Intended for healthcare professionals

Letters Covid-19: global vaccine coverage

Covid-19: an economic perspective on vaccinating the world

BMJ 2021; 373 doi: (Published 15 June 2021) Cite this as: BMJ 2021;373:n1498
  1. Cam Donaldson, Yunus chair and distinguished professor of health economics,
  2. Olga Biosca, reader in economics
  1. Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
  1. cam.donaldson{at}

The most recent vulnerability of societal structures exposed by covid-19 is the inability of pharmaceutical regulation systems to ensure global vaccine coverage. We are currently seeking to resolve problems related to demand (exacerbated by vaccine nationalism) with alternative solutions such as fair and equitable priority setting,1 none of which helps achieve universal coverage. The solution is to combine priority setting with the other side of the economic equation—supply.23

Vaccines for all, as proposed by prominent campaigns,45 is restricted by patent protectionism in combination with the ability (and willingness) of rich nations, on the demand side, to ensure gross over provision for their own populations—vaccine nationalism. Meagre donations to global initiatives such as Covax, the programme aiming to provide vaccines to the wider world, have resulted.6 (Note, too, the lack of transparency in contracts struck with the pharmaceutical industry, which are likely to result in higher and inequitable pricing than might otherwise be the case.)

Two keys can unlock this.

The first key would require current vaccine producers to waive their patents2 and place their intellectual property in the public domain, at least temporarily, thus unleashing the power of generic drug manufacture to vastly increase supply at greatly reduced prices. Many of the publicly funded scientists behind vaccine development support this.

The second key is an operator to ensure that supply goes to where it is most needed (not demanded). Gavi, the Vaccine Alliance, of which Covax is a part, presents a ready made not-for-profit model for necessary interactions between stakeholders and could ensure manufacturing standards, creation of skilled generic producing jobs in lower income countries, and suitable recompense for patent holding companies.

Such companies would also benefit, along with wider society, from a quicker move to the post-covid world we all crave. Any estimate of the worldwide health and economic benefits of such a proposal far outweighs the costs.7 If we focus on supply side solutions, we can get vaccines done—globally, not nationally.


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