Analysis of the institutional landscape and proliferation of proposals for global vaccine equity for COVID-19: too many cooks or too many recipes?

This article outlines and compares current and proposed global institutional mechanisms to increase equitable access to COVID-19 vaccines, focusing on their institutional and operational complementarities and overlaps. It specifically considers the World Health Organization's (WHO's) COVAX (COVID-19 Vaccines Global Access) model as part of the Access to COVID-19 Tools Accelerator (ACT-A) initiative, the WHO's COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS (Trade-Related Aspects of Intellectual Property Agreement) intellectual property waiver and other proposed WHO and World Trade Organization technology transfer proposals. We argue that while various individual mechanisms each have their specific individual merits-and in some cases weaknesses-overall, many of these current and proposed mechanisms could be highly complementary if used together to deliver equitable global access to vaccines. Nonetheless, we also argue that there are risks posed by the proliferation of proposals in this context, including the potential to disperse stakeholder attention or to delay decisive action. Therefore, we argue that there is now a clear need for concerted global multilateral action to recognise the complementarities of specific models and to provide a pathway for collaboration in attaining global equitable access to vaccines. The institutional infrastructure or proposals to achieve this amply exist at this point in time-but much greater cooperation from industry and clear, decisive and coordinated action from states and international organisations are urgently needed.

Tech sharing, not tech hoarding: Covid-19, global solidarity, and the failed responsibility of the pharmaceutical industry

The Covid-19 pandemic has highlighted the importance of health technologies to mitigate against the spread of the disease and improve care, dominantly including life-saving vaccines. But the pandemic has also highlighted that the current biopharmaceutical business model, based on the enclosure of these technologies and on the immense accumulation of capital it enables, leads to vast inequalities in healthcare particularly in low and middle-income countries. We believe that the pharmaceutical industry has a moral duty to enable and enact global solidarity through tech sharing instead of tech hoarding, but judging by current technology transfer practices we question their willingness to assume their role in organizing healthcare markets through solidaristic principles. In the absence of a voluntary adoption of solidaristic principles and practices by biopharmaceutical firms, the institutionalization of global solidarity as a fundamental organizing principle for healthcare markets is necessary to strengthen resilience and know-how globally. With this call, we add to existing conceptualizations of solidarity by (a) introducing a global level of solidarity and (b) thinking through the concept not as an abstract humanistic stance but as a concrete organizing principle for global healthcare markets.

Organizing the sharing economy through experiments: framing and taming as onto-epistemological work

Prior work on performativity has illustrated how theories intervene in economic organizing. We expand this body of research by studying how concepts, and particularly those that are loosely defined and/or not widely understood, provoke their own realities through experiments. We examine how different experimental set-ups allow these concepts to be seized by a multitude of actors all wishing to instantiate worlds in their own interests, and how they potentially open up multiple competing realities as a result. We follow the concept of Mobility-as-a-Service as it mobilizes various experiments across public and private realms in Stockholm and Dublin, and we analyse how specific types of experiments co-produce epistemic and ontological work. Our results illustrate how different experimental designs can be conducive in taming and/or framing ambiguous concepts through interconnected processes of such onto-epistemological work. This highlights the distributed and relational but also the ‘provocative’ facets of performing ambiguous concepts through experiments. We discuss the consequences of these insights for how we think about scaling from experiments to broader socio-economic realities.

Strategies of stratification: Regulating market access in the era of personalized medicine

Personalized medicine raises the stakes of pharmaceutical market regulation. Drawing on pragmatist valuation studies and science and technology studies literature on personalized medicine and pharmaceutical markets, this article demonstrates how complex negotiations about the value of a pharmaceutical can constitute a market in various ways, while also shaping the concerned patient populations. Tracing the path of a pharmacogenetic treatment, Spinraza, from its approval by the European Medicines Agency to its adoption in the publicly funded Danish healthcare system, we show how the market was formatted through particular stratifications of the patient population. We conceptualize these seemingly technical moves as strategies of stratification, that is, the application of techniques to assemble and divide data - and what data are meant to represent - into groups delineated by certain characteristics. We argue that stakeholders' use of strategies of stratification has important implications not only for market access, but also for the delineation of diseases and patient populations. Hence, it is crucial to make intelligible the mutual constitution of pharmaceutical markets and patient populations and the political efforts of delineating and connecting the two.

‘Let the virus spread’. A doctrine of pandemic management for the libertarian-authoritarian capital accumulation regime

Debates have grown around the initial COVID-19 response of radical right-wing governments such as those of the UK, the US and Brazil. These governments initially let the virus spread among the population and delayed the enforcement of strong social distancing measures such as a lockdown. Focusing on the UK’s early response to COVID-19, this article builds on Nicos Poulantzas’ Marxist theory of the state to highlight how this pandemic management doctrine stemmed from changes in the UK’s capitalist class. It traces the ideological grounding of this doctrine, relating it to the rise of libertarian think tanks in British conservative circles and shifts in the policy committees in charge of pandemic preparedness. It suggests that this pandemic response is an episode of the ongoing replacement of the dominant neoliberal accumulation regime with a new libertarian-authoritarian one and examines how this latter materialises the interests of an emerging group of ‘disaster capitalists’. Therefore, it takes the COVID-19 crisis as an example of how the reconfiguration of capitalist accumulation regimes articulates a new doctrine of catastrophe management, radical right-wing ideologies, libertarian-authoritarian institutions and the growing power of capitalist actors able to profit from extreme events.

Market Fashioning

How do markets come about? This article offers a first systematic analysis of three different ideal types of market fashioning: mutual adjustment, organization, and fields. Although aspects of these are identifiable in most empirical markets, these three ideal types provide analytic tools for students of real markets and marketplaces. After going through this comprehensive literature, it is argued that mutual adjustment, which refers to non-planned processes, is affinity with markets in which products are differentiated, for example, producer markets. Organization refers to process driven by attempts to decide for others and shows affinity with markets for standardized and homogenous products, for example, stock exchanges. Organization also accounts for the making of marketplaces. The broader notion of fields does not refer to any specific process, but accounts for the context of market fashioning and its respective power struggles.