Intended for healthcare professionals

Letters Covid-19: Equitable global vaccination

Failure to achieve global vaccine equity will have dire consequences

BMJ 2021; 372 doi: (Published 19 March 2021) Cite this as: BMJ 2021;372:n712
  1. Andrew Goldstein, assistant professor, primary care physician
  1. New York University School of Medicine, Bellevue Hospital, 462 1st Avenue, Ambulatory Care, New York, NY, 10016, USA
  1. andrewdgoldstein{at}

I appreciate Hurley’s call for internationally equitable vaccination, which makes a clear case on the grounds of both altruism and self-interest.1 Many rich and powerful countries are donating vaccine doses through Covax. But these doses—in the order of hundreds of millions—are too little and too slow.

With a global population of 7.7 billion people, vaccine acquired herd immunity is likely to require at least 12 billion doses. Current production estimates put us on pace to reach that target in many years rather than many months. To get to the number of doses humanity needs on a faster timeline, production must be greatly expanded. This seems to be beyond the capacity of the patent holding drug companies and those to which they are willing to license production. Given the emergency and catastrophic nature of this pandemic, rich and powerful countries, and the global institutions they control, must do more.

Firstly, they must use the World Trade Organization’s trade related intellectual property rights (TRIPS) waiver to free vaccine intellectual property so that other entities can manufacture these vaccines.23 Secondly, because these are somewhat novel and expensive production processes, they must use the World Health Organization’s covid-19 technology access pool to share vaccine production knowledge and to fund increased production.45

Failing to take these steps risks moral culpability for millions of preventable deaths, case resurgences in highly vaccinated countries caused by travel to and from under vaccinated countries, variants with vaccine resistance that threaten our pandemic endgame strategy, and economic shockwaves for all globally. These risks could extend the duration of the pandemic worldwide and worsen the toll of death and suffering. The medical community can support campaigns advocating for policies for global vaccination equity such as the People’s Vaccine Alliance (, the Médecins Sans Frontières Access Campaign ( ), and their partners.


  • Competing interests: None declared.

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