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Fairer financing of vaccines in a world living with COVID-19
  1. Itamar Megiddo1,
  2. Justice Nonvignon2,
  3. Richmond Owusu2,
  4. Kalipso Chalkidou3,4,
  5. Abigail Colson1,
  6. Mohamed Gad3,
  7. Petra Klepac5,6,
  8. Francis Ruiz3,4,
  9. Alec Morton1
  1. 1 Department of Management Science, University of Strathclyde, Glasgow, UK
  2. 2 School of Public Health, University of Ghana, Legon, Ghana
  3. 3 Global Health Development group, Imperial College London School of Public Health, London, UK
  4. 4 Center for Global Development Europe, Washington, London, UK
  5. 5 Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, LSHTM, London, UK
  6. 6 Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Itamar Megiddo; itamar.megiddo{at}strath.ac.uk

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Summary box

  • The COVID-19 pandemic has disrupted routine and campaign-based vaccination, potentially increasing the future vaccine-preventable disease burden and threatening to overwhelm health systems.

  • Vaccine-preventable diseases are transboundary problems that require global cooperation to achieve the best outcomes.

  • Investments, predominantly by rich countries—in effect transfers to poor countries—are required as part of the financing solution. Theoretical advances show how such funds can be operationally prioritised and disbursed equitably. Such transfers are also in the interest of high-income countries, and cooperation achieves better outcomes than strategies such as travel restrictions for vaccine-preventable diseases.

  • Similar cooperation and financing issues will arise if and when it is time to distribute a COVID-19 vaccine.

The COVID-19 pandemic underscores that infectious disease is a global challenge. For many infectious diseases, vaccines are the best tools available for control and elimination. Vaccines helped eliminate smallpox and reduce annual measles deaths from 2.6 million before widespread vaccination to 140 000 in 2018.1 Vaccines avert two to three million deaths annually, and they are often touted as one of the most cost-effective health interventions.1 Since infectious diseases do not recognise borders, vaccine deployment requires global cooperation to achieve the best outcomes.

Presently, many countries have halted vaccination programmes and campaigns, including for measles and polio, where vaccination has had transformative impact on the burden of disease. Gavi estimates that at least 13.5 million people are missing vaccinations, and that will rise as the pandemic continues.2 Hence, the burden of vaccine-preventable diseases will increase as a consequence of COVID-19: this is especially true in low-income and middle-income countries (LMICs), which already suffer from a greater infectious disease burden than high-income countries and where the pandemic could, as elsewhere, overwhelm health systems that have a lower capacity. Sustaining routine vaccination programmes in Africa, for example, is estimated to prevent 140 deaths for every …

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