The pursuit of equity in COVID-19 policy and policymaking: A qualitative systematic review.

Background: The COVID-19 pandemic produced a devastating and unequal effect on global population health and wellbeing. Although research demonstrated multiple COVID-19 inequalities, the pursuit of equity (to address unfair inequalities) remained politically contested and overshadowed by higher priority crisis responses. It is essential to learn from these experiences to inform future crisis responses and anticipate the lack of proportionate and sustained attention to inequalities. We seek to understand how COVID-19 equity research defines this policy problem, offers solutions, and considers their feasibility in complex and political policy processes. Methods: We conducted a qualitative systematic review (2024) to identify peer reviewed journal articles on COVID-19, policymaking, and equity in three databases (Web of Science, Scopus, Proquest). We sought articles providing a non-trivial reference to policymaking concepts, including 55 texts that meet the inclusion criteria, and adding 30 texts by snowballing. We used an immersive and inductive approach to identify key themes and show how the use of policy concepts and theories informs an overall narrative of COVID-19 equity research. Results: This research documents the unequal impact of the COVID-19 pandemic and policy, then identifies potential policy solutions and some hopes that governments will support them. However, it highlights a major gap between this aspiration for change versus political reality, and identifies barriers to the production and use of lessons for future crises. Conclusion: Most governments appear to have learned few lessons about inequalities from their COVID-19 experiences. The literature suggests that most governments will contribute to very similar unfair inequalities in their responses to the next crisis.