This evidence synthesis has been compiled by members of the CITF Secretariat and does not necessarily represent the views of all CITF members.

By Alexis Palmer-Fluevog

In a Science commentary, journalists Jon Cohen and Kai Kupferschmidt highlight the ongoing health inequities in the global vaccine rollout while laying out a roadmap for moving forward. The authors begin by exploring the moral and ethical argument of equitable vaccine delivery and quickly move to what we already know: none of us are safe until we are all safe. The authors then outline four ways in which sustained global vaccine coverage can be made a reality: commitments to COVAX; an increase in vaccine production; knowledge sharing; and an investment in building vaccine production facilities worldwide. As wealthy countries begin to gain control over COVID-19, lower income countries remain in the grips of the pandemic. How the global community chooses to act will have lasting implications for global health and security.


In his May 24st 2021 address to the World Health Assembly, Director-General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus called attention to the growing inequity in global vaccine rollout. This was in reference to the fact that more than 75% of all vaccines manufactured globally have only been distributed to 10 countries, all of which are high-income. He brought to light that countries that “vaccinate children and other low-risk groups now, do so at the expense of health workers and high-risk groups in other countries.” In this Science article, journalists Jon Cohen and Kai Kupferschmidt acknowledge the inequities in vaccine rollout and map out four ways to move forward. They argue that in order for COVID-19 to be controlled globally, all regions of the world must have vaccine access. Should COVID-19 be allowed to go unchecked in any region, the risk of the virus being reintroduced along with dangerous variants exists for all of us.

Key points for ensuring equitable vaccine access:

  • Sustained commitment to COVID-19 Vaccines Global Access (COVAX)
  • Increased production of vaccines
  • Knowledge sharing
  • Investment in production facilities worldwide


The COVID-19 crisis has exposed already existing inequities in a stark manner. COVAX was designed as an initiative to ensure that all countries have access to the vaccines. The authors note that almost every country in the world has signed up for COVAX, and yet, the commitments remain to be fulfilled. They highlight that a recent report from the Independent Panel for Pandemic Preparedness and Response recommends that wealthy countries donate 1 billion doses to COVAX by 1 September 2021 and another billion by mid-2022.

Increasing production is a logical way to ensure that vaccines are available, but there are currently not enough manufacturers to operate plants. Companies are working to increase their production pace, but there have been challenges in acquiring raw materials, such as disposable bags that line bioreactors, filters, and cell-culture media. The authors point to a document that suggests that, without any setbacks, 14 billion vaccines could be produced before the end of the year.

The authors also discuss the importance of knowledge sharing to boost vaccine output. In an attempt to foster the sharing of technical know-how and intellectual property, the WHO launched the COVID-19 Technology Access Pool (C-TAP). C-TAP has yet to be embraced by vaccine developers, but the authors argue that this will be vital to increasing access. The authors also discuss the importance of India and South Africa’s request to the World Trade Organization to issue a broad-reaching waiver for patents and other intellectual properties that pertain to “prevention, containment or treatment of COVID-19.”

With COVID-19 and future health crises, having additional manufacturing plants will be greatly beneficial. The authors discuss how manufacturing is concentrated in certain areas of the globe, which sustains power within limited regions. Building capacity globally across various regions of the world will ensure that needs are met in a timely and equitable manner everywhere. In light of the current pandemic, what is being proposed is vaccinating everyone on the planet: this has never been done before and will require commitment, collaboration, and creativity.


Cohen J, Kupferschmidt K.  Rich countries cornered COVID-19 vaccine doses. Four strategies to right a ‘scandalous inequity’. Science. 2021 May 26.