Allocating COVID-19 Vaccines Globally: An Urgent Need

The first coronavirus disease 2019 (COVID-19) vaccines have undergone regulatory approvals in high-income countries. Vaccine producers are delivering the orders they received months ago, prepaid at a price that would guarantee buyers to be first in line. Vaccination campaigns are already underway in these high-income countries. Leaders of the European Commission, France, Germany, United Kingdom, Norway, and Saudi Arabia announced public commitments at the launch of the Access to COVID-19 Tools (ACT) Accelerator in May 2020 to collaborate as one global community united against the pandemic and to regard vaccines as public goods. However, wealthier countries also have successfully put themselves at the front of the supply queue, which will inevitably delay access to COVID-19 vaccines for the vast majority of the global population in less resourced countries.

The platforms designed to distribute COVID-19 vaccines globally have not received enough funding to meet the needs of less wealthy countries. To date, the funding committed through COVAX, the global initiative set up by the World Health Organization to ensure equitable access to new coronavirus vaccines, covers at best 20% of the population in each low- and middle-income country (LMIC), provided that many of the identified risks are successfully addressed and that vaccine deliveries are not redirected to wealthy nations. The World Bank has committed additional funding targeted at the delivery systems required for vaccines for 1 billion people living in LMICs, mainly through loans that these countries will have to repay.

Even if an LMIC could pay the same price paid by wealthy nations (often kept secret as “proprietary commercial information”), it would still find itself at the back of the vaccine queue. Despite the lack of manufacturing capacity by approved producers to meet the global need for COVID-19 vaccines, high-income countries, including the US, European Union, Switzerland, and Japan, have teamed up to reject a proposal to the World Trade Organization by South Africa, Kenya, India, and Eswatini to allow low-income countries to produce these vaccines.¹ The synthetic manufacture of RNA and its ease of production allows new vaccines to be produced up to 10 times faster than conventional vaccine production technologies and uses considerably less resources, space, and capital investment, making vaccine production easier and thus feasible in less wealthy nations.² Owing to the current approach of wealthy countries, however, the vast majority of the global population may wait 2 years or longer before reaching an acceptable level of COVID-19 vaccine coverage.

The current global strategy of COVID-19 vaccine allocation will delay control of viral transmission and result in unnecessary deaths.³ Up to twice as many people could die with the current allocation strategy compared with the adoption of a much more cooperative strategy designed on a global scale. Furthermore, the global economy (including in wealthy nations) is likely to incur significant damage if lower-income countries do not have adequate, prompt, and equitable access to COVID-19 vaccines.⁴

By pooling rights to technologies used for COVID-19 detection, prevention, control, and treatment during the current pandemic, the COVID-19 Technology Access Pool (C-TAP) is a mechanism expressly set up by the World Health Organization to help accelerate the development and manufacturing scale-up of health products needed to fight COVID-19. To date, C-TAP could leverage 18 generic pharmaceutical companies to scale up manufacturing and has been endorsed by 40 countries, including Belgium, Luxembourg, Norway, Portugal, and the Netherlands. Therefore, C-TAP could offer a suitable instrument to make vaccines accessible and affordable as quickly as possible by dramatically improving RNA vaccine manufacturing capacity to meet the global demand. Governments should take proactive action to support C-TAP through national legal and policy measures and international collaboration. Most importantly, the holders of all relevant knowledge, intellectual property, and data should voluntarily share or license these rights to enable widescale and worldwide production, distribution, and use of these technologies.

The current global allocation of COVID-19 vaccines is likely to delay control of the pandemic, causing unnecessary deaths and avoidable economic damages. Scientific evidence is available to support better economic and health outcomes by adopting a cooperative, equitable, and fair distribution of vaccines on a global scale. As India’s ambassador to the World Trade Organization has stated, “While discovering vaccines was a test of science, making them accessible and affordable is going to be a test of our humanity.”⁵

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Li Bassi L. JAMA Health Forum.

Corresponding Author: Luca Li Bassi, MD, DPH, Independent Global Health Professional, Ch Colledon, 1218 Geneva, Switzerland (luca.libassi@mac.com).

Conflict of Interest Disclosures: None reported.