COVID-19 vaccine equity: a health systems and policy perspective

ABSTRACT

Introduction

The global COVID-19 vaccine rollout has highlighted inequities in the accessibility of countries to COVID-19 vaccines. Populations in low- and middle-income countries have found it difficult to have access to COVID-19 vaccines.

Areas covered

This perspective provides analyses on historical and contemporary policy trends of vaccine development and immunization programs, including the current COVID-19 vaccination drive, and governance challenges. Moreover, we also provide a comparative health system analysis of the COVID-19 vaccine deployment in some countries from different continents. It recommends that the international Access to COVID-19 Tools Accelerator (ACT-A) partnership requires a strong governance mechanism and urgent financial investment.

Expert opinion

All WHO member states should agree on technology transfer and voluntary license-sharing via a commonly governed technology access pool and supported by a just Intellectual Property regime. Contextualized, dynamic understandings and country-specific versions of health systems strengthening are needed to improve vaccine equity in a sustainable matter.

KEYWORDS:

• ACT-A
• capacity development
• COVID-19 pandemic
• vaccine equity
• low-income countries
• research & development ecosystem
• Tanahashi health systems framework
• technology transfer
• TRIPS

Article highlights

• Vaccine development for childhood diseases has been advanced over the last 50 years via agencies such as UNICEF, WHO, and Gavi, but for pandemic vaccine development and rollout international cooperation and governance modalities require strengthening and finance.

• The current international property regime, limited technology transfers, as well as preexisting health systems capabilities and resources are hindrances for vaccine manufacturers to produce COVID-19 vaccines in several regions across the globe, notably in lower-income countries. This provides a risk for vaccine availability, affordability, and the global pandemic response.

• Applying the Tanahashi health systems framework for vaccine coverage indicates that countries across the globe do, and will continue to, face challenges in scaling up national COVID-19 vaccination strategies and implementation.

• After two decades of pandemic viral vaccine development, there is still no global, institutional, and legal framework that regulates R&D, manufacturing, pricing, procurement, and allocation. This requires immediate attention and proposals in the wake of the pandemic.

• International mechanisms like the COVAX facility, Access to COVID-19 Tools Accelerator (ACT-A), and the COVID-19 Technology Access Pool (C-TAP) require enforcement that are aligned with a fair and supportive Intellectual Property Regime, that allows for technology transfer, regional manufacturing, and rapid responsiveness to extraordinary situations including in lower-income countries.

• Inclusive and adaptive public health approaches, with their use of diverse sources of knowledge, disciplines, and capabilities will be more effective to meet the 21st-century challenges of pandemic diseases. A contextualized, dynamic understanding and country-specific version of health systems strengthening are needed to improve vaccine and health equity in a sustainable matter.

• COVID-19 vaccine rollout is the most powerful immediate strategy to control the pandemic, support economic recovery, and ensure access to essential vaccination products as a human right. Pandemic vaccination should be considered a global public good.

Reviewer disclosures

A reviewer on this manuscript is a member of the Joint Committee on Vaccination & Immunisation (JCVI), but does not participate in policy decisions on COVID19 vaccine. They are also a member of the WHO’s SAGE, and an investigator on clinical trials of Oxford University’s COVID19 vaccine funded by NIHR. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Acknowledgments

Ritwik Dahake, for scientific editing.

Notes

1. World Bank country income classifications are applied throughout the article: https://datahelpdesk.worldbank.org/knowledgebase/articles/906,519-world-bank-country-and-lending-groups

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.