The Impact of Power Dynamics on Global Health Cooperation and Health Equity during the COVID-19 Crisis: Lessons for Future Policy and Pandemic Preparedness

Abstract The COVID-19 pandemic is over, but its impact on global health equity remains a significant concern. The pandemic highlighted and, in some cases, exacerbated longstanding inequities in global health systems, especially in low-resource settings. Power dynamics played a critical role in shaping global health equity and cooperation, influencing the allocation of resources, decision-making processes, and access to life-saving interventions. While existing studies have examined the relationship between global health diplomacy and health equity, the specific impact of power dynamics on health equity and diplomacy during the pandemic remains underexplored. This review explores how power dynamics influenced global health cooperation and health equity during the COVID-19 pandemic. A narrative review, guided by Lukes' three-dimensional model of power, was conducted. The review spans publications from 2000 to 2025 and includes 89 eligible articles, encompassing research studies, policy documents, and global health reports. Data extraction focused on three key domains: Development Assistance for Health (DAH), equity in the pandemic response, and political power dynamics. The review revealed that donor countries increased Development Assistance for Health (DAH) support in response to COVID-19. However, vaccine nationalism, geopolitical tensions, sanctions, and intellectual property regimes perpetuated inequities between the Global North and South. Despite multilateral initiatives like COVAX, inequitable access to vaccines and diagnostics persisted, largely due to the concentration of decision-making power among high-income countries and powerful institutions. The review concludes that achieving sustainable global health equity requires confronting entrenched power asymmetries that hinder meaningful cooperation, promoting inclusive governance, and depoliticizing health diplomacy. Transparent, equity-focused policies, strengthened regional health systems, and expanded South-South collaboration are essential for building resilience to future global health crises. Further research is recommended to evaluate the post-pandemic impact of power dynamics on global health equity and cooperation.