Short abstract:

We foreground global pharmaceutical institutions and policies and trace their development from the early 2000s to contemporary scientific and institutional developments. We examine their harmonisation dynamics to analyse a dual movement of increased globalisation and differentiation.

Long abstract:

We consider the question of whether the ‘global health era’ starting around the turn of the century, in effect, led to a harmonisation of pharmaceutical policies across the globe. Beginning in the early 2000s, we will examine several examples, such as the WHO essential medicines list, clinical trial and patenting legislation, and health technology assessment, to consider the interplay between different institutional layers at the supra-national level. We then move on to the crucial period of 2019-2022 and the system shock of the COVID-19 pandemic, which has led to global controversy around stark vaccine inequalities, and significant but as-yet unfulfilled institutional efforts towards intellectual property waivers, patent pools, and knowledge transfers. The COVID-19 period has arguably shown the failure of the global harmonisation era to the benefit of regional coordination efforts. Whilst the Pandemic Accord negotiations and a redrafting of the International Health Regulations (IHR) continue to aim for global harmonisation, this regionalisation trend has continued in the European HERA initiative and the ‘local’ production of vaccines. We also briefly consider the likely implications of heightened scholarly, policy, and advocacy interest in intersectionality and current high-tech medical advances (gene therapies, etc).

Concluding, we analyse a dual movement over time. On the one hand, the move towards supra-national harmonisation on specific policy topics has varying causes and vastly differing effects. On the other hand, we see increased awareness of and efforts to actively combat inequities deriving from these differentiated harmonisations in a contextually appropriate manner.