. 2023 May 15;23:890. doi: 10.1186/s12889-023-15709-5

Table 2.

Four elements of analysis, applied across a case example of a deliberative dialogue study on vaccine nationalism

Example The Solidarity for Vaccine Equity (SOLVE) study uses deliberative dialogue to learn from the role of vaccine nationalism in hindering more equity-responsive approaches to global health governance (https://www.solve-study.ca/).
Worldview How is the world understood and described? Who are the actors within it? How does power work within it?	Study analyzed the worldview as portrayed by the Government of Canada, through an in-depth analysis of publicly available policy documents. Particular narratives of Canada in the world were identified, and situated in the context of policy actions proposed and taken. Observations were made during global governance proceedings on the worldviews advanced by different actors involved in the World Health Organization’s Intergovernmental Negotiating Body (WHO-INB) in the elaboration of a new pandemic instrument/treaty/accord (known as WHO CA+).	Document analysis unfolded alongside scholar activism, with the SOLVE Study research team gaining designated stakeholder status with the WHO-INB. Results emerging from policy analysis and deliberative dialogue were used to guide equity- and evidence-informed contributions to the INB proceedings for the development of the conceptual zero draft and continued through to offering interventions in proceedings after the release of the zero draft of the proposed instrument or treaty/accord (titular language for which is yet to be negotiated).
Coherence How coherent is the logic between what is proposed and the evidence about inequities? How coherent is what is said with what is done?	Alignment between rhetorical statements made by the Government of Canada and actual policy directions were mapped out as part of the policy analysis. Coherence in Canada’s policy trajectory was further assessed by examining the ways in which pandemic-related inequities were portrayed. This analysis was extended to iterative drafts of the proposed WHO CA+, evolving through the WHO-INB proceedings.	Demonstrations of incoherence between a rhetoric of equity and Canada’s actual policy actions were highlighted in a number of different settings, including national and international forums that included policy makers (e.g., lead author Plamondon delivered a keynote presentation entitled “Holding onto equity in a political ecology of nationalism, capitalism, and neocolonialism” at the March 2023 Government of Canada Pandemic Instrument Partner & Stakeholder Engagement Forum). Line-by-line review of drafts of the pandemic treaty identified points of incoherence and provided specific recommendations on how to promote greater coherence. These reviews were submitted to the WHO-INB for consideration in successive iterations of the proposed WHO CA + and guided interventions delivered at proceedings of the WHO-INB (see: https://www.solve-study.ca/reports-publications). Research team members attended all four sessions for the WHO CA + informal, focused consultations (IFC) Sept-Oct 2022 and provided real-time comments to highlight implications for equity coherence and equity potential.
Potential What impact will action have on known causes of inequities?	As with coherence, Canada’s policy actions were analyzed in the context of the evidence on known causes of inequities for their possible impacts. This analysis involved monitoring of relevant data and literature as it became available (e.g., global distribution of vaccines; modelling on deaths averted due to access to vaccines). Given the WHO CA + emphasis on the new instrument as centering equity as a driving principle and primary outcome, we extended the same analysis of possible equity impacts to iterative drafts.
Accountability How is knowledge of power inequities responded to (particularly by those with more power)?	Accountability, in this study, is a central question guiding deliberative dialogues. For each gathering, we posed (and continue to pose) questions about when collective obligations to humanity supersede obligations to protect state-based rights and interests. All participants exposed to these dialogues receive documents naming the pre-existing contexts of inequity in which the pandemic unfolded and its direct impacts on amplifying inequities. These materials summarize the evidence that demonstrates prioritization of profits and lives for those living high-income countries. The study invites people to consider their own spheres of influence as part of the dialogic process.	Accountability, as a concept, is the guiding star for this study and all analytic and action-focused activities as described throughout table (e.g., engagement with stakeholders in deliberative dialogues, participation in the WHO INB proceedings including contributions to iterative drafts of WHO CA+) are done with the ultimate aim to ensure those in positions of power (e.g., Government of Canada, WHO INB, individuals within their own spheres of influence) act with accountability to those who have less power during a pandemic.

Example
The Solidarity for Vaccine Equity (SOLVE) study uses deliberative dialogue to learn from the role of vaccine nationalism in hindering more equity-responsive approaches to global health governance (https://www.solve-study.ca/).

SEA Framework Element

Description of analytic content and processes

How analysis was accompanied by action

Worldview

How is the world understood and described? Who are the actors within it? How does power work within it?

Study analyzed the worldview as portrayed by the Government of Canada, through an in-depth analysis of publicly available policy documents. Particular narratives of Canada in the world were identified, and situated in the context of policy actions proposed and taken.

Observations were made during global governance proceedings on the worldviews advanced by different actors involved in the World Health Organization’s Intergovernmental Negotiating Body (WHO-INB) in the elaboration of a new pandemic instrument/treaty/accord (known as WHO CA+).

Document analysis unfolded alongside scholar activism, with the SOLVE Study research team gaining designated stakeholder status with the WHO-INB. Results emerging from policy analysis and deliberative dialogue were used to guide equity- and evidence-informed contributions to the INB proceedings for the development of the conceptual zero draft and continued through to offering interventions in proceedings after the release of the zero draft of the proposed instrument or treaty/accord (titular language for which is yet to be negotiated).

Coherence

How coherent is the logic between what is proposed and the evidence about inequities? How coherent is what is said with what is done?

Alignment between rhetorical statements made by the Government of Canada and actual policy directions were mapped out as part of the policy analysis. Coherence in Canada’s policy trajectory was further assessed by examining the ways in which pandemic-related inequities were portrayed.

This analysis was extended to iterative drafts of the proposed WHO CA+, evolving through the WHO-INB proceedings.

Demonstrations of incoherence between a rhetoric of equity and Canada’s actual policy actions were highlighted in a number of different settings, including national and international forums that included policy makers (e.g., lead author Plamondon delivered a keynote presentation entitled “Holding onto equity in a political ecology of nationalism, capitalism, and neocolonialism” at the March 2023 Government of Canada Pandemic Instrument Partner & Stakeholder Engagement Forum).

Line-by-line review of drafts of the pandemic treaty identified points of incoherence and provided specific recommendations on how to promote greater coherence. These reviews were submitted to the WHO-INB for consideration in successive iterations of the proposed WHO CA + and guided interventions delivered at proceedings of the WHO-INB (see: https://www.solve-study.ca/reports-publications).

Research team members attended all four sessions for the WHO CA + informal, focused consultations (IFC) Sept-Oct 2022 and provided real-time comments to highlight implications for equity coherence and equity potential.

Potential

What impact will action have on known causes of inequities?

As with coherence, Canada’s policy actions were analyzed in the context of the evidence on known causes of inequities for their possible impacts. This analysis involved monitoring of relevant data and literature as it became available (e.g., global distribution of vaccines; modelling on deaths averted due to access to vaccines).

Given the WHO CA + emphasis on the new instrument as centering equity as a driving principle and primary outcome, we extended the same analysis of possible equity impacts to iterative drafts.

Accountability

How is knowledge of power inequities responded to (particularly by those with more power)?

Accountability, in this study, is a central question guiding deliberative dialogues. For each gathering, we posed (and continue to pose) questions about when collective obligations to humanity supersede obligations to protect state-based rights and interests. All participants exposed to these dialogues receive documents naming the pre-existing contexts of inequity in which the pandemic unfolded and its direct impacts on amplifying inequities. These materials summarize the evidence that demonstrates prioritization of profits and lives for those living high-income countries.

The study invites people to consider their own spheres of influence as part of the dialogic process.

Accountability, as a concept, is the guiding star for this study and all analytic and action-focused activities as described throughout table (e.g., engagement with stakeholders in deliberative dialogues, participation in the WHO INB proceedings including contributions to iterative drafts of WHO CA+) are done with the ultimate aim to ensure those in positions of power (e.g., Government of Canada, WHO INB, individuals within their own spheres of influence) act with accountability to those who have less power during a pandemic.