Urgent needs of low-income and middle-income countries for COVID-19 vaccines and therapeutics

Tracking the safety and effectiveness of different COVID-19 vaccines over time in various populations and settings will necessitate improvements in pharmacovigilance.14 Regulatory authorities in many LMICs need to be strengthened and could benefit from a programme of national and international support, as well as regional cooperation and reliance mechanisms.15 As part of internationally coordinated actions, COVID-19 technologies should be transferred to LMIC-based manufacturers, accompanied by regulatory guidance. Efforts to boost local manufacturing capacity in LMICs will contribute to equity, global solidarity, and global health security. India and South Africa have called for the suspension of intellectual property rights related to COVID-19 vaccines to improve access for LMICs, a move now supported by many other countries, but opposed by the pharmaceutical industry, which cites the disincentive to innovation.16
There are further challenges. Governments in LMICs with strong private health sectors, as those in high-income countries, will need to manage the inherent potential for inequity, whereby the rich could access COVID-19 vaccines before individuals with less access to private care who may be at increased risk of severe disease and death, such as older people and those with comorbidities. LMICs affected by war, civil conflict, economic crises, or natural disasters, or with large refugee populations or populations with special needs or vulnerabilities need additional support for vaccines and vaccination under extremely difficult operational conditions.
Re-examining global governance structures, including the UN and its Security Council, is much needed so that the voices and interests of billions of people in LMICs are better represented and recognised. Global support to multilateral institutions is essential to sustain their support to LMICs to facilitate vaccinations globally. The COVID-19 pandemic shows that no nation can stand alone. We are all part of a common humanity that requires us to respect our diverse experiences, cultures, and countries and forge partnerships that better serve the interests of all.
MEB and PH are developers of a COVID-19 vaccine construct, which was licensed by Baylor College of Medicine to Biological E Ltd, a commercial vaccine manufacturer for scale-up, production, testing, and licensure. JPF and GK are members of the WHO SAGE Working Group on COVID-19 vaccines. SG has a ChAdOx1 nCoV-19 patent application licensed to AstraZeneca. MH is Founder and Managing Director of SaudiVax. JHK reports personal fees from SK biosciences. GK is an Independent Director of Hilleman Laboratories Private Limited and Vice Chair of the Board of CEPI. HL reports grants and honoraria for training talks from GlaxoSmithKline, and grants and honoraria from Merck as a member of the Merck vaccine confidence advisory board, outside the submitted work. TS reports grants from National Institute of Allergy and Infectious Diseases, research contracts from GlaxoSmithKline, research contracts from ViiV Healthcare, and grants from Fast Grants. SS reports grants from the US Department of Defense, Bloomberg Foundation, State of Maryland, Ansun, Astellas, Cidara, F2G, T2, Shire, Shionogi, and Scynexis; personal fees from Acidophil, Amplyx, Janssen, Karyopharm, Intermountain Health, and Immunome; grants and personal fees from Merck, Reviral outside the submitted work. All other authors declare no competing interests. The authors’ views and opinions in this Comment do not necessarily represent the views, decisions, or policies of the institutions, universities, or health systems with which they are affiliated. We thank Jeffrey Sachs, Chair of the Lancet COVID-19 Commission, and Yanis Ben Amor, member of the Secretariat of this Commission, for their invaluable review and feedback.
University of the West Indies, Mona, Kingston, Jamaica (JPF); Texas Children’s Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA (MEB, PH); Médecins Sans Frontières, Rio de Janeiro, Brazil (CB); Koc University Research Center for Infectious Diseases, Istanbul, Turkey (OE); Jenner Institute, Nuffield Department of Medicine, Oxford University, Oxford, UK (SG); Middle East Technical University, Ankara, Turkey (MG); College of Medicine, King Saud University, Riyadh, Saudi Arabia (MH); International Vaccine Institute, Seoul, South Korea (JHK); University of Houston College of Medicine, Houston, TX, USA (BL); London School of Hygiene & Tropical Medicine, London, UK (HL, AW-S); ISGlobal-Barcelona Institute for Global Health-Hospital Clinic-University of Barcelona, Spain (DN); University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA (TS); Johns Hopkins University School of Medicine, Baltimore, MD, USA (SS); Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany (NS-W); Drugs for Neglected Diseases Initiative, Geneva, Switzerland (NS-W); Center for Global Development, Washington, DC, USA (PY); Harvard Medical School, Boston, MA, USA (PY); Christian Medical College, Vellore, India (GK)
Source : Lancet