States, global power and access to medicines: a comparative case study of China, India and the United States, 2000–2019
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...
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BMC
2025-02-01
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| Series: | Globalization and Health |
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| Online Access: | https://doi.org/10.1186/s12992-024-01092-2 |
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| author | Berit S. H. Hembre Maulik Chokshi Steven J. Hoffman Fatima Suleman Steinar Andresen Kristin Sandberg John-Arne Røttingen |
| author_facet | Berit S. H. Hembre Maulik Chokshi Steven J. Hoffman Fatima Suleman Steinar Andresen Kristin Sandberg John-Arne Røttingen |
| author_sort | Berit S. H. Hembre |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-fbcbd6596ff34a889a82209972c7ccb9 |
| institution | Kabale University |
| issn | 1744-8603 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Globalization and Health |
| spelling | doaj-art-fbcbd6596ff34a889a82209972c7ccb92025-02-02T12:47:31ZengBMCGlobalization and Health1744-86032025-02-0121111810.1186/s12992-024-01092-2States, global power and access to medicines: a comparative case study of China, India and the United States, 2000–2019Berit S. H. Hembre0Maulik Chokshi1Steven J. Hoffman2Fatima Suleman3Steinar Andresen4Kristin Sandberg5John-Arne Røttingen6Norwegian Institute of Public HealthACCESS Health InternationalGlobal Strategy Lab, York UniversitySchool of Health Sciences, University of Kwa-Zulu-NatalFridtjof Nansen InstituteFridtjof Nansen InstituteNorwegian Institute of Public HealthAbstract 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.https://doi.org/10.1186/s12992-024-01092-2Access to medicinesChinaIndiaUnited StatesStructural powerInternational political economy |
| spellingShingle | Berit S. H. Hembre Maulik Chokshi Steven J. Hoffman Fatima Suleman Steinar Andresen Kristin Sandberg John-Arne Røttingen States, global power and access to medicines: a comparative case study of China, India and the United States, 2000–2019 Globalization and Health Access to medicines China India United States Structural power International political economy |
| title | States, global power and access to medicines: a comparative case study of China, India and the United States, 2000–2019 |
| title_full | States, global power and access to medicines: a comparative case study of China, India and the United States, 2000–2019 |
| title_fullStr | States, global power and access to medicines: a comparative case study of China, India and the United States, 2000–2019 |
| title_full_unstemmed | States, global power and access to medicines: a comparative case study of China, India and the United States, 2000–2019 |
| title_short | States, global power and access to medicines: a comparative case study of China, India and the United States, 2000–2019 |
| title_sort | states global power and access to medicines a comparative case study of china india and the united states 2000 2019 |
| topic | Access to medicines China India United States Structural power International political economy |
| url | https://doi.org/10.1186/s12992-024-01092-2 |
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