Development of a Canadian Framework for Global Health Access and Equity: Outcomes from the 2025 Global Health Access and Equity Workshop at the University of British Columbia

Fanan Fattah; Richard Lester; Khumbo Kalua; Brett Sharp; Adam Houston; Andrew Goldman; Sirinivas Murthy; Justin Mendoza; Kishor Wasan

doi:10.20944/preprints202509.1989.v1

Submitted:

21 September 2025

Posted:

24 September 2025

You are already at the latest version

Abstract

The COVID-19 pandemic revealed stark inequities in access to life-saving technologies and innovations, particularly for countries in the Global South. While scientific advances were rapid, the benefits of those breakthroughs were not equitably shared, highlighting deep structural imbalances in global health governance. In response, Canadian institutions must lead by example to ensure that future innovations arising from publicly funded research are made equitably accessible. The Global Health Access and Equity Workshop, held in March 2025 by the Neglected Global Diseases Initiative at UBC, convened experts from academia, civil society, and government to identify key barriers and propose a framework for action. This viewpoint outlines the workshop’s vision, summarizes outcomes, and calls for the establishment of a Canadian framework guided by Global Access and Equity Principles (GAEP) to promote health equity globally and fulfill Canada’s moral, scientific, and policy obligations in the post-pandemic era.

Keywords:

global health

;

equity

;

access

;

essential medicines

Subject:

Public Health and Healthcare - Public Health and Health Services

Introduction

The COVID-19 pandemic magnified pre-existing inequities in global health. While high-income countries secured rapid access to vaccines and therapeutics, many countries in the Global South experienced delays, shortages, and preventable deaths [1,2]. This imbalance underscored the urgent need to reassess how health innovations are developed, shared, and accessed worldwide, especially in low- and middle-income countries (LMICs), but also within high-income countries where rising costs and restrictive intellectual property regimes have limited access to essential medicines [5]. From diagnostics to treatments, the global response often excluded those without sufficient purchasing power or manufacturing capacity, even though many of these innovations were publicly funded.

Inequalities of access and the resulting disparities in health outcomes in LMICs extend far beyond COVID-19 and are present across multiple disease fields. For example, despite decades of scientific progress, access to affordable treatments for HIV, tuberculosis, and malaria remains highly uneven, with many patients still facing delays, shortages, or unaffordable costs. Similar barriers exist for neglected tropical diseases, where research and development are chronically underfunded and delivery systems are weak [3,8,14]. These challenges are not limited to infectious diseases: recent analyses of GLP-1 receptor agonists for diabetes and obesity suggest that, without policy interventions, such therapies will remain inaccessible to most patients globally [16]. These patterns highlight that inequitable access is not confined to pandemics or emerging infections but rather reflects systemic challenges across global health that demand sustained and coordinated responses.

As a country with globally respected research institutions and significant public investment in innovation, Canada has a moral and strategic responsibility to address these disparities. This responsibility stems from the fact that taxpayer-funded research should deliver public benefit globally, and because Canada’s own health security and international influence depend on equitable systems of innovation and access. Canadian universities play a critical role in translating research into solutions for global health challenges, including neglected tropical diseases, pandemics and other infectious disease outbreaks, and a wide range of other pressing health needs. But without structured policies to guide equitable dissemination of innovation, the country risks perpetuating exclusionary models.

The Global Health Access and Equity Workshop, hosted by the Neglected Global Diseases Initiative at the University of British Columbia (UBC) in March 2025, brought together Canadian and international leaders to co-develop strategies to ensure that innovations arising from publicly funded research are disseminated and made accessible globally in an affordable and equitable manner. One of the central proposals was the establishment of a national framework grounded in Global Access and Equity Principles (GAEP) that would guide Canadian universities in implementing equitable practices in research translation and licensing.

Why Canada Needs a National Framework

Despite the global reach and influence of Canadian universities’ research outputs, all major research universities currently lack robust access and equity policies embedded within their intellectual property (IP) strategies. As a result, licensing practices often prioritize commercial returns over public benefit, restricting the availability of innovations such as vaccines, diagnostics, and treatments [3,4]. National frameworks have begun to form for access licensing in the United States via the National Institutes of Health [17] and among multiple major research institutions in North America, leaving space and need for a Canadian framework.

A national framework for Global Health Access and Equity would:

Require equitable licensing models and transparent decision-making as conditions for receiving public research funding or membership in the U15 Group of Canadian Research Universities (a coalition of Canada’s leading research-intensive universities)[18].
Align Canadian research practices with internationally recognized frameworks for health equity, including the Sustainable Development Goals, the WHO Roadmap for NTDs, and the Pandemic Agreement.
Build on successful precedents from other regions, such as the University of California’s Socially Responsible Licensing Program and Yale’s affordable licensing model for LMICs [4,5].

Importantly, a national framework would also provide researchers and institutions with consistent guidance and reduce uncertainty about how to navigate global access obligations. By creating shared expectations and incentives across institutions, this framework would enable Canadian universities to collectively lead in advancing health equity, fulfilling their social contracts as stewards of publicly funded research [15].

Workshop Outcomes: Vision to Action

Participants at the workshop coalesced around three core action items:

Develop a White Paper on GAEP:

A collaboratively developed White Paper would serve as a practical policy tool to guide implementation of GAEP across Canadian universities. Drawing on lessons from the COVID-19 pandemic and established global access initiatives, the document would synthesize evidence, stakeholder consultations, and case studies to define actionable equity principles and propose concrete implementation models. It would also include a roadmap for integrating these principles into the Canadian university system, with attention to feasibility, accountability, and monitoring.
Secure Funding for Implementation:

Federal and provincial governments have a central role not only in providing financial resources, but also in embedding GAEP into policy frameworks. This could include linking public research funding to adoption of equity principles, providing regulatory guidance, and ensuring that commercialization practices align with national commitments to global health equity. Investments in infrastructure and administrative support will be essential but must be paired with policy measures that make equity a core expectation across Canadian research institutions.
Convene a Multi-Sector Coalition:

Sustained collaboration across academia, government, civil society, and the private sector is critical for shaping and sustaining a national approach to equitable health innovation. Beyond institutional change, a cross-sectoral coalition should also focus on advocacy to ensure that GAEP principles are embedded into government policy and funding frameworks, thereby creating an enabling environment for long-term adoption.

Key Barriers to Equitable Global Health Access

The workshop identified a variety of interconnected barriers to equitable global health access, ranging from restrictive intellectual property and licensing practices to resource and data limitations in LMICs, to challenges of incentives, institutional leadership, and risk mitigation. While not exhaustive, these themes illustrate the systemic obstacles that any Canadian framework must confront. A summary of the key barriers and their implications for Global Access and Equity Principles (GAEP) is presented in Table 1. The solutions outlined below were developed with these barriers in mind, focusing particularly on those most relevant to ensuring equitable access to innovations emerging from publicly funded Canadian research.

Table 1. Key barriers to equitable global health access identified during the 2025 Global Health Access and Equity Workshop, and their implications for GAEP.

Barrier	Implication for GAEP
Polarizing role of IP rights	Licensing terms can restrict access; GAEP must embed equitable licensing provisions [6].
Insufficient resources in LMICs	Need to address both adoption and local production capacity [8].
Ambiguity in operationalizing equity	Without shared definitions, commitments risk being symbolic.
Lack of generalizable data	Inclusive trials and real-world evidence needed for equity across contexts [9].
Leadership gaps in universities	GAEP requires institutional champions (e.g., under VPRs).
Institutional and cultural resistance	Incentives and metrics must shift toward public benefit [11].
Red tape and regulatory delays	Streamlined processes needed for timely global access.
Lack of incentives for humanitarian innovation	Current funding prioritizes profit > public health.
Distrust in Indigenous & marginalized communities	Calls for centering local ownership & Indigenous data sovereignty [7].
Environmental considerations	Sustainability intersects with equity but beyond GAEP scope [10].
Fear of risk and failure	Risk-mitigation support needed for equity-focused innovation.

Taken together, the core action items, and the barriers summarized above reflect both the immediate priorities and the systemic challenges identified by workshop participants. Building on this momentum, participants outlined a more comprehensive roadmap for action: a set of solutions designed to institutionalize GAEP, address structural obstacles, and enable long-term impact across Canada’s research ecosystem.

Solutions: A Canadian Roadmap for Action

The workshop also proposed a set of solutions, alongside key enabling conditions, to overcome these barriers

Draft a National Consensus Document on GAEP

Building on the foundational White Paper, a National Consensus Document would be co-created through broad consultation with universities, government, civil society, and other stakeholders. This document would codify shared Global Access and Equity Principles (GAEP), establish nationally recognized benchmarks for accountability, and provide a durable framework to guide implementation across Canada’s publicly funded research institutions.
Enhance Institutional Prestige for Global Health Engagement

Position global health leadership as a strategic goal that enhances university reputation and competitiveness. Highlight case studies that demonstrate the value of equity-focused innovation.
Establish a National Coalition of Universities

A national coalition would enable universities to act collectively, presenting a unified voice to policymakers and advocating for systemic change. By coordinating directly with the federal government, the coalition could ensure that health equity goals are embedded in research funding mandates and aligned with international frameworks such as the WHO Pandemic Accord [12].
Center Community-Led Approaches

To ensure that Global Access and Equity Principles (GAEP) are meaningful in practice, innovations must be co-designed with affected communities. Embedding cultural knowledge, local leadership, and community ownership into licensing and implementation processes helps prevent extractive models of research and ensures equitable uptake. Participatory design and co-governance models are not only important for sustainability but also provide accountability mechanisms that align institutional practices with community priorities [13].
Create Systems for Monitoring and Evaluation

Continuous evaluation and risk analysis will ensure initiatives remain effective and accountable. Metrics should include accessibility, affordability, and stakeholder satisfaction.
Increase Public Advocacy and Awareness

Engaging the public through media, podcasts, and civil society platforms can build broad support for equitable access. Public engagement can also pressure institutions and funders to align with GAEP.
Convene a National Working Group

A diverse team of 15–20 representatives from academia, government ministries, and regulatory bodies should develop and oversee GAEP implementation. This group could produce toolkits, training modules, and annual progress reports.
Balance Market and Public Health Interests

Require appropriate access clauses designed to facilitate affordable access to the downstream products, and social impact metrics into contractual agreements concerning intellectual property and the research and development of medical technologies [14]. Play an active role in calling for and supporting utilization of the use of access-oriented conditions in the funding of upstream research by philanthropic and public funders.
Engage Key National Stakeholders

Funding agencies (CIHR, NSERC, SSHRC), regulatory bodies, and ministries must be part of the conversation from the outset to ensure coherence across national policy frameworks.
Enable Flexible Implementation Across Institutions

Universities should have latitude to tailor access strategies both to their institutional context and to the specific characteristics of different products or technologies, while upholding shared principles. This flexibility promotes innovation, accountability, and local ownership.
Leverage Crisis for Systemic Reform

Pandemics and global emergencies offer moments to reshape policy—Canada must seize these opportunities to lead. Recovery planning must include structural changes that promote equity and resilience.

Conclusion

Canada invests over CAD $1.4 billion annually through the Canadian Institutes of Health Research (CIHR) alone, placing its research institutions in a leadership role in advancing global health equity [15]. Building on the momentum of the Global Health Access and Equity Workshop, we urge Canadian universities, research funders, and government bodies to collectively commit to a framework grounded in Global Access and Equity Principles. If we act together with courage, accountability, and collaboration, we can ensure that life-saving Canadian innovations deliver benefits both domestically and globally, advancing health equity for communities at home and abroad.

Health equity must not be a peripheral goal. It must be central to how we define scientific success and national leadership. Canada can (and must) step forward as a global leader in equitable innovation by embedding access and justice into the research lifecycle from the outset.

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