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Developing a safe, effective COVID-19 vaccine alone will not be enough to end the pandemic—the vaccine must also be delivered globally at a price affordable to all governments and allocated in a way that maximises public health impact and achieves equity.
These goals are being threatened as rich nations enter into bilateral purchase agreements with COVID-19 vaccine manufacturers, potentially hoarding the global supply.
It is impossible to stop these bilateral deals—the best we can achieve is to find ways to configure these deals to also benefit the new COVID-19 Vaccine Global Access Facility (COVAX), which aims to guarantee equitable access to COVID-19 vaccines worldwide.
A game theory analysis suggested ways in which bilateral deals could potentially improve the global supply of vaccines, for example, if the manufacturer involved in the deal shares know-how or if the deal expands the global supply of critical inputs that might otherwise constrain production of COVAX vaccines.
Introduction
Progress in developing COVID-19 vaccines has been rapid: the first clinical trial of a vaccine candidate began in Seattle, USA on 16 March 2020—just 63 days after China shared the genetic sequence of SARS-CoV-2, the virus that causes COVID-19. As of 12 November 2020, there were 48 candidate vaccines in clinical trials.1 Given standard attrition rates, we can expect at least a handful of COVID-19 vaccines to eventually be launched.
However, developing a safe, effective vaccine alone will not be enough to end the pandemic. The vaccine must also be delivered globally at a price affordable to all governments and allocated in a way that maximises immediate and long-term public health impact and simultaneously achieves equity. In previous pandemics, these goals were not achieved. For example, in the 2009 influenza A (H1N1) pandemic, rich countries monopolised the vaccine supply; low-income countries (LICs) and middle-income countries (MICs) received …
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