Context

The COVID-19 pandemic has had a catastrophic effect on low- and middle-income countries (LMICs) and placed an enormous burden on weak health systems while disrupting other essential public health services. The COVID-19 pandemic has highlighted the inequitable distribution of new vaccines and therapeutics, which has resulted from several factors. The unavailability of capacity to immediately scale up production, patchy supply chain infrastructure, and weak health systems have contributed to the global disparity in vaccine procurement. Additionally, early purchase of most available stock by high-income countries’ authoritarian bids left little for international procurement for LMICs.

Product delivery

Pharmaceutical companies, having rapidly developed vaccines, treatments, and diagnostics for COVID-19, have launched several key vaccines and therapeutics directly targeting COVID-19. The report assessed the sale of three COVID-19 vaccines through the COVID-19 Vaccines Global Access (COVAX) programme promoting equitable global access to COVID-19 vaccines. Further, voluntary licensing agreements have enabled access to affordable medicines for expansion in LMICs. Pharmaceutical companies have a public health responsibility to ensure people have equitable access to COVID-19 products by taking steps both during drug development and after products are launched on the market. Finally, effective steps towards equitable pricing and supply mechanisms for innovative products must align with the public health needs of LMICs.

Product delivery – Vaccines

Astrazeneca has been in the forefront performing best in the field of technology transfer, with technology transfers of its vaccine across more than 15 countries, reflecting the sources of funding for the vaccine. This was also attributed to the fact that 97% of the funding for research and development (R&D) of Astrazeneca’s vaccine came from public and charitable contributions. To ensure transparency of supranational procurement agreements, future pandemics mandates must consider supranational treaty clauses to include equitable distribution access and pricing and transparent global access.

Product delivery – Licensing

Voluntary licensing agreements are an effective strategy, which can facilitate generic supply, expand availability and affordability, and enable low-income countries to produce low-price medicines that are re-purposed for adjacent diseases. Examples of licensing agreements include transferring intellectual property (IP) rights to a licensee, enabling them to produce generic versions of their product under certain conditions. However, voluntary licensing agreements for COVID-19 products have limited effectiveness posing access barriers. For example, vaccine manufacturing remains concentrated in select few countries, including India, South Africa, and Brazil. This poses an impact on the sizeable low-income populations that can only access the more expensive branded version of the drug, without the option of a more affordable generic version.

Research and development

Investment in R&D is critical for the development of products targeting diseases that have epidemic or pandemic potential. The WHO has compiled a list of priority emerging infectious diseases (EIDs) that pose the greatest public health risk due to their epidemic potential, such as Lassa fever that requires a preventative vaccine that does not exist. Although companies responded quickly by developing COVID-19 vaccines and therapeutics, five out of the 20 companies in scope of the report engage in R&D efforts for EIDs other than COVID-19 and have no projects in development for 13 out of 17 priority EIDs. This indicates product gaps remain unaddressed, creating a disparity that leaves considerable population groups vulnerable. Hence, the report recommends actors collaborate and increase awareness of their roles and responsibilities towards pandemic preparedness.