Intellectual property and pandemic preparedness: a qualitative study of COVID-19 waiver negotiations

Abstract Background Stark COVID-19 vaccine inequities have reignited debate over the intellectual property rights (IPR) regime governed by the WTO TRIPS agreement and its impact on pharmaceutical innovation and access. In 2022, WTO members adopted a COVID-19 TRIPS waiver, and IPR became a divisive issue in the WHO pandemic agreement negotiations. Recognizing the critical role of IPR in pandemic preparedness, this study explores the COVID-19 waiver negotiations to inform IPR solutions for future health emergencies. Methods We conducted twelve qualitative interviews (July 2024 - January 2025) with key informants from member state delegations (n = 4), civil society (n = 4), industry (n = 2), the media (n = 1), and an international IP expert (n = 1). The interviews explored perspectives on the COVID-19 waiver negotiations, focusing on frames, narratives, and power, and were analysed using a thematic analysis approach. Results Experiences of the negotiations and opinions regarding appropriate IPR measures were marked by deep divisions, heightened by pandemic-related pressures and power shifts. Members of HIC delegations and industry framed the negotiations predominantly as a technical issue, while others emphasised power imbalances and experienced a dismissal of their views and interests. Opinions regarding the adopted waiver ranged from viewing it as an ineffective result of a fraught process to a helpful product of expertise sharing. Most interview participants also suggested that trade outweighed health and human rights frames. Conclusions Our results suggest that, although a waiver was adopted, the negotiations failed to sustainably bridge divides on IPR, owing in part to a perceived dominance of high-income member states, the prioritization of trade interests, and pandemic-related challenges. This shows that a durable solution should be found in the interpandemic period, in an equitable forum appropriate for discussions on the IPR-health nexus with a renewed focus on public interests. Key messages • The COVID-19 waiver negotiations were marked by deep divisions in negotiating experience and IPR positions, heightened by the pandemic, resulting in a waiver based on the lowest common denominator. • A durable consensus on IPR and health is vital for pandemic preparedness and must be built in transparent and equitable forums.