Geopolitical Conflicts as Emerging Determinants of Access to Medicines in Low- and Middle-Income Countries
Abstract
Geopolitical conflicts, including armed conflict, economic sanctions, trade restrictions, and financial disruptions, increasingly shape access to medicines in low- and middle-income countries (LMICs). This conceptual policy commentary examines the pathways through which geopolitical pressures affect pharmaceutical systems and argues that they should be recognized as structural determinants of medicine access. Existing evidence indicates that disruptions to global pharmaceutical supply chains, banking and payment channels, logistics networks, and procurement systems can increase costs, delay deliveries, and intensify medicine shortages. These effects are particularly severe in import-dependent LMICs with limited domestic manufacturing capacity and may compromise continuity of care and widen existing health inequities. Strengthening pharmaceutical-system resilience requires the integration of geopolitical risk assessment into pharmaceutical policy, diversification of suppliers and procurement routes, development of strategic stockpiles, expansion of regional pooled procurement, and support for local production of active pharmaceutical ingredients and generic medicines. Stronger global and regional governance mechanisms are also needed to safeguard humanitarian exemptions and promote equitable access during crises. Integrating geopolitical analysis into pharmaceutical policy and health-systems research can support more anticipatory, resilient, and equitable responses in LMICs.
Keywords: geopolitical conflict; access to medicines; pharmaceutical supply chains; economic sanctions; health-system resilience; low- and middle-income countries.
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