Submission ID 131711
| Issue/Objective | COVID-19 exposed critical failures in global health governance, with international mechanisms including the International Health Regulations (2005) producing inequitable outcomes that disproportionately harmed the Global South. Regional and sub-regional institutions have since emerged as key sites for equity-driven governance, yet no comprehensive synthesis exists on whether or how equity has been operationalized within these systems between 2005 and 2026. This study addresses that gap, mapping how equity is defined, deployed, and institutionalized across regional health governance frameworks-directly responding to the conference's call to restore structural commitment to global health equity. |
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| Methodology/Approach | A PRISMA-guided scoping review examined seven multidisciplinary databases (HeinOnline, ProQuest, JSTOR, PubMed, Westlaw, Web of Science, and HealthSTAR) from January 2005 to March 2026. From 20,021 records identified, 31 studies met inclusion criteria. Data were coded using NVivo around three dimensions: extent (depth of institutional embedding), range (populations and instruments covered), and nature (distributive, recognitional, procedural, or transformative). Findings were complemented by a January 2026 research symposium examining Canada's equity leadership during COVID-19. |
| Results | Substantial regional variation was identified. Europe demonstrated the most robust institutionalization through binding legal mandates and multilevel governance mechanisms. Africa showed moderate deployment concentrated in pharmaceutical regulation and health financing. The Americas exhibited normative engagement through PAHO, though formalization varied across sub-regions. MENA, the Caribbean, and the Pacific Islands displayed limited institutional embedding, relying on indirect references or external partnerships. Across all regions, a persistent gap emerged between formal equity commitments and enforceable governance practice. The symposium revealed parallel tensions in Canada: domestic vaccine disparities reflected structural barriers misframed as hesitancy, while surplus procurement during global scarcity raised international credibility concerns. |
| Discussion/Conclusion | Equity in regional health governance remains more rhetorical than structural. The absence of legal mandates, defined equity groups, and monitoring mechanisms reflects upstream governance failures-fragmented power, inequitable financing, and weak leadership-central to sub-theme 1. Strengthening regional governance requires moving from aspirational equity commitments toward codified, accountable, and transformative institutional frameworks, contributing to the collective reclamation of global health equity. |
| Presenters and Affiliations | Aeda Salim York University Jasmeen Bassi Toronto Metropolitan University Uchechukwu Ngwaba Toronto Metropolitan University Michelle Amri University of British Columbia |
