutics as well as vaccines, reflecting “failures in the global response”. 

Concentration of development 

Apart from the hurdles of global vaccine distribution, development and manufacturing of these products was “concentrated in Western countries” according to the paper. Despite efforts to “encourage voluntary sharing”, distribution of intellectual property and technology transfer were limited. We know from speaking to experts like Professor Petro Terblanche and Dr Matthew Downham that these concerns over “geo-diversification” are gradually being addressed, but will we be better prepared before the next health threat? 

The political sphere 

The paper applies a political economy of health approach to analysis of the development of inequities. This approach requires an examination of political, economic, and social factors and how they operate and interact at multiple levels. The researchers used four categories of factors: 

  • The social, political, economic, and historical context (international) 
  • Politics, institutions, and policies (international and national) 
  • Pathways to (ill) health (national and local) 
  • Human health consequences (local and individual) 

The paper suggests that this framework can be used as a blueprint for understanding health inequities as a “form of structural violence”. Structural violence is here used to refer to “systematic forms of oppression”, with violence implying forms of harm that lead to “reduced life chances”.  

“Given the colonial and racialised lines along which this structural violence plays out, this in turn reveals a form of necropolitics, in which elites of the Global North tend to hold the power to determine who lives and who dies.”

Image shows four columns for the research framework in the paper.

To access the analysis in full, we recommend you visit the article here.  

Conclusions and changes 

The researchers state that their analysis illustrates how inequities and failures to rectify them are “deeply embedded within and born of a historical legacy of capitalism, neoliberal globalisation, and structural violence”. The perspective that they bring adapts a structured approach to “examine the factors at different levels that shape health outcomes”.  

“To enable equitable access to health products and technologies in future public health emergencies, it will be necessary to disrupt the current neoliberal paradigm and power asymmetries, through reforming the ways in which pharmaceutical R&D are funded, preventing exclusive monopolies on health products and technologies, righting the power imbalances between public and private actors and between rich and poor countries – and the ways these are reflected and reproduced in global governance structures.”  

The authors suggest that the “most promising” effort to create “conditions” for more equitable access is represented by the negotiations for a WHO Pandemic Accord. However, there is tension between the “promising proposals” of this effort and attempts to “derail or dilute” them.  

“For the Pandemic Accord to drive equitable access to pandemic response products in future, it will be critical for LMICs and civil society to be empowered to participate meaningfully, with a corresponding reduction in the power wielded by rich countries, donors, and industry stakeholders.” 

Do read the article in full here and let us know if you think this is a useful contribution to the discussion about equitable access. To stay informed with weekly updates, subscribe to our newsletter here.