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Abstract

This article draws on the Covid-19 vaccine supply chain to illustrate the structural inequalities characterising Global Value Chains. We show how the highly unequal vaccine distribution between the Global North and the Global South is shaped by the concentration of high-added value activities of vaccine development and production in the Global North and their nationalistic economic policies. These policies are short-sighted, as they fail to take account of the health risks that low vaccination rates in the Global South entail, not only for the North, but for the whole world. Using the metaphor of pawns moving in a chess game, we advance two possible scenarios. In the first, regional suppliers from low- and middle-income Global South countries will remain unimportant actors in the global vaccine supply chain, leaving inequalities intact. In the second, these suppliers will upgrade their activities in the vaccine supply chain, supported by public policies fostering industrial infrastructure, systems reforms and technological standardisation, leading to a more polycentric supply chain configuration. The persisting concentration of the governance of Global Value Chains in the Global North, we argue, will not only exacerbate current inequalities, but also likely lead to worldwide health, economic and social vulnerabilities.

Keywords

Brazil chess metaphor Covid-19 Global North Global South global supply chains Global Value Chains inequality vaccines

Introduction

The Covid-19 pandemic has exposed worldwide vulnerability to extreme events. It has compelled governments to impose lockdowns and limit economic activity while competing in a race to develop a vaccine. All these events have highlighted the great interdependence among countries including in global health care supply chains (Evenett, 2020). Most of these chains have been hugely impacted due to reductions in manufacturing capacity as well as challenges to deliver to customers. As a consequence, disruptions have been amplified by the much longer duration of Covid-19 compared to other extreme events, such as the SARS epidemic, the global economic recession of 2008/2009 or the 2011 earthquake and tsunami in Japan (Kano and Oh, 2020). Lockdowns have been implemented in different countries, resulting in a ripple effect on international trade and causing global supply chain disruptions (Miroudot, 2020). Suppliers, often the most vulnerable links within global supply chains, have suffered severe consequences. For instance, some Global Value Chains (GVCs), like that of international fashion, have cancelled or postponed their orders with negative impacts on suppliers and workers’ incomes (Voss, 2020). In this sense, the pandemic has highlighted the dependence of leading buying firms on foreign suppliers, as well as their vulnerability to risks, leading to the continuing disruption of economic activity, shortage of goods and loss of gross national income and jobs in most countries.

This Speaking Out article analyses the Covid-19 global vaccine supply chain (VSC), as it has become increasingly clear that a broad vaccine programme is the key to national and global economic recovery. Despite the increased awareness of global interdependence, high-income countries in the Global North have already bought enough vaccines for their entire populations, and even purchased more than needed, whereas, at the time of writing, low-income countries in the Global South are still struggling to receive even small amounts. High-income countries have purchased almost 50% of the doses produced worldwide (BBC, 2020). Eight months after the first Covid-19 vaccine injection, 80% of the vaccines have been administered in high- and upper-middle-income countries, while, in low-income countries, the figure has been less than 1% (Our World in Data, 2021). This slow response is even more problematic taking into account that the need for vaccines is generally higher in low- and middle-income countries due to the relative lack of sanitation, constituting an important barrier to stop the spread of the virus (Okoi and Bwawa, 2020). Nationalistic economic policies fail to recognise that, if vaccination does not have global scope, in a short period of time, there will be a potential risk of the pandemic lasting much longer, due to the likelihood of more transmissible variants arising, such as those found in Brazil, India and South Africa (BBC News, 2021). A global development approach that considers challenges covering all countries, in both South and Global North, is required and demands shared solutions to avoid uneven impacts across the world (Oldekop et al., 2020).

We argue that the current pandemic has amplified the North-South inequalities by analysing the VSC as a GVC, a perspective that emphasises how supply chains are characterised by power asymmetry, in that actors located in industrialised countries control the governance of information, knowledge access and value appropriation (Gereffi, 2020). We use the metaphor of pawns moving in a chess game to illustrate how the pandemic is adversely affecting the global VSC. More specifically, we argue that, to promote the ‘pawns’ (weaker firms in the GVCs), public policies should support the governance of global supply chains by Global South actors.

Below, we first present a summary of the literature on GVCs, and then introduce the specific case of the Covid-19 VSC to exemplify the North-South tensions and inequalities. Using the chess game metaphor, we discuss potential alternatives for vaccine manufacturers located in Brazil, a country severely impacted by the pandemic. Based on this discussion, we close this paper discussing the future of the healthcare GVCs.

Global Value Chains

The concept of a GVC proposed by Gereffi (1995) in the mid-1990s highlights the governance processes of different actors and value-adding stages across the activities in global supply chains. Gereffi et al. (2005) considered two central elements of GVC governance: the degree of explicit co-ordination and the power asymmetry between buyers and suppliers. The key aspects for both elements are defined for three key determinants: the complexity of transactions; the codifiability of information; and the capability of suppliers. GVCs range from the raw materials stage to the final consumers via a multi-stage production flow. They are present in major industries like garments, food, automobiles and electronics, among many others. GVC governance commonly presents a power concentration in high-added value activities, usually located in the most advanced economies (Gereffi and Lee, 2012). A historical example is the tea GVC, the product being China and India’s largest export industry until the beginning of the 20th century (Rappaport, 2017). Today, even though Asian countries remain the main tea producers, most of the brand leaders controlling the whole supply chain are located in Global North economies. A similar situation has been clearly revealed in the healthcare industry during the current pandemic, especially with regard to vaccines.

Usually, in business relationships, each party will attempt to appropriate as much money and resources as possible (Mizik and Jacobson, 2003). Whereas some authors argue that GVCs leverage trade between developed and emerging economies (Lee, 2016), there are recurrent criticisms of the imbalance between the value added and the value appropriation by emerging and developed countries, that is, the actors from industrialised economies retaining more value than the others (Aguiar de Medeiros and Trebat, 2017; Gereffi and Lee, 2012). According to Brito and Miguel (2017, p. 68), when asymmetric power is present, buyers ‘. . . put pressure on suppliers in order to get the lowest price and the best conditions’. Tsing (2005: 4) offers the ‘friction’ metaphor – the ‘awkward, unequal, unstable and creative qualities of interconnection across difference’ – to unravel the predatory nature of the encounter between industrialised and emerging economies. Shenkar et al.’s (2008) definition of friction is closer to the conflicts in GVC governance: possessing divergent resources and interests, holding asymmetric power and a hierarchical position. In GVCs, this ‘friction’ entails worker exploitation, often of women workers (cf. Alamgir and Alakavuklar, 2020), enduring poverty and value capture by the actors in industrialised economies from the weaker parties in the emerging ones (Selwyn, 2019).

Pointing to the epistemic violence underpinning GVCs, knowledge produced in the Global South is considered peripheral and ‘inadequate’ in comparison to Western standards (Hughes et al., 2015; Mir and Mir, 2009), thus reflecting the usual patterns of Global North dominance (Bauman, 1998; Dussel and Ibarra-Colado, 2006). In the VSC, Abdul Muktadir, CEO of Incepta, a Bangladeshi pharmaceutical manufacturer, has contacted executives of Moderna, Johnson & Johnson and Novavax offering to make his company available to produce vaccine for distribution throughout Asia. At the time of writing, he has not received an answer from any of them (The Washington Post, 2021). This fact shows how specific regional knowledge is sometimes not valued by global companies.

Most studies of GVCs have taken a top-down approach to explain the governance of global supply chains. However, some have focussed, bottom-up, on emerging economies and the ‘upgrading’ process of firms pursuing an increase in the added value of their products (Gereffi and Lee, 2012; Humphrey and Schmitz, 2002; Lee and Gereffi, 2015). Historically, the Global North has been able to appropriate more value than the Global South in the GVCs due to the weak regional support for economic and social upgrading in emerging countries (Lee and Gereffi, 2015). De Marchi et al. (2018) characterised the GVC actors located in emerging economies as ‘marginal innovators’, as they generally present low levels of innovation, have restricted access to the technology available within the GVC and scarcely use other external sources. In the case of the Covid-19 pandemic, the protectionism and government intervention of different countries have emphasised dominance, self-interested behaviour and increased global inequity (Liu et al., 2020). Nevertheless, some industries located in emerging economies pursue new strategies in order to change their roles in GVCs.

The metaphor of pawn promotion in a chess match aids understanding of the change process undergone by these industries. We consider two potential movements of pawns during a match. In the first, they retain a less important role compared to other more ‘qualified’ pieces. In this case, they are easily captured and often ‘offered’ to the adversary to preserve other pieces as part of the general strategy. In GVCs, this refers to a relation among the actors that is characterised by low integration. They are tied in transactions usually based on market relations (Gereffi et al., 2005), which are characterised by constant bargaining pressure and potential threats of supply discontinuity. To date, this is the case of most industries in the Global South. A striking example is the vanilla GVC. Madagascan farmers face increasing difficulties in appropriating even only a small portion of this commodity’s added value, despite being the second most expensive spice in the world, its price varying from $200 to $400 a kilo (Touboulic and McCarthy, 2019). Low integration and bargain pressures have led to these farmers’ low value appropriation.

In the second type of movement, when a pawn reaches the opponent’s end of the chessboard, it enjoys promotion and becomes one of the most powerful pieces. Likewise, industries in emerging countries seek to internalise high-added value activities. Therefore, in this case, there is a severance or strategic decoupling from the GVC (Horner, 2014). The last three decades of the Indian I.T. industry is an example of such strategic decoupling, whereby it changed its role of supplier based on skilled, low-cost workers in global supply chains and started to develop their I.T. solutions for the global market completely locally (Elias and Mathew, 2015).

We now apply these two pawn movements to interpret what is happening today in the Covid-19 vaccine GVC. In particular, based on the Brazilian vaccine industry, we focus on the role of public policy in enabling the vaccine industry in some countries in the Global South to move beyond a subordinate position in the GVC that has made them permanently vulnerable.

The case of the Covid-19 global vaccine value chain

The VSC can be regarded as a GVC, including a multiplicity of international organisations and uneven power balance among them. The VSC encompasses four main stages: product development, production, vaccine allocation and distribution (Duijzer et al., 2018). While the first two components are mainly centralised in a few multinational companies and concentrated in the Global North (Andrenelli et al., 2021; Liu et al., 2020; Sell et al., 2021), vaccines are needed by all countries.

To test vaccine efficacy during product development, it is important to perform clinical tests in different regions, and this is only possible based on partnerships with manufacturers in other countries. For example, while the Oxford/Astrazeneca vaccine was developed in Europe, the organisation needed to work with more than 20 supply partners in different countries, such as India, China, Brazil and Thailand, to evaluate it in different contexts.

Once approved, leading firms depend on raw material supply and production capacity to ramp up production and speed up product availability. Manufacturers are dependent on global suppliers located in different countries (Andrenelli et al., 2021). For example, Moderna buys lipids from a German company, while active ingredients are currently produced by a Swiss manufacturer (Neubert, 2021). Germany, France, China, Turkey, Argentina, Switzerland and Italy are the main exporters of the core ingredients for the vaccine itself, while China, the United States, Germany and Ireland are the main sources of vials, rubber stoppers, needles and syringes (Andrenelli et al., 2021). In order to increase vaccine supply, this complex global supply chain also needs to scale up production.

Manufacturing capacity is also a current bottleneck in the VSC, as it is a sophisticated process that requires high technology and skilled labour (Andrenelli et al., 2021). Therefore, production is centralised in few countries (the top three exporters are Ireland, Belgium and France). Only 10 countries, all in the Global North, account for more than 90% of the export volume (Andrenelli et al., 2021). To increase production rates, leading manufacturers usually have subcontracted firms abroad. For example, India has played a major role in increasing production capacity for the Oxford/Astrazeneca vaccine. Different from the manufacturers in the USA and EU, the Indian supplier seems to be able to boost production and export to poor countries in the vaccine sharing programme (The Economist, 2021). In this case, it may become a promoted pawn, known as a rising-power firm (Lechner et al., 2020; Lee and Gereffi, 2015), which is an organisation located in an emerging country that can challenge the Global North by developing new business models or capabilities (Lee and Gereffi, 2015; Sinkovics et al., 2014; Yamin and Sinkovics, 2015).

Centralised product development and production can also create disadvantages for countries in the Global South, as they generally follow product standards developed for the northern markets, and do not consider local needs in emerging economies. One example is the first version of the vaccine vial developed by Pfizer, which needed to be stored at less than 70°C, and was thus only one appropriate for distribution in urban centres. In the Global South, vaccines must be distributed to distant populations, often small communities, difficult to access. These countries lack the infrastructure to store vials at low temperatures. Moreover, each vial contains multiple doses. As the number of people that turn up for immunisation in small communities varies, it is common for vials to be only partially used, which results in wastage, as doses should be used immediately. In this case, a greater quantity needs to be bought, which obviously requires more supply and financial resources (Duijzer et al., 2018). In addition to the product standards, vaccines developed in the Global North are expensive, an additional obstacle for the Global South that demands lower added value vaccines (Homma et al., 2013).

From a country’s perspective, a successful vaccination programme depends on each national government procuring the amount of vaccine sufficient to assure population coverage and to have policies to transport, store and distribute it (De Boeck et al., 2020; Duijzer et al., 2018). This results in another advantage for Global North countries, as they have more financial resources to place orders and negotiate with manufacturers. During the current pandemic, even without previous vaccine approval, most of the forthcoming production had been reserved for the rich and emerging economies (Global Health Institute, 2020). As a result, the middle- and low-income countries have not been able to protect their populations in the short term, given that they have faced problems to raise funds and secure the vaccines, and have lacked the appropriate infrastructure to maintain and distribute them in the right conditions (Duijzer et al., 2018; Lydon et al., 2017). The consequences have been delays in the procurement process, resulting in a slower national immunisation programme. This is even worse when, as mentioned, these same countries lack good sanitation and broad access to health services (Okoi and Bwawa, 2020), which underlines the importance of public policies to support an effective reconfiguration of the VSC. As an example, Haiti, one of the poorest countries in the world, had administered vaccines for only 0.2% of the population until August 2021 (Reuters, 2021).

Power asymmetry between countries and nationalism were also demonstrated by the US hoarding tens of millions of Astrazeneca doses in their stockpile awaiting approval, before the American government decided to release these products to other countries, without assuring replacement of doses (NY Times, 2021). As traditional manufacturers are struggling to balance supply and demand, stockpiling of vaccines represents an additional challenge for a worldwide immunisation campaign as it increases disruption in different markets.

The lack of a global perspective considering shared challenges (Oldekop et al., 2020), and the current protectionism and self-interest of countries increase South-North inequalities. Most countries in the Global South are highly dependent on imported vaccines, as they have no capacity to develop, produce or even buy them. To reduce this inequality, it is important to foster new arrangements in the VSC beyond the traditional configurations of the Global North-South or West-East, as proposed by Cattaneo et al. (2010) and Lee (2016).

In the next section, we apply the metaphor of the pawn promotion to the Covid-19 VSC, using the case of two Brazilian vaccine manufacturers. Brazil is one of the countries most affected by the pandemic. When the number of cases accelerated, the country faced a lack of beds in intensive care units in the majority of hospitals. To reduce the number of cases, the country needed an intense immunisation programme, but this was delayed due to government resistance and inefficiency in planning and procuring the amount of vaccines needed.

Persistent vulnerability: Surviving as a pawn in the VSC

Due to the size of the country, Brazil has played a major role in the clinical test phases of different vaccines, mainly Astrazeneca (UK) and Coronavac (China). Two local manufacturers (Osvaldo Cruz Foundation – Fiocruz and Butantan Institute) signed partnerships to participate not only in the test phase, but to produce the vaccine themselves. Both manufacturers have sound expertise in vaccine production and are renowned as regional references (Douglas and Samant, 2018; Homma et al., 2020). The Butantan Institute is a national leader in vaccine production (Raw, 2019). Fiocruz is also well known as a key partner in the development of different vaccines. Together they account for 70% of the vaccine supply in the Brazilian public sector (Homma et al., 2020). Historically, they have acted in partnership in many immunisation initiatives (Homma et al., 2013).

By January 2021, the Brazilian health agency approved the use of two vaccines (AstraZeneca and Coronavac), that should be initially imported. By March 2021, both local manufacturers were allowed to produce vaccines in Brazil (Coronavac – Butantan and Oxford/Aztrazeneca – Fiocruz). However, the local production was still highly dependent on imported active pharmaceutical ingredients from India and China. These manufacturers have two alternatives: survive as a pawn or try to achieve pawn promotion.

Brazil has faced several problems with the secondary role of the local companies in the VSC. Ever since the first vaccines were approved by the national health agency, the volume of products being delivered in the country has been insufficient for speedy vaccination of the whole population.

In January 2021, Fiocruz announced the delivery of 50 million doses of the AstraZeneca vaccine by April 2021, and kept this forecast even when the first difficulties to fulfil it appeared. However, the number of doses delivered to the National Immunisation Programme (NIP) in the period was 22.5 million, less than half. At the same time, contrary to the agreement signed with the federal government for 46 million doses, only 42 million were made available by the deadline (CNN Brazil, 2021). In both cases this was due to raw material shortages caused by delays in supply from China and India.

After approval of the Oxford/Astrazeneca vaccines from India, the Indian government has delayed authorisation for shipments to Brazil in order to prioritise domestic vaccination, reinforcing the idea that nationalistic policies have led to developing countries not benefitting in the same way as their Global North counterparts in these partnerships (Liu et al., 2020). As a result of these delays, million of people have received the second dose of the vaccine later than planned (Estadao, 2021).

In other words, the case of Brazil shows how organisations from emerging and low-income countries are often like unimportant pawns in a worldwide chess game, kept playing in a subordinate role.

Pawn promotion in the VSC

Despite its supporting role, a pawn can become a powerful chess piece, just like business enterprises, which may take advantage of knowledge acquired in a GVC via an upgrading process. In this case, industries in emerging countries seek to internalise high-added value activities.

This reconfiguration of GVCs crucially depends on decisions at the political level and the firm level. National governments should promote policies that foster macro-regional or national production of critical items in order to decrease dependence on the Global North (Barbieri et al., 2020; Horner, 2014). These policies should focus on developing innovation capabilities by promoting training and education as well as policies that foster adoption of new technologies and protect intellectual properties, scaling up local manufacturing capacity, reducing public bureaucracies, as well as investing in technological standardisation (Malkin, 2020). This might result in industrial sectors that are more competitive. Despite the difference between regional policies and regulation, local governments should play a key role by regulating norms and rules to set international labour and environmental standards to avoid labour exploitation and uncompetitive products (Knorringa and Nadvi, 2016).

At the firm level, enterprises should develop both innovation and market capabilities, which will allow them to develop new products and processes, and adopt new technologies, as well as attract new buyers (Sinkovics et al., 2014). With regard to VSC, there is an opportunity for vaccine producers in the Global South to play an important role by developing and producing their own vaccine(s). This is the case of a vaccine called ButanVac under experimental study by the Butantan Institute. This vaccine uses a genetically modified virus, developed in embryonated eggs (EBC, 2021). The technology was partly developed by the Mount Sinai Institute in the USA and was shared with an international consortium of vaccine producers. However, the Butantan Institute is mainly responsible for developing the different processes, such as the provision of the embryonated eggs, inoculation, viral growth, processing and purifying, inactivation, formulation, qualification, quality control, scale production, packaging, labelling and sanitary records. If approved, the vaccine could be produced using local raw materials, reducing dependence on foreign suppliers. The Butantan Institute has also partnered with Vietnam and Thailand to test and produce this vaccine. The Institute will be responsible for 85% of the total production capacity, and is committed to exporting supplies to low- and middle-income countries.

This is a good example of a functional upgrading process in which firms occupy more gainful nodes (Gereffi and Lee, 2012; Lee and Gereffi, 2015). Instead of being a contracted manufacturer, the Butantan Institute will lead the product and process development, and will govern the whole supply chain. Thus, it might become a rising-power firm and challenge the traditional vaccine manufacturers (Sinkovics et al., 2014; Yamin and Sinkovics, 2015) by focussing on new technologies and new markets. Thus, the pawn would become a strategic player in vaccine GVC.

The future of healthcare GVCs

As mentioned, the pandemic has revealed the vulnerability of the VSC and the profound North-South inequality despite their mutual dependence. Late access to vaccines threatens to extend the economic crisis in several countries, which will incur negative consequences like unemployment and problems in public health systems. The traditional vaccine supply chains reflect the same asymmetric relations between the Global North and South countries that also characterised the healthcare GVCs during the Covid-19 pandemic. The global need for medications and medical devices has resulted in shortages and inequalities between countries. The USA and EU countries, for example, have sought to assure provision of scarce medical equipment and testing kits by paying more than other countries (NY Times, 2020).

Since the beginning of the current crisis, both academics and practitioners have been discussing its impact on the future of healthcare GVCs and international trade (Gereffi, 2020; Kano and Oh, 2020; Miroudot, 2020; UNCTAD, 2020; Weforum, 2020), including regulatory policies in the home markets and increased transparency of international supply chains, because informal subcontracting has led to lower quality medical supplies and delivery dependability.

The Covid-19 pandemic has also shown that even powerful GVC actors from the Global North do not have enough knowledge to cope with extreme and unexpected events alone (Oldekop et al., 2020). In fact, during the pandemic, the potential global supply shortage, especially in the health and food sectors, has been reduced by increased production capacity on the part of the Global South rather than that of the Global North suppliers (Evenett, 2020).

Using our chess game metaphor, there are two possible scenarios for the healthcare GVCs. In the first, Global South actors will remain unimportant actors in GVCs. The concentration of product development and production will remain in the Global North. This case does not consider immunisation and healthcare services on a global scale, and prioritises vaccine and medical goods distribution in advanced economies. Current national policies reflecting this approach will increase regional inequalities and vulnerability. The danger here is that the pandemic may last longer than expected, exposing the world to new risks, such as new variants. Moreover, as supply chains are global, North-South immunisation asymmetry is likely to negatively impact multiple GVCs, besides those of goods directly related to the pandemic. Immunisation only in advanced countries may cause additional economic losses, even for the Global North, due to their participation in international trade (Cakmaklı et al., 2021).

In the second scenario, actors from the South will seek to upgrade their activities, thereby creating a more polycentric configuration (Horner and Nadvi, 2018), leading to GVCs with lower power concentration in terms of geographical location. Thus, vaccines and medical goods controlled by actors in the South will also be distributed to these countries as other examples of GVCs (Gereffi and Lee, 2012; Horner and Nadvi, 2018; Lee, 2016; Lee and Gereffi, 2015; Tang and Tomlin, 2008). A potential increase in the number of healthcare sources could lead to more balanced access to health in the world. This would result from increased innovation, production capacity and distribution in low- and middle-income countries, thereby expediting their recovery.

A remaining issue is how regional suppliers will be able to change their roles in these GVCs. Will this movement promote both economic and social upgrading in the South (Gereffi and Lee, 2016), where producers face different challenges and outcomes (Horner and Nadvi, 2018)? In this case, social and economic upgrading may lead to ‘improving the overall well-being of workers as well as their dependents and communities’ (Gereffi and Lee, 2016: 29). Or will powerful focal companies from the South impose actions and norms on less powerful suppliers, dictating the specifications for inclusion or exclusion, as well as for value creation and capture (Dallas et al., 2019; Kano et al., 2020)? Thus, it is important to further explore whether and how these promoted pawns will address transparency and compliance to prevent potential unethical practices like forced labour and other modern slavery practices (New, 2020; Voss, 2020). There is also a need to address how vulnerable GVC actors, such as the ones located in low-income countries, can increase their access to new technologies, such as digital, for further dissemination in local networks (Engel and Taglioni, 2017; Oldekop et al., 2020), thereby avoiding increased technological inequality.

From a firm’s perspective, the reconfiguration of GVCs will not be easy due to pressure for cost reduction based on the asymmetric relations between the North and South actors, and the time needed to recreate regional supply chains (Ancarani et al., 2021; Boffelli et al., 2020). Moreover, nationalistic public policies may increase conflicts in GVC relations. While in the North, public policies try to keep governance and the power in these GVCs, the challenge for the South is to develop local conditions to improve knowledge and create added value. This aspect is central for ongoing reconfigurations of the healthcare GVCs, if the historic challenges that generated the dominance of the South by the North still persist. Nowadays, the North does not have the capacity to produce vaccines to meet the worldwide need. In fact, the crisis has revealed a need to count on the South to address global public risks.

Despite its specificities, the vaccine supply chain illustrates well how geopolitics cannot be ignored in the debate about global supply chains (Gereffi, 2020; Wieland, 2020). It has made particularly visible how decisions at firm level do not simply result from market dynamics, but are heavily influenced by politics and policy (Barbieri et al., 2020; Gereffi, 2020). To be better prepared for risks in the future and to overcome some of the barriers against the more vulnerable economies that render them and local companies ‘mere pawns’, governments in low- and middle-income countries should invest in industrial infrastructure, systems reforms and technological standardisation.

The current pandemic has revealed how decisions concentrated in the Global North may lead the world to a highly risky situation in terms of health, economic and social issues. Moreover, current ‘friction’ related to nationalism, asymmetric power and short-term policies may further exacerbate current inequalities and increase future world vulnerabilities.

Footnotes

Funding

The author(s) received financial support for the research, authorship, and/or publication of this article from CNPq and Capes.

ORCID iD

Ely L Paiva

Author biographies

Ely L Paiva Professor at FGV- EAESP. Ph.D. in The Federal University of Rio Grande do Sul, Brazil. Visiting Scholar at UNC-Chapel Hill, and at the University of Texas Rio Grande Valley. Regional Editor for Latin America of the Journal of Supply Chain Management. Research interests are Sustainable Operations, Operational Capabilities, and Supply Chain Management.

Priscila LS Miguel Assistant Professor at Operations Management Department at FGV-EAESP. Graduated in Chemical Engineering by Unicamp and Master’s and Ph.D. in Business Administration in FGV-EAESP. Research interests are Logistics, Supply Chain Management, Buyer-Supplier Relationships, Diversity in Supply Chain, Supply Chain Risk and Resilience.

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Overcoming enduring inequalities in Global Value Chains? Interpreting the case of Brazil’s Covid-19 vaccine supply through a chess metaphor

Abstract

Keywords

Introduction

Global Value Chains

The case of the Covid-19 global vaccine value chain

Persistent vulnerability: Surviving as a pawn in the VSC

Pawn promotion in the VSC

The future of healthcare GVCs

Footnotes

Funding

ORCID iD

Author biographies

References