Towards Innovation for All: Building Equitable Global Innovation Systems for Infectious Disease Outbreaks

Infectious diseases continue to pose a persistent and disproportionate threat to global health, with low- and middle-income countries (LMIC) bearing the greatest burden. While advances in vaccines, diagnostics, and therapeutics have transformed the landscape of infectious disease control, the global response to outbreaks remains hampered by critical gaps in innovation, systemic vulnerabilities, and persistent inequities in access and participation. The COVID-19 pandemic, in particular, exposed the limitations of current innovation systems and underscored the urgent need for more inclusive, resilient, and responsive approaches. This dissertation addresses the central research question: How can global innovation systems be strengthened to address the challenges posed by infectious disease outbreaks in a way that promotes equity, particularly for low- and middleincome countries? To answer this, the research builds on Innovation Systems Theory (IST) and Global Innovation Systems (GIS), and - integrating insights from inclusive innovation frameworks - applies a systems-thinking perspective to examine how actors, institutions, and policies interact across domains. A multi-method, case-based research design was employed, combining quantitative analyses - such as meta-analyses and patent and clinical trial mapping - with qualitative methods including stakeholder interviews and policy reviews. Case studies were selected to reflect diverse contexts and challenges, focusing on recent outbreaks (MERS, Ebola, Zika, COVID-19) and technologies (e.g., rapid diagnostics, vaccine manufacturing), with emphasis on LMIC settings. Key findings reveal that global innovation systems consistently struggle to address the specific health needs of LMIC due to misaligned R&D investments, limited local participation, and persistent exclusion from research leadership and intellectual property ownership. R&D priorities remain skewed toward commercially profitable conditions, leaving high-burden diseases in LMIC underfunded. LMIC actors are frequently relegated to roles in data collection and clinical trials, with minimal influence over research agendas or benefit-sharing. The centralisation of vaccine and diagnostic production creates supply chain vulnerabilities and delays, while the institutional environment - including restrictive IP regimes and geopolitical contestation - often reinforces inequities by prioritising the interests of established actors. Crucially, these barriers are not isolated but interconnected through reinforcing dynamics and hypothesized feedback loops: exclusion from leadership can reinforce misaligned priorities, which in turn can weaken local capacity, while fragile production and restrictive policy environments may sustain cycles of dependency. By systematically mapping these barriers across multiple domains and highlighting their interrelatedness within and between them, this dissertation provides a comprehensive analysis of why global innovation systems fall short of delivering equitable health solutions. The findings underscore the need for realigning R&D priorities with regional disease burdens, structurally including LMIC actors in all stages of the innovation process, decentralizing manufacturing, and reforming policy frameworks, including the more explicit integration of equity. Taken together, these results suggest that sustainable improvements require systemic transformation: addressing reinforcing feedback loops across domains is likely to be critical to making global innovation systems more effective, resilient, and inclusive.