States, global power and access to medicines: a comparative case study of China, India and the United States, 2000-2019.

IF 5.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Globalization and Health Pub Date : 2025-02-01 DOI:10.1186/s12992-024-01092-2

Berit S H Hembre, Maulik Chokshi, Steven J Hoffman, Fatima Suleman, Steinar Andresen, Kristin Sandberg, John-Arne Røttingen

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引用次数: 0

Abstract

Background: 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.

Results: 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.

Conclusion: 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.

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国家、全球力量和药品可及性：2000-2019年中国、印度和美国的比较案例研究。

背景：什么构成了国家影响药品可及性的全球力量？它在各州之间是如何分布的，从2000年到2019年是如何变化的？在这个比较案例研究中，我们探讨了中国、印度和美国的力量，并讨论了我们在大流行前时代的发现是否反映在与药品相关的全球COVID-19应对措施中。我们使用了关于结构性权力的国际关系文献中的分析框架，并在将其适应药物获取的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。结果：我们发现，从2000年到2019年，在药品的融资和生产方面，权力向中国和印度转移，特别是中国在知识、财务保护和报销方面的权力增加了。美国在金融和知识方面仍然很强大。有关贸易和官方发展援助的数据表明，在这些结构中，中国也日益强大。在2019冠状病毒病大流行期间，我们发现美国的尖端创新延续了过去几十年的模式。美国和印度的贸易限制以及美国有限的有效援助与我们的研究结果形成了对比。基于我们对结构性权力的研究结果，我们认为，在2019冠状病毒病大流行期间，结构性权力和政治决策共同影响了医疗技术的获取。我们还审查了这三个国家在全球卫生治理发展方面的作用和立场，包括covid - 19机制、《与贸易有关的知识产权协定》豁免和在这方面的大流行协议。结论：从2000年到2019年，中国和印度在塑造全球医疗技术获取方面的结构性力量有所增强。最近的COVID-19大流行表明，结构性权力和政治决策共同影响了全球对COVID-19技术的获取。

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来源期刊

Globalization and Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

18.40

自引率

1.90%

发文量

期刊介绍： "Globalization and Health" is a pioneering transdisciplinary journal dedicated to situating public health and well-being within the dynamic forces of global development. The journal is committed to publishing high-quality, original research that explores the impact of globalization processes on global public health. This includes examining how globalization influences health systems and the social, economic, commercial, and political determinants of health. The journal welcomes contributions from various disciplines, including policy, health systems, political economy, international relations, and community perspectives. While single-country studies are accepted, they must emphasize global/globalization mechanisms and their relevance to global-level policy discourse and decision-making.