Pepperrell Toby, Koivusalo Meri, Grant Liz, McCallum Alison
Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom.
Faculty of Social Sciences, Tampere University, Tampere, Finland.
PLOS Glob Public Health. 2025 Jun 16;5(6):e0004012. doi: 10.1371/journal.pgph.0004012. eCollection 2025.
The ongoing Pandemic Agreement negotiations illustrate significant gaps in action required to respond effectively to the lessons of the COVID-19 pandemic and make progress towards public health goals, including Sustainable Development Goals (SDGs). The pandemic revealed vaccine equity as a unifying health need, and international trade as a Commercial Determinant of Health. We explored where policy action could reshape trade relationships, identifying recommendations for vaccine equity within stakeholder literature pertaining to Free Trade Agreements (FTAs). We searched online libraries for stakeholder documents that focused on the interface between FTAs, vaccination, and vaccine equity published between 01/01/2010-31/03/2022. Our analytic framework drew from the rights, regulation, and redistribution (3R) framework, combined with systems analysis, using leverage pointsto categorise recommendations as Technical Mechanisms, Collaborative and Adaptive Mechanisms, or Determinants of Vaccine Equity (DVE). These were then located on a novel systems map to elucidate gaps and actions.No cohesive strategies for change were identified. Technical proposals were reactive, repetitive, and lacked enforcement mechanisms or incentives. There were significant gaps in the articulation of alternative Collaborative Mechanisms to democratise FTA policymaking processes. The underlying DVE and lack of policy coherence were not addressed. These findings are limited by under-representation of low- and middle-income country authorship in the studies, including in ours, reflecting imbalances in international research and policymaking processes. Overall, our research shows how the current trade paradigm has produced and sustained vaccine inequity. We propose potential pathways for action but highlight the importance and urgency of more fundamental change in negotiation and implementation of FTAs. New technologies will be crucial for the global response to emerging, neglected, and non-communicable diseases that are vaccine-preventable or -modifiable. Multilateral organisations must, therefore, prioritise the right to health above FTAs, including through TRIPS waivers on Essential Technologies.
正在进行的《大流行协议》谈判表明，在有效吸取新冠疫情教训并朝着包括可持续发展目标（SDGs）在内的公共卫生目标取得进展所需采取的行动方面，存在重大差距。疫情揭示了疫苗公平是一项统一的卫生需求，以及国际贸易是健康的商业决定因素。我们探讨了政策行动可以在哪些方面重塑贸易关系，并在与自由贸易协定（FTAs）相关的利益相关者文献中确定了实现疫苗公平的建议。我们在在线图书馆中搜索了2010年1月1日至2022年3月31日期间发表的、聚焦于自由贸易协定、疫苗接种和疫苗公平之间接口的利益相关者文件。我们的分析框架借鉴了权利、监管和再分配（3R）框架，并结合系统分析，利用杠杆点将建议归类为技术机制、协作和适应性机制或疫苗公平决定因素（DVE）。然后将这些建议置于一张新颖的系统图上，以阐明差距和行动。未发现具有凝聚力的变革战略。技术提案具有被动性、重复性，且缺乏执行机制或激励措施。在阐明使自由贸易协定决策过程民主化的替代性协作机制方面存在重大差距。潜在的疫苗公平决定因素以及政策连贯性不足的问题未得到解决。这些发现因研究中（包括我们的研究）低收入和中等收入国家作者代表性不足而受到限制，这反映了国际研究和决策过程中的不平衡。总体而言，我们的研究表明当前的贸易范式如何产生并维持了疫苗不公平现象。我们提出了潜在的行动途径，但强调在自由贸易协定的谈判和实施中进行更根本性变革的重要性和紧迫性。新技术对于全球应对可通过疫苗预防或改善的新发、被忽视和非传染性疾病至关重要。因此，多边组织必须将健康权置于自由贸易协定之上，包括通过对基本技术给予与贸易有关的知识产权（TRIPS）豁免。
