The COVID-19 pandemic is unlikely to end until there is global roll-out of vaccines that protect against severe disease and preferably drive herd immunity. Regulators in numerous countries have authorised or approved COVID-19 vaccines for human use, with more expected to be licensed in 2021. Yet having licensed vaccines is not enough to achieve global control of COVID-19: they also need to be produced at scale, priced affordably, allocated globally so that they are available where needed, and widely deployed in local communities. In this Health Policy paper, we review potential challenges to success in each of these dimensions and discuss policy implications. To guide our review, we developed a dashboard to highlight key characteristics of 26 leading vaccine candidates, including efficacy levels, dosing regimens, storage requirements, prices, production capacities in 2021, and stocks reserved for low-income and middle-income countries. We use a traffic-light system to signal the potential contributions of each candidate to achieving global vaccine immunity, highlighting important trade-offs that policy makers need to consider when developing and implementing vaccination programmes. Although specific datapoints are subject to change as the pandemic response progresses, the dashboard will continue to provide a useful lens through which to analyse the key issues affecting the use of COVID-19 vaccines. We also present original data from a 32-country survey (n=26 758) on potential acceptance of COVID-19 vaccines, conducted from October to December, 2020. Vaccine acceptance was highest in Vietnam (98%), India (91%), China (91%), Denmark (87%), and South Korea (87%), and lowest in Serbia (38%), Croatia (41%), France (44%), Lebanon (44%), and Paraguay (51%).

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The end of the twentieth century was marked by a sea change in global governance in the realm of intellectual property rights (IPRs). Whereas countries historically retained substantial autonomy with regard to what they defined as intellectual “property” and the rights granted to the owners of intellectual property, the 1990s witnessed the establishment of new global obligations regarding national practices. This paper focuses on the case of software “piracy” to assess the mechanisms by which the new global obligations for the treatment of IPRs are transmitted from the international to the national levels. We first consider a set of national‐level factors that many scholars have shown to be important determinants of IPR policy. We then supplement the standard emphasis on domestic factors with an analysis of new transnational factors: countries' multilateral obligations under the World Trade Organization's (WTO) Agreement on Trade‐Related Aspects of Intellectual Property Rights (TRIPS) and bilateral pressures from the United States to increase the protection of IPRs. Population‐averaged panel data models are used to assess the effects of these national and transnational determinants on levels of software piracy in 80 countries from 1994 to 2002. Our results indicate that membership in the WTO and bilateral pressures from the United States—particularly pressures that offer reciprocal concessions—lead to substantial increases in levels of protection in rich and poor countries. There is, in short, a new international political economy of intellectual property.

BackgroundTrade and investment agreements negotiated after the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have included increasingly elevated protection of intellectual property rights along with an expanding array of rules impacting many aspects of pharmaceutical policy. Despite the large body of literature on intellectual property and access to affordable medicines, the ways in which other provisions in trade agreements can affect pharmaceutical policy and, in turn, access to medicines have been little studied. There is a need for an analytical framework covering the full range of provisions, pathways, and potential impacts, on which to base future health and human rights impact assessment and research. A framework exploring the ways in which trade and investment agreements may affect pharmaceutical policy was developed, based on an analysis of four recently negotiated regional trade agreements. First a set of core pharmaceutical policy objectives based on international consensus was identified. A systematic comparative analysis of the publicly available legal texts of the four agreements was undertaken, and the potential impacts of the provisions in these agreements on the core pharmaceutical policy objectives were traced through an analysis of possible pathways.ResultsAn analytical framework is presented, linking ten types of provisions in the four trade agreements to potential impacts on four core pharmaceutical policy objectives (access and affordability; safety, efficacy, and quality; rational use of medicines; and local production capacity and health security) via various pathways.ConclusionsThe analytical framework highlights provisions in trade and investment agreements that need to be examined, pathways that should be explored, and potential impacts that should be taken into consideration with respect to pharmaceutical policy. This may serve as a useful checklist or template for health and human rights impact assessments and research on the implications of trade agreements for pharmaceuticals.

This article explores the dynamics of regional economic integration in the Americas. Economic globalisation, or an increased volume of trade and investment and increased mobility of capital, presents developing countries with new opportunities and challenges. In particular, the emergence of south-east Asia as a major site for the production and export of manufactured goods has generated intense competition among developing countries for foreign investment and export-market shares. In this article, globalisation and ensuing competition is linked to the process of economic integration between the United States and countries of Latin America and the Caribbean. Fundamental changes in global patterns of investment and trade, in combination with international and domestic power asymmetries, contribute to the spread and proliferation of regional and bilateral trade agreements (RBTAs) between the United States and its hemispheric neighbours.