Power and Distribution in Global Health Governance Since at least the 1980s, private actors and market-based mechanisms have played an increasingly important role in the provision of public goods and services and the pursuit of public policy objectives in general. A market approach is also widely used in the field of public health. In effect, the PPP approach, as illustrated by COVAX, can work to structurally protect the interests of (a majority) of the high-income countries. While PPPs in global health may do a lot of good things, their private law, contractualist nature and structures safeguard formal state sovereignty and voluntarism, predominantly benefitting high-income donor countries
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