Keele University.
Milbank Q. 2021 Jun;99(2):426-449. doi: 10.1111/1468-0009.12503. Epub 2021 Mar 2.
Policy Points Equitable access to a COVID-19 vaccine in all countries remains a key policy objective, but experience of previous pandemics suggests access will be limited in developing countries, despite the rapid development of three successful vaccine candidates. The COVAX Facility seeks to address this important issue, but the prevalence of vaccine nationalism threatens to limit the ability of the facility to meet both its funding targets and its ambitious goals for vaccine procurement. A failure to adequately address the underlying lack of infrastructure in developing countries threatens to further limit the success of the COVAX Facility.
Significant effort has been directed toward developing a COVID-19 vaccine, which is viewed as the route out of the pandemic. Much of this effort has coalesced around COVAX, the multilateral initiative aimed at accelerating the development of COVID-19 vaccines, and ensuring they are equitably available in low- and middle-income countries (LMICs). This paper represents the first significant analysis of COVAX, and the extent to which it can be said to have successfully met these aims.
This paper draws on the publicly available policy documents made available by the COVAX initiatives, as well as position papers and public statements from governments around the world with respect to COVID-19 vaccines and equitable access. We analyze the academic literature regarding access to vaccines during the H1N1 pandemic. Finally, we consider the WHO Global Allocation System, and its principles, which are intended to guide COVAX vaccine deployment.
We argue that the funding mechanism deployed by the COVAX Pillar appears to be effective at fostering at-risk investments in research and development and the production of doses in advance of confirmation of clinical efficacy, but caution that this represents a win-win situation for vaccine manufacturers, providing them with opportunity to benefit regardless of whether their vaccine candidate ever goes on to gain regulatory approval. We also argue that the success of the COVAX Facility with respect to equitable access to vaccine is likely to be limited, primarily as a result of the prevalence of vaccine nationalism, whereby countries adopt policies which heavily prioritize their own public health needs at the expense of others.
Current efforts through COVAX have greatly accelerated the development of vaccines against COVID-19, but these benefits are unlikely to flow to LMICs, largely due to the threat of vaccine nationalism.
在所有国家实现公平获得 COVID-19 疫苗仍然是一个关键政策目标，但以往大流行病的经验表明，尽管三种成功的疫苗候选者迅速开发，发展中国家的获得途径仍将受到限制。COVAX 基金旨在解决这一重要问题，但疫苗民族主义盛行可能会限制该基金实现其资金目标和为疫苗采购制定的雄心勃勃目标的能力。未能充分解决发展中国家基础设施不足的根本问题，可能会进一步限制 COVAX 基金的成功。
为开发 COVID-19 疫苗投入了大量努力，人们认为这是摆脱大流行的途径。这项工作的大部分都集中在 COVAX 上，这是一个旨在加速 COVID-19 疫苗开发并确保在中低收入国家（LMICs）公平获得疫苗的多边倡议。本文代表了对 COVAX 的首次重大分析，以及可以说它在多大程度上成功地实现了这些目标。
本文借鉴了 COVAX 倡议提供的公开政策文件，以及世界各地政府就 COVID-19 疫苗和公平获得问题发表的立场文件和公开声明。我们分析了有关大流行性流感 H1N1 期间疫苗可及性的学术文献。最后，我们考虑了世卫组织全球分配系统及其旨在指导 COVAX 疫苗部署的原则。
我们认为，COVAX 支柱所采用的供资机制似乎有效地促进了对研发的高风险投资，并在临床疗效得到确认之前提前生产疫苗剂量，但我们警告说，这对疫苗制造商来说是一个双赢局面，无论其疫苗候选者是否获得监管批准，都为他们提供了获益的机会。我们还认为，COVAX 基金在公平获得疫苗方面的成功可能会受到限制，主要是因为疫苗民族主义盛行，各国采取的政策优先考虑本国的公共卫生需求，而牺牲了其他国家的利益。
通过 COVAX 进行的当前努力极大地加速了针对 COVID-19 的疫苗开发，但这些好处不太可能流向 LMICs，主要是因为疫苗民族主义的威胁。
