By Victor J. Dzau, Celynne A. Balatbat and Anaeze C. Offodile II
Although the unprecedented speed of development of COVID-19 diagnostics, vaccines, and treatments has been lauded, one shortcoming that persists is vaccine inequity. The global roll-out of vaccines has been uneven, progressing expeditiously in many highincome countries (HICs) and delayed in low-income countries (LICs).
Early in the COVID-19 pandemic, vaccine production was insufficient to meet global demand. Many wealthy countries turned inwards, procuring vaccine doses through exclusive bilateral deals for their domestic populations (vaccine nationalism), and manufacturing countries, such as India, imposed temporary export bans. These events catalysed the global vaccine inequity that is still evident today. During the past 19 months, there has been considerable increase in vaccine production globally with a projected output of 24 billion total doses by mid-2022. Unfortunately, as of May 2, 2022, only 15·7% of eligible individuals in LICs have received a single vaccine dose, largely due to constraints in both availability and absorptive capacity. The focus has now shifted to increasing the distribution of doses to LICs that are purchased directly by respective governments or procured through multilateral initiatives, such as COVID-19 Vaccines Global Access (COVAX) and Access to COVID-19 Tools (ACT) Accelerator. However, these attempts, along with other approaches, such as COVID-19 vaccine dose sparing and time-limited intellectual property (IP) waivers, do not address an underlying structural driver of vaccine inequity: the insufficient number of vaccine manufacturers and the location of their factories predominantly in HICs. In LICs there is a need for access to local capacity for manufactured vaccines that is uncoupled from donated doses or excess production capacity in HICs (vaccine sovereignty).
Read the full article in The Lancet.
