Competitive interdependence: A critical political economy of regulation during the COVID-19 pandemic.

This article investigates Canada's health product regulatory authority, Health Canada (HC), and other major national regulators' responses to COVID-19. Drawing on semi-structured interviews with HC officials and secondary data on the activities of other major regulators, including the European Medicines Agency, the United Kingdom's Medicines and Healthcare Products Regulatory Agency, and the United States Food and Drug Administration, we show that during COVID-19 product evaluations, HC and other regulatory authorities adopted a strategy of increased collaboration and competition with one another. We term this strategy a pattern of 'competitive interdependence.' Using a critical political economy (CPE) approach, we argue that regulatory authorities employed the strategy to mediate increased structural tensions between capitalism and democracy engrained in health product regulation. The CPE approach, informing our analysis of competitive interdependence, highlights the dialectical nature of health product regulation. In light of our data, we demonstrate the regulators' role in upholding capitalism at both the national and global levels while also organizing popular consent by generating public trust in the safety and efficacy of medicines.