An exploration of power asymmetries and their impact on global COVID-19 access to medicines response

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1. How have power asymmetries manifested within ACT A, how does this influence the governance processes of ACT A, and what implications does this have on the initiative's aim to promote equitable access to medical technology?a. Which actors are engaged in ACT A and what kind of power do they employ?b. How did/do these actors influence the agenda-setting, formulation, decision-making and outputs of ACT A?c. What structural factors influence the kinds of power actors can employ and how do they influence ACT A?d. Which power asymmetries exist, what impact did these have on ACT A process and how could these have been mitigated?e. What linkages, if any, exist between an actor's power and the proposed solutions to access issues?f. What can ACT A tell us about the architecture of and accountability in GHG?2. Which theoretical models of power can best be applied to understand power in GHG?To answer the research questions, the project will adopt a mixed-methods approach combining qualitative desk-based policy review and cross-sectional stakeholder interviews. This will be achieved through the use of a scoping review of policy and grey literature, a literature review of secondary academic analysis, a stakeholder analysis, stakeholder interviews, content analysis and power mapping. Theoretically valuable models of power from global health and political studies will be mapped out, amalgamated with adaptive revision, and applied as a novel theoretical framework.Consequently, the original contribution of this project will be four-fold. First, this project will construct, and pilot a cross-disciplinary mixed theory analytical framework rooted in political science and global health to offer a theoretically rigorous study of power associated with ACT A in GHG. Second, insights generated from the analytical framework will have complimentary translations to other key GHG mechanisms, which will provide a heuristically valuable model in the study of GHG more broadly. Third, this project offers a timely and significant analysis of GHG and one of its key access to medicines structures during the biggest health crisis in recent history. Fourth, given that ACT A is a new, yet fundamental component to global COVID-19 immunization, this project will be at the cutting edge of nascent and developing research in this area. These empirical findings will contain important implications for global health actors in terms of how they each occupy political space and power, and the implications this has on the purpose and outcomes of multilateral initiatives, particularly ACT A. Additionally, in collaboration with civil society partners, the findings of this research will be able to form recommendations as to how power asymmetries might be mitigated, and how actors at the weaker end of the distribution can better harness existing opportunities and have influence. More importantly, the project aims to design normative and practical recommendations to help increase equitable distribution under the ACT A initiative, something that is currently under threat of failure.