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Addressing inequity in vaccine access

As G20 health ministers meet in Yogyakarta on June 20-21 to continue to tackle COVID-19 and prepare for future pandemics, there is an opportunity to learn lessons and ensure we fight future outbreaks more effectively than we did the last one.

One of the major successes in the COVID-19 response has been without doubt the development and deployment of vaccines in a timespan previously unimaginable. With SARS-CoV-2 spreading to all corners of the world, killing almost 2 million people in 2020, speed was a driving force in achieving this success. What was missed however, was imperative to secure global access to these products once they became available.

As of June 2022, approximately 65 percent of the world’s population had received at least one dose of a COVID-19 vaccine; among low-income countries the rate averaged 15 percent

Support for initiatives like COVAX, set up to distribute vaccines more equitably, came late, and vaccination rates in low-income countries remain low. As of June 2022, approximately 65 percent of the world’s population had received at least one dose of a COVID-19 vaccine; among low-income countries, the rate averaged 15 percent. Low vaccination rates remain a key risk to extending the pandemic, not least through the emergency of new COVID-19 variants.

This inequity didn’t have to happen. There are models of responses to other infectious diseases prior to COVID-19 that offered a template on how to respond to pandemics more equitably.

In the response to ongoing major epidemics like HIV/AIDS, tuberculosis, and malaria, as well as other neglected infectious diseases, innovative public-private partnerships were created several decades ago to develop vaccines, medicines, diagnostics and other health technologies to make these products accessible to people most impacted by these diseases, notably in low-resource settings.

The assets, expertise and global partnerships of Product Development Partnerships (PDPs), combined with their ability to work end-to-end across the R&D continuum, from discovery to access, can enhance preparedness for and response to future pandemics. PDPs products have reached more than 2.4 billion people around the world, often in low-resource settings and PDP partners are working to tackle the COVID-19 response, such as FIND, the global diagnostics alliance co-chairing the diagnostics pillar for the ACT-Accelerator, or IAVI’s work to apply its vaccine platform to develop a COVID vaccine that is particularly suited for use in low-resource settings.

Beyond developing products that can be used and accessed globally, strengthened and sustained health R&D and innovation systems in low- and middle-income countries will be needed for a more equitable response to future pandemics. Much of those efforts to date have focused on building manufacturing facilities in Africa, with the African Centres for Disease Control and Prevention aiming to locally manufacture 60 percent of Africa’s vaccine needs by 2040. Those efforts are urgently needed — a major contributor to vaccine access inequity was the large dependency of countries in Africa on vaccine supply from the U.S. and Europe, with Africa only having one manufacturing plant in South Africa.

A major contributor to vaccine access inequity was the large dependency of countries in Africa on vaccine supply from the U.S. and Europe, with Africa only having one manufacturing plant

Ensuring that new manufacturing capacity becomes sustainable will require a coordinated effort across the region, taking into account current and future vaccines needs, not only for COVID-19, but also for other major infectious disease risks in Africa, such as tuberculosis, for which several vaccines are in late-stage development. Importantly, not all vaccines will utilize mRNA technology, emphasizing the need for diversified manufacturing capabilities in addition to having localized manufacturing capabilities.  

Beyond manufacturing, strengthened health and health innovation systems need to consider laboratory and clinical research infrastructure, as well as regulatory capacity to enhance surveillance, epidemiology, product development and evaluation. The importance of clinical trials capacity was recognized in the recent 75th WHO World Health Assembly through an adopted resolution put forward by the U.K. and Argentina.

Clinical trial capacity is not the only challenge – many countries in Africa harbor robust and experience clinical trials sites and networks, for example to evaluate experimental vaccines against infectious diseases such as HIV, tuberculosis and malaria. Yet only 15 of 309 completed COVID-19 vaccine studies worldwide were in the African region[1]. Greater engagement in vaccine development in Africa and regions globally will ensure that these products can be effective in the context of locally circulating viruses or other pathogens and in people with diverse health and immune status, while building greater trust in these products and enabling access once they are proven safe and effective.

Sustainability will be key. To ensure health R&D systems for pandemic preparedness offer durable resilience, they should be developed, strengthened and supported to respond to ongoing, emerging and future pandemics, creating an innovation ecosystem able to address global health challenges broadly. For example, strengthening clinical trial capacity to enable late-stage development of promising new TB vaccines creates a path towards the rapid development of new vaccines in the advent of a new infectious disease outbreak.

As leaders worldwide and at the upcoming G20 Health ministerial meetings are advancing the creation of a new global financing facility for pandemic preparedness and response, there is an urgent need to create the necessary incentives and resources to support health systems and health R&D systems in an integrated way. Stimulating and accelerating the development of vaccines, treatments, diagnostics, and other health technologies to tackle emerging epidemics. Ensuring that they can be produced at scale, priced affordably and allocated globally so that they are available wherever and whenever needed.  Without it, we cannot be secure from future pandemics. 



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