How to reshape trade for vaccine equity: gaps in policy discourse
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University of Edinburgh, United Kingdom
Centre for Population Health Sciences, United Kingdom
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A373
Background and Objective: While trade-related impacts on health are often difficult to assess, the COVID-19 pandemic revealed vaccine inequity as a unifying health need, an example of trade as a commercial determinant of health (CDH). We analysed stakeholder views and priorities regarding trade and vaccine equity, exploring where policy and action may shift to reshape trade relationships for wider transition to wellbeing economics, and to build a transferable analytical framework for policy analysis of trade as a CDH. Methods: We undertook a systematic literature search (01/03/22-01/06/22) exploring major stakeholder libraries, Policy Commons, and linked reference searches from 2010. Stakeholder views on contributors to vaccine inequity were mapped onto an adapted rights, responsibilities, redistribution framework as causal process observations to create a network of policy recommendations. Results: The available policy advice was fragmented and revealed significant gaps. While existing tools and legal flexibilities were acknowledged, the deep-set politico-economic barriers that limit successful use were not. Technocratic solutions lacked incentives or requirements for cooperation. The determinants of vaccine equity and application of collaborative mechanisms, other than trade agreements, were rarely considered. The shrinkage of policy space inhabited by governments, public health, and NGOs by current approaches to free trade agreements was not addressed. Few spaces for real change were explored, even when distributional inequity was clear. Conclusions: Our analytical framework illustrates gaps in the consideration of policy options and implementation mechanisms that would help address current levels of vaccine inequity. The narrow policy discourse and resistance to implement existing mechanisms designed to mitigate inequity has delayed essential action and limited co-creation of solutions. In addition to a TRIPS+ waiver, trade-related factors that increase health inequity must be tackled explicitly. Alternative collaborative mechanisms with the potential for real change must be prioritised above trade agreements that serve corporate over community interests.
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