Research Article
Open Access
Global Health Diplomacy and Access Inequality in the Global South: A Comparative Study of HIV/AIDS and COVID-19
Abstract
Inequities in access to medicines, vaccines and health technologies continue to remains a major challenge in global health governance, majorly in the Global South. The present study underscores the importance of global health diplomacy as a contributor to inequity in access to health services on an international scale by drawing parallels between the HIV/AIDS epidemic and the COVID-19 pandemic. The methodology employed in this study is qualitative comparative case study design that is a methodology in which documentary evidence is used in the form of peer-reviewed articles, academic books, international organizations' policy documents and reports. Theories: Dependency Theory and Liberal institutionalism. These two theories will be used to examine the impact of structural inequalities and global partnerships on global health outcomes.
Findings show that global health diplomacy has facilitated global cooperation, resource mobilization and institutional response to big health crises.However, the disparities in drug production, patents and technologies, and geopolitical power are still important drivers of access. During the HIV/AIDS pandemic in many Global South countries, there was a restriction of access to antiretroviral (ARV) drugs due to patent barriers and high treatment costs. COVID-19 pandemic also highlighted inequalities in vaccine nationalism, inequitable vaccine procurement processes and limited technology transfer.
WHO, UNAIDS, the Global Fund and COVAX were active in improving relations, but had limited capacity to ensure equitable distribution. The study finds the need for improved technology transfer systems, increased pharmaceutical manufacturing capacities, increased IP action and increased accountability within the global health institutions to move the agenda forward on international health equity.
Keywords
Global Health Diplomacy, Global Health Governance, Inequality of Access, HIV/AIDS Epidemic, COVID-19 Pandemic, Inequality of Vaccine, Global South, Dependency Theory, Liberal Institutionalism.
References
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World Trade Organization. (2001). Declaration on the TRIPS Agreement and public health (WT/MIN(01)/DEC/2). WTO.
Yin, R. K. (2018). Case study research and applications: Design and methods (6th ed.). SAGE Publications.
Axelrod, R., & Keohane, R. O. (1985). Achieving cooperation under anarchy: Strategies and institutions. World Politics, 38(1), 226–254. https://doi.org/10.2307/2010357
Benatar, S. R. (2013). Global health and global health ethics. Global Public Health, 8(10), 1167–1180. https://doi.org/10.1080/17441692.2013.846058
Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 27–40. https://doi.org/10.3316/QRJ0902027
Bryman, A. (2016). Social research methods (5th ed.). Oxford University Press.
Cardoso, F. H., & Faletto, E. (1979). Dependency and development in Latin America. University of California Press.
Correa, C. M. (2007). Trade related aspects of intellectual property rights: A commentary on the TRIPS Agreement. Oxford University Press.
Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications.
Dados, N., & Connell, R. (2012). The Global South. Contexts, 11(1), 12–13. https://doi.org/10.1177/1536504212436479
Davies, S. E., Kamradt-Scott, A., & Rushton, S. (2015). Disease diplomacy: International norms and global health security. Johns Hopkins University Press.
Dos Santos, T. (1970). The structure of dependence. American Economic Review, 60(2), 231–236.
Elbe, S. (2010). Security and global health: Toward the medicalization of insecurity. Polity Press.
Farmer, P. (2001). Infections and inequalities: The modern plagues. University of California Press.
Fidler, D. P. (2003). SARS: Political pathology of the first post-Westphalian pathogen. Journal of Law, Medicine & Ethics, 31(4), 485–505. https://doi.org/10.1111/j.1748-720X.2003.tb00124.x
Fidler, D. P. (2010). The challenges of global health governance. Council on Foreign Relations Working Paper.
Frank, A. G. (1967). Capitalism and underdevelopment in Latin America: Historical studies of Chile and Brazil. Monthly Review Press.
Frenk, J., & Moon, S. (2013). Governance challenges in global health. New England Journal of Medicine, 368, 936–942. https://doi.org/10.1056/NEJMp1302962
Harman, S. (2023). Pandemic politics: The political economy of COVID-19. Routledge.
Keohane, R. O. (1984). After hegemony: Cooperation and discord in the world political economy. Princeton University Press.
Keohane, R. O., & Nye, J. S. (1977). Power and interdependence: World politics in transition. Little, Brown.
Kickbusch, I., Silberschmidt, G., & Buss, P. (2007). Global health diplomacy: The need for new perspectives, strategic approaches and skills. Bulletin of the World Health Organization, 85(3), 230–232. https://doi.org/10.2471/BLT.06.039222
Kickbusch, I., & Gleicher, D. (2012). Governance for health in the 21st century. World Health Organization Regional Office for Europe.
Labonté, R., & Gagnon, M. (2010). Framing health and foreign policy: Lessons for global health diplomacy. Globalization and Health, 6, Article 14. https://doi.org/10.1186/1744-8603-6-14
Lee, K., & Smith, R. (2011). Global health diplomacy: Concepts, issues, actors, instruments, fora and cases. Springer.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. SAGE Publications.
Mearsheimer, J. J. (1994). The false promise of international institutions. International Security, 19(3), 5–49. https://doi.org/10.2307/2539078
Moon, S., Røttingen, J. A., & Frenk, J. (2022). Global health governance and COVID-19 vaccine equity. The Lancet, 399(10328), 1235–1240.
Piot, P. (2012). No time to lose: A life in pursuit of deadly viruses. W. W. Norton & Company.
Resnik, D. B. (2020). What is ethics in research & why is it important? National Institute of Environmental Health Sciences.
Rushton, S., & Williams, O. D. (2012). Frames, paradigms and power: Global health policy-making under neoliberalism. Global Society, 26(2), 147–167. https://doi.org/10.1080/13600826.2012.656266
Schreier, M. (2012). Qualitative content analysis in practice. SAGE Publications.
't Hoen, E. (2009). The global politics of pharmaceutical monopoly power. AMB Publishers.
World Health Organization. (2021). Strengthening global health security and preparedness: WHO report. World Health Organization.
World Trade Organization. (2001). Declaration on the TRIPS Agreement and public health (WT/MIN(01)/DEC/2). WTO.
Yin, R. K. (2018). Case study research and applications: Design and methods (6th ed.). SAGE Publications.