Hembre Berit S H, Chokshi Maulik, Hoffman Steven J, Suleman Fatima, Andresen Steinar, Sandberg Kristin, Røttingen John-Arne
Norwegian Institute of Public Health, Postboks 222 Skøyen, Skøyen, Oslo, 0213, Norway.
Institue of Health and Society, Faculty of Medicine, University of Oslo, PB 1130, Blindern, Oslo, 0318, Norway.
Global Health. 2025 Feb 1;21(1):3. doi: 10.1186/s12992-024-01092-2.
What constitutes state`s global power to shape access to medicines? How was it distributed between states and how did this change from 2000 to 2019? In this comparative case study, we explored the powers of China, India and the United States, and discuss whether our findings from the pre-pandemic era were reflected in the global COVID-19 response related to pharmaceuticals. We used an analytical framework from the international relations literature on structural power, and assessed the following power structures after adapting them to the context of access to medicines: finance, production, financial protection, knowledge, trade and official development assistance.
We found that from 2000 to 2019 there had been a power-shift towards China and India in terms of finance and production of pharmaceuticals, and that in particular China had increased its powers regarding knowledge and financial protection and reimbursement. The United States remained powerful in terms of finance and knowledge. The data on trade and official development assistance indicate an increasingly powerful China also within these structures. During the COVID-19 pandemic, we found that the patterns from previous decades were continued in terms of cutting-edge innovation coming out of the United States. Trade restrictions from the United States and India contrasted our findings as well as the limited effective aid from the United States. Building on our findings on structural powers, we argue that both structural power and political decisions shaped access to medical technologies during the COVID-19 pandemic. We also examined the roles and positions of the three states regarding developments in global health governance on the COVAX mechanism, the TRIPS Agreement waiver and the pandemic accord in this context.
From 2000-2019, China and India increased their structural powers to shape global access to medical technologies. The recent COVID-19 pandemic demonstrated that both structural power and political decisions shaped global access to COVID-19 technologies.
国家塑造药品获取途径的全球权力由哪些因素构成？这种权力在各国之间是如何分配的，以及从2000年到2019年发生了怎样的变化？在本比较案例研究中，我们探讨了中国、印度和美国的权力，并讨论我们在疫情前时代的研究结果是否反映在全球与药品相关的新冠疫情应对中。我们使用了国际关系文献中关于结构权力的分析框架，并在将其应用于药品获取背景后，评估了以下权力结构：金融、生产、金融保护、知识、贸易和官方发展援助。
我们发现，从2000年到2019年，在药品的金融和生产方面，权力已向中国和印度转移，特别是中国在知识、金融保护和报销方面增强了其权力。美国在金融和知识方面仍然强大。贸易和官方发展援助数据表明，中国在这些结构中也日益强大。在新冠疫情期间，我们发现，美国在前沿创新方面延续了前几十年的模式。美国和印度的贸易限制与我们的研究结果形成对比，美国的有效援助也有限。基于我们对结构权力的研究结果，我们认为结构权力和政治决策在新冠疫情期间塑造了医疗技术的获取途径。我们还在此背景下研究了三国在全球卫生治理中关于新冠疫苗实施计划机制、《与贸易有关的知识产权协定》豁免和大流行协议发展方面的作用和立场。
从2000年到2019年，中国和印度增强了其塑造全球医疗技术获取途径的结构权力。最近的新冠疫情表明，结构权力和政治决策都塑造了全球对新冠技术的获取途径。
