Achieving Equitable Access to Medicines and Health Services: a COVID-19-time Recalled Matter

Document Type : Review Paper


1 Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.

2 Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

3 Evidence-Based Evaluation of Cost-Effectiveness and Clinical Outcomes Group, Pharmaceutical Sciences Research Center (PSRC), and the Pharmaceutical Management and Economics Research Center (PMERC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.

4 Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.



In the 21st century, while some people seek to use artificial intelligence for health services delivery, others have to surrender their health rights to meet basic needs. The gradient in health has become more pronounced in the COVID-19 crisis considering discrepancies in disease prevalence, geographical accessibility, availability, affordability, quality/safety of health services, and human resources. Through PubMed, GoogleScholar, Scopus, WHO, OECD, and UN databases, the English documents and global statistics were collected. Determining the role of health equity-related factors and introducing mechanisms to maintain regional and international justice in health, specifically during the COVID-19 pandemic, were among the core concepts of this paper. Social determinants of health (SDH), interregional and intraregional bodies are the main drivers of discrimination in health services. Governments should relish chief health strategists' role in possessing legitimacy, accountability, direction, transparent performance, fairness, and good governance in one word. Improving health literacy and telemedicine, providing income support, and reforming insurance where needed, are other national mechanisms to amend inequity. Among interregional issues, what is concerning is the matter of sanctions on access to health services, which is against the Universal Declaration of Human Rights. Shortage of vital medications, ventilators, test kits, COVID-19 vaccines, pharmaceutical raw materials, foreign currency, decreased national currency value, purchasing power parity, and quality/safety of health services resulted from such oppression. The article also provides practical suggestions, paving the way for re-establishing global solidarity and developing health justice in deprived regions.

Graphical Abstract

Achieving Equitable Access to Medicines and Health Services: a COVID-19-time Recalled Matter


(1)        WHO. Health Equity Policy Tool. A framework to track policies for increasing health equity in the WHO European Region – Working document (2019). 2019 [cited 2021 10 July]; Available from: centre/events/events/2019/06/healthy,-prosperous-lives-for-all-in-the-european-region-high-level-conference-on-health-equity/documents/technical-and-policy-documents/health-equity-policy-tool.-a-framework-to-track-policies-for-increasing-health-equity-in-the-who-european-region-working-document-2019.
(2)        WHO. Total population pushed below the $1.90 a day poverty line by household health expenditures. 2021 [cited 2021 17 July]; Available from:
(3)        Kokabisaghi F. Assessment of the Effects of Economic Sanctions on Iranians' Right to Health by Using Human Rights Impact Assessment Tool: A Systematic Review. Int. J. Health Policy Manag. (2018) 7: 374-93.
(4)        Karimi A and Turkamani HS. U.S.- Imposed Economic Sanctions on Iran in the COVID-19 Crisis From the Human Rights Perspective. Int. J. Health Serv. (2021) 51: 570-2.
(5)        Cioffi A and Cioffi F. COVID-19 vaccine: Risk of inequality and failure of public health strategies. Ethics Med. Public Health (2021) 17: 10065.
(6)        Afzali M, Khorasani E, Alvandi M, Sabbagh-Bani-Azad M, Sharif Z, Saiyarsarai P and Nikfar S. Providing a framework for assessment of the access to medicine. DARU J. Pharm. Sci. (2019) 27: 243-54.
(7)        Hanefeld J, Reeves A, Brown C and Östlin P. Achieving health equity: democracy matters. Lancet (2019) 394: 1600-1.
(8)        WHO. Healthy, prosperous lives for all: the European Health Equity Status Report (2019). 2019 [cited 2021 10 July]; Available from:
(9)        Ndumbe-Eyoh S, Muzumdar P, Betker C and Oickle D. 'Back to better': amplifying health equity, and determinants of health perspectives during the COVID-19 pandemic. Glo. Health Promot. (2021) 28: 7-16.
(10)      WHO. Governance for health equity (2014). 2014 [cited 2021 10 July]; Available from:
(11)      Ivers LC and Walton DA. COVID-19: Global Health Equity in Pandemic Response. Am. J. Trop. Med. Hyg. (2020) 102: 1149-50.
(12)      WHO. Indicator 3.8.1: Coverage of essential health services: Universal Health Coverage index. 2021 [cited 2021 14 July]; Available from:
(13)      WHO. Health equity and its determinants. 2021 [cited 2021 10 July]; Available from:
(14)      WHO. Monitoring health inequality: an essential step for achieving health equity. 2014 [cited 2021 08 July]: Available from:
(15)      Benjamin GC. Ensuring health equity during the COVID-19 pandemic: the role of public health infrastructure. Rev. Panam. Salud. Publica (2020) 29: 70.
(16)      Smith JA, Wells L, Gelbart L and Lawson T. Beyond COVID-19: Consumers call for greater focus on health equity. Health. Promot. J. Austr. (2021) 32: 3-5.
(17)      Thronson LR, Jackson SL and Chew LD. The Pandemic of Health Care Inequity. JAMA Netw. Open (2020) 3: 2021767
(18)      Ghiasvand H, Mohamadi E, Olyaeemanesh A, Kiani MM, Armoon B and Takian A. Health equity in Iran: A systematic review. Med. J. Islam. Repub. Iran (2021) 35: 51.
(19)      Johnson S.B. Advancing Global Health Equity in the COVID-19 Response: Beyond Solidarity. J. Bioeth. Inq. (2020) 17: 703-7.
(20)      Siker ML, Deville C Jr, Suneja G and Winkfield K. Lessons From COVID-19: Addressing Health Equity in Cancer Care. Int. J. Radiat. Oncol. Biol. Phys. (2020) 108: 475-8.
(21)      Loree JM, Anand S, Dasari A, Unger JM, Gothwal, Ellis LM, Varadhachary G, Kopetz S, Overman MJ and Raghav K. Disparity of Race Reporting and Representation in Clinical Trials Leading to Cancer Drug Approvals From 2008 to 2018. JAMA Oncol. (2019) 5: 191870.
(22)    Duma N, Vera Aguilera J, Paludo J, Haddox CL, Gonzalez Velez M, Wang Y, Leventakos K, Hubbard JM, Mansfield AS, Go RS and Adjei AA. Representation of Minorities and Women in Oncology Clinical Trials: Review of the Past 14 Years. J. Oncol. Pract. (2018) 14: 1-10.
(23)      Dastafkan R, Salehi H and Hooshmand MM. Provision of Peace and Right to Health through Sanctions: Threats and Opportunities. Arch. Iran. Med. (2020) 23: 43-8.
(24)      Ayati N, Saiyarsarai P and Nikfar S. Short and long term impacts of COVID-19 on the pharmaceutical sector. DARU J. Pharm. Sci. (2020) 28: 799-805.
(25)      Takian A, Kiani MM and Khanjankhani K. COVID-19 and the need to prioritize health equity and social determinants of health. Int. J. Public. Health (2020) 65: 521-3.
(26)      Data OWI. Statistics and Research: Coronavirus (COVID-19) Vaccinations. 2021 [cited 2021 05 July]; Available from:
(27)      WHO. Vaccine inequity undermining global economic recovery. 2021 [cited 2021 23 July]; Available from:
(28)      Mousavi T and Abdolahi M.The Economic Status of OIC Member States During and After the COVID-19 Pandemic. (2021) 29: 10-14.
(29)      Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, Hertzman C, Kelly MP, Kjellstrom T, Labonté R, Lundberg O, Muntaner C, Popay J, Sen G and Vaghri Z. Priorities for research on equity and health: towards an equity-focused health research agenda. PLoS. Med. (2011) 8: 1001115.
(30)      Hudspeth J and Morse M. Health Information and Global Health Inequity: Point-of-Care Knowledge Systems as a Foundation for Progress. J. Gen. Intern. Med. (2017) 32: 572-5.
(31)      Economic, U.N.D.o. and S. Affairs. World Economic Situation and Prospects 2021. 2021 [Cited 2021 18 July]; Available from:
(32)      WHO. Countries. 2021 [cited 2021 17 July]; Available from:
(33)      Bank TW. World Bank Country and Lending Groups. 2020 [cited 2021 17 July]; Available from:
(34)      WHO. Current health expenditure (CHE) as percentage of gross domestic product (GDP) (%). 2021 [cited 2021 10 July]; Available from:
(35)      OECD. 2017 PPP Benchmark results. 2021 [cited 2021 18 July]; Available from:
(36)      WHO. Countries that have passed legislation on Universal Health Coverage (UHC). 2017 [cited 2021 10 July]; Available from: