Structural Inequity and the Architecture of Failure: A Critical Analysis of Global Vaccine Governance During the COVID-19 Pandemic- An Integrated Scoping Review and Multi-Method Case Study

The COVID-19 pandemic exposed deep structural inequalities within the architecture of global health governance, particularly in access to vaccines and other essential medical countermeasures. This study critically examines the institutional, legal, political, and economic determinants of global vaccine inequity, with particular attention to the COVAX Facility, African procurement and manufacturing initiatives, intellectual property regimes, and national public health capacity. A qualitative multi-method case study design was employed, integrating process tracing, comparative historical analysis, Most Similar Systems Design, and thematic document analysis. Data were drawn from peer-reviewed literature, policy documents, institutional reports, and official statements published between 2001 and 2025. From 1,504 initially identified records, 127 documents were included in the final analysis. Findings indicate that COVAX's failure was structurally embedded in its voluntary financing model, limited enforcement authority, bilateral advance purchase agreements, and the dominance of high-income countries in global vaccine markets. Comparison with the 2009 H1N1 pandemic demonstrates the persistence of voluntary governance failures, while the HIV/AIDS antiretroviral experience illustrates how clear legal provisions, particularly the Doha Declaration, can facilitate access through compulsory licensing and generic production. African initiatives, including the African Vaccine Acquisition Trust and Partnerships for African Vaccine Manufacturing, represent important advances in procurement and production sovereignty, although dependence on external financing, technology, and intellectual property remains significant. The Nigeria-South Korea comparison further demonstrates that strong domestic institutions can improve surveillance, testing, and response capacity but cannot independently overcome global vaccine allocation constraints. The study concludes that vaccine inequity is not merely a logistical or supply problem but a structural consequence of unequal global governance. It recommends legally binding allocation quotas, mandatory technology and know-how transfer, sustainable assessed financing, independent compliance mechanisms, pre-negotiated regional manufacturing rights, and stronger African manufacturing and regulatory integration.