Intended for healthcare professionals

Letters Financing covid-19 mRNA vaccines

Public investment in the development of vaccines: providing equitable access around the world

BMJ 2023; 381 doi: (Published 06 April 2023) Cite this as: BMJ 2023;381:p743
  1. Julia Barnes-Weise, executive director1,
  2. Laura Hoemeke, adjunct professor2,
  3. Bridie Telford, development director1
  1. 1Global Healthcare Innovation Alliance Accelerator (GHIAA), PO Box 14713, Research Triangle Park, NC 27709, USA
  2. 2University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
  1. jbw{at}

Lalani and colleagues’ paper on US public investment in mRNA covid-19 vaccines1 introduces important considerations for actions to support equitable access to publicly funded vaccines and other medical products. Several recent articles have similarly proposed attaching access related conditions to public funding.234 Lacking in the literature published to date, however, is a thorough discussion of what these conditions should be and the practicalities of implementation through both national policies and agreement provisions.

Public funding must, from the outset, aim to support global—not just national—interests. And this mindset must be sustained, globally, from product development funding through to procurement of the final product. Attaching equitable access conditions to development funding will not have the intended effect if high income countries buy most of the product supplies for their own national use, effectively restricting the supplies available for equitable distribution, as was often the case with covid-19 vaccines.5

Governments must tackle equitable access in policies, provisions, and planning, starting with early stage research. Early research funding agreements should establish obligations to plan for equitable access throughout the product development and commercialisation processes. Such planning requires consideration of the commitments needed to achieve equitable access and the partnerships (such as voluntary licensing agreements) that can best facilitate that process.

A range of contract provisions must work together to support equitable access including, but not limited to, product pricing, supply commitments, appropriate product profiles, data sharing, and management of intellectual property rights.6 To be effective, equitable access obligations must be further supported by contract provisions that allow for enforcement and monitoring,6 and they must flow through from initial funding to all subsequent agreements that could affect the affordability, availability, and accessibility of resulting products.

This only touches the surface of the actions needed to ensure equitable access to medical products. Attaching conditions to public funding is just one piece of a bigger picture requiring a collaborative global effort that encompasses all aspects of product innovation, development, manufacturing, approval, supply, administration, and engagement.


  • Competing interests: GHIAA has received funding from the Wellcome Trust for the creation of access resources and guidance for funders (grant no 225262/Z/22/Z).