Reshaping trade for vaccine equity: gaps in policy discourse

Abstract

AbstractThe recent 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 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 in 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. Using the rights, regulation and redistribution (3R) framework, recommendations were categorised as Technical Mechanisms, Collaborative and Adaptive Mechanisms, or Determinants of Vaccine Equity. 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 Determinants of Vaccine Equity and lack of policy coherence were not addressed. These findings are limited by under-representation of low– and middle-income country authorship, demonstrating deep institutional and methodological barriers to change, and reflecting imbalances in international policymaking processes.Overall, our research shows how the current trade paradigm has produced and sustained vaccine inequity, leading a synthesis of action proposals. Transformation of FTA policy is essential and urgent, particularly since 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 serving corporate over community interests, including through TRIPS waiver on Essential Technologies.