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Alonso Ruiz A, Bezruki A, Shinabargar E, Large K, Vieira M, Slovenski I, Liu Y, Agarwal S, Becker A, Moon S. Which roads lead to access? A global landscape of six COVID-19 vaccine innovation models. Global Health 2024; 20:25. [PMID: 38532484 DOI: 10.1186/s12992-024-01017-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Unequal and inequitable access to Covid-19 vaccines in low- and middle-income countries (L&MICs) was a major political, ethical and public health failure in the pandemic. However, vaccine developers' practices were not monolithic, but rather, took diverse approaches to supplying different countries, with important implications for global access. RESULTS Using data on R&D investments, regulatory approvals, manufacturing and purchase agreements, and vaccine deliveries, we identified six distinct innovation models that apply across the 14 COVID-19 vaccines with more international presence from 2020-2022. "Western Early Arrivers" Pfizer/BioNTech and Moderna supplied the largest volumes quickly and prioritized high-income countries (HICs) from registration to vaccine delivery. "Western Latecomers" Janssen and Novavax supplied intermediate volumes later, also prioritizing HICs but with a greater proportion to L&MICs. "Major Chinese Developers" Sinopharm and Sinovac supplied intermediate volumes early, primarily to middle-income countries (MICs). "Russian Developer" Gamaleya completed development early but ultimately supplied small volumes, primarily to middle-income countries (MICs). "Cosmopolitan Developer" Oxford/AstraZeneca supplied large volumes early to HICs and MICs at the lowest prices. Finally, "Small MIC Developers" CanSino, Bharat Biotech, Medigen, Finlay Institute and the Center for Genetic Engineering and Biotechnology (CGEB), exported relatively small volumes to a few MICs. Low-income countries (LICs) were not targeted by any developer, and received far fewer doses, later, than any other income group. Almost all developers received public funding and other forms of support, but we found little evidence that such support was leveraged to expand global access. CONCLUSIONS Each of the six innovation models has different implications for which countries get access to which vaccines, how quickly, and at which prices. Each offers different strengths and weaknesses for achieving equitable access. Our findings also suggest that Western firms had the greatest capacity to develop and deliver vaccines quickly during the pandemic, but such capacity is rapidly becoming more globally distributed with MICs playing a significant role, especially in supplying other MICs. Given the critical role of public support in enabling pandemic vaccine development and supply, governments have both the capacity and responsibility to craft international rules that will make responses to future pandemics more equitable and effective.
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Affiliation(s)
- Adrián Alonso Ruiz
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland.
| | - Anna Bezruki
- Georgetown University, 3700 O St NW, Washington, DC, 20057, USA
| | - Erika Shinabargar
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Kaitlin Large
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Marcela Vieira
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Iulia Slovenski
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Yiqi Liu
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Surabhi Agarwal
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Anna Becker
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
| | - Suerie Moon
- Global Health Centre, Graduate Institute of International and Development Studies, Chem. Eugène-Rigot 2, Genève, 1202, Switzerland
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Quinn GA, Connolly M, Fenton NE, Hatfill SJ, Hynds P, ÓhAiseadha C, Sikora K, Soon W, Connolly R. Influence of Seasonality and Public-Health Interventions on the COVID-19 Pandemic in Northern Europe. J Clin Med 2024; 13:334. [PMID: 38256468 PMCID: PMC10816378 DOI: 10.3390/jcm13020334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Most government efforts to control the COVID-19 pandemic revolved around non-pharmaceutical interventions (NPIs) and vaccination. However, many respiratory diseases show distinctive seasonal trends. In this manuscript, we examined the contribution of these three factors to the progression of the COVID-19 pandemic. METHODS Pearson correlation coefficients and time-lagged analysis were used to examine the relationship between NPIs, vaccinations and seasonality (using the average incidence of endemic human beta-coronaviruses in Sweden over a 10-year period as a proxy) and the progression of the COVID-19 pandemic as tracked by deaths; cases; hospitalisations; intensive care unit occupancy and testing positivity rates in six Northern European countries (population 99.12 million) using a population-based, observational, ecological study method. FINDINGS The waves of the pandemic correlated well with the seasonality of human beta-coronaviruses (HCoV-OC43 and HCoV-HKU1). In contrast, we could not find clear or consistent evidence that the stringency of NPIs or vaccination reduced the progression of the pandemic. However, these results are correlations and not causations. IMPLICATIONS We hypothesise that the apparent influence of NPIs and vaccines might instead be an effect of coronavirus seasonality. We suggest that policymakers consider these results when assessing policy options for future pandemics. LIMITATIONS The study is limited to six temperate Northern European countries with spatial and temporal variations in metrics used to track the progression of the COVID-19 pandemic. Caution should be exercised when extrapolating these findings.
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Affiliation(s)
- Gerry A. Quinn
- Centre for Molecular Biosciences, Ulster University, Coleraine BT52 1SA, UK
| | | | - Norman E. Fenton
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London E1 4NS, UK
| | | | - Paul Hynds
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability & Health Institute, Technological University Dublin, D07 H6K8 Dublin, Ireland
- Irish Centre for Research in Applied Geoscience, University College Dublin, D04 F438 Dublin, Ireland
| | - Coilín ÓhAiseadha
- Spatiotemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability & Health Institute, Technological University Dublin, D07 H6K8 Dublin, Ireland
- Department of Public Health, Health Service Executive, Dr Steevens’ Hospital, D08 W2A8 Dublin, Ireland
| | - Karol Sikora
- Department of Medicine, University of Buckingham Medical School, Buckingham MK18 1EG, UK
| | - Willie Soon
- Institute of Earth Physics and Space Science (ELKH EPSS), H-9400 Sopron, Hungary
- Center for Environmental Research and Earth Sciences (CERES), Salem, MA 01970, USA
| | - Ronan Connolly
- Independent Researcher, D08 Dublin, Ireland
- Center for Environmental Research and Earth Sciences (CERES), Salem, MA 01970, USA
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Amimo F, Magit A. Measuring income-associated inequalities in COVID-19 vaccination on a global scale: a modeling study. J Public Health Policy 2023; 44:449-463. [PMID: 37604927 DOI: 10.1057/s41271-023-00433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
Inequalities in the accessibility and utilization of quality, safe, and effective coronavirus disease 2019 (COVID-19) vaccines across and within countries limited their value in protecting health during the COVID-19 pandemic. We quantified cross-country, income-associated inequality in COVID-19 vaccination using statistical models based on the data for 79 countries through December 2021. We found notable inequality in vaccinations per capita. At least 11.9% of doses administered in high-income countries could be redistributed to low-income countries to substantially reduce income-associated inequality in vaccinations. The results of this modeling study indicate that reliance on multiple doses of vaccine to attain optimal protection from COVID-19 is a significant contributor to inequality in vaccinations per capita. Dose-sharing mechanisms should account for and include efforts to optimize the capabilities of health systems to deliver vaccines.
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Affiliation(s)
- Floriano Amimo
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
| | - Anthony Magit
- Department of Surgery, University of California San Diego School of Medicine, San Diego, CA, USA
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Zbiri S, Boukhalfa C. Inequality in COVID-19 vaccination in Africa. J Public Health Afr 2023; 14:2353. [PMID: 37680874 PMCID: PMC10481897 DOI: 10.4081/jphia.2023.2353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 09/09/2023] Open
Abstract
Background The COVID-19 pandemic has spread rapidly to all countries with significant health, socioeconomic, and political consequences. Several safe and effective vaccines have been developed. However, it is not certain that all African countries have successfully vaccinated their populations. Objective To study the distribution and determinants of COVID-19 vaccination in Africa from March 2021 to June 2022. Methods Using reliable open-access data, we used the proportion of fully vaccinated people with a complete schedule as a reference variable. To analyze the level of inequality in COVID-19 vaccination, we computed common inequality indicators including two percentile ratios, the Generalized Entropy index, the Gini coefficient, and the Atkinson index. We also estimated the Lorenz curve. To identify drivers of COVID-19 vaccination, we estimated univariate and multivariate regression models as a function of COVID-19-related variables, demographic, epidemiologic, socioeconomic, and health system-related variables. To overcome a potential endogeneity bias, we checked our results using simultaneous equation models. Results 53 African countries with available data were included in the study. The proportion of fully vaccinated people increased during the study period. However, this increase remained unequal across African countries. Based on the inequality indicators and the Lorenz curve, inequalities in COVID-19 vaccination across African countries were high, although they have decreased in recent months. Total COVID-19 cases and human development index were identified as significant determinant factors that were independently associated with COVID-19 vaccination. Conclusions Inequality in COVID-19 vaccination in Africa was high. Promoting adequate information to the general population and providing financial and logistical support to low-income countries can help expand COVID-19 vaccination in Africa.
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Affiliation(s)
- Saad Zbiri
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca
- Laboratory of Public Health, Health Economics and Health Management, Mohammed VI Center for Research and Innovation, Rabat
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Clemens SAC, Clemens R. The need and challenges for development of vaccines against emerging infectious diseases. J Pediatr (Rio J) 2023; 99 Suppl 1:S37-S45. [PMID: 36495947 PMCID: PMC10066445 DOI: 10.1016/j.jped.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To identify and describe learnings from past pandemics and to suggest a framework for vaccine development as part of epi/pandemic readiness. SOURCE OF DATA Articles/ reviews/letters on pandemic preparedness/ vaccines published between 2005 and 2022 in PubMed, MEDLINE, MedRxiv, BioRxiv, Research Square, Gates Open Research; who.int, cepi.net, visualcapitalist.com, airfinity.com, ted.com websites; press releases. SUMMARY OF FINDINGS Disease pandemics caused by emerging pathogens impacted the social development, health and wealth of most societies in human history. In an outbreak, the first months determine its course. To block an exponential spread and the development of an epi/ pandemic early, vaccine availability in sufficient quantities is of paramount importance. It is inevitable that new human viruses will emerge. Any future pandemic will come likely from RNA viruses through zoonotic or vector transmission, but we cannot predict when or where "Disease X" will strike. Public health, scientific and societal readiness plans need to include: continuous identification of new viruses in common mammalian reservoir hosts; continuous epidemiological surveillance, including wastewater sampling; establishment of prototype vaccine libraries against various virus families sharing functional and structural properties; testing of various and innovative vaccine platforms including mRNA, vector, nasal or oral vaccines for suitability by virus family; functional clinical trial sites and laboratory networks in various geographies; more efficient phasing of preclinical and clinical activities; global harmonization and streamlining of regulatory requirements including pre-established protocols; and societal preparedness including combating any pandemic of misinformation. CONCLUSIONS "Outbreaks are unavoidable, pandemics are optional".
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Affiliation(s)
- Sue Ann Costa Clemens
- Department of Pediatrics, Oxford University, Oxford, United Kingdom; Institute for Global Health, University of Siena, Siena, Italy
| | - Ralf Clemens
- International Vaccine Institute (IVI), Seoul, South Korea.
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Aderinto N, Oladipo E, Amao O, Omonigbehin O. Africa vaccinating Africa: Pre- and post-COVID-19 perspectives, challenges, future prospects, and sustainability. J Glob Health 2023; 13:03006. [PMID: 36701375 PMCID: PMC9879556 DOI: 10.7189/jogh.13.03006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
| | - Elizabeth Oladipo
- Department of Medical Laboratory Science, Federal Neuropsychiatric Hospital, Lagos, Nigeria
| | | | - Oyinkansola Omonigbehin
- Department of Medical Laboratory Science, University of Abuja Teaching Hospital, Abuja, Nigeria
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Borges LC, Zeferino de Menezes H, Crosbie E. More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry's Role in Widening the Access Gap. Int J Health Policy Manag 2022; 11:3101-3113. [PMID: 36028975 PMCID: PMC10105197 DOI: 10.34172/ijhpm.2022.6942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND An effective response to the coronavirus disease 2019 (COVID-19) pandemic entails a comprehensive strategy that ensures equitable access to all COVID-19-fighting technologies. To achieve this goal, the international community has acknowledged immunization as a public good. However, a trend of grossly unequal dose distribution emerged, owing, among other factors, to pharmaceutical companies' profit-driven actions, jeopardizing the mechanisms built to increase vaccine access. The contradiction between public health interests and corporate discretion in determining vaccine dose distribution poses critical concerns about the health risks associated with lengthening the duration of the pandemic and the eventual liability of companies for violations of human rights. METHODS To evaluate the risks posed to the COVID-19 immunization program, data on vaccine allocation and delivery, vaccine dose application, immunized populations, and the volume of Advanced Purchase Agreements (APAs) between countries and pharmaceutical companies were compiled and assessed. A descriptive analysis was then conducted to analyze the role of pharmaceutical companies in providing equitable access to COVID-19 vaccines. RESULTS When the data is broken down by income (as of June 2021), it shows that high-income countries (HICs) have already crossed the COVID-19 Vaccine Global Access (COVAX) 20% immunization threshold. However, countries of all other income levels have yet to achieve this mark for fully vaccinated people. Upper-middle-income countries (UMICs) have approximately 3%, low- and middle-income countries (LMICs) have approximately 2% and low-income countries (LICs) have less than 0.1% of fully vaccinated people per hundred. The supply shortage is expected to last until the second half of 2021. CONCLUSION As a result of the COVAX failure, a health gap emerged with countries living in a pre-immunization period for an extended time. The existing conflict between the international response to tackle COVID-19 and corporate profit-driven behavior contributed to prolonging pandemic, especially in Africa. Accordingly, there is a need to approve an international treaty that targets the activities of all actors, including the pharmaceutical companies, in protecting human rights and the right to health realms.
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Affiliation(s)
| | | | - Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, NV, USA
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
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Shanker A, Tsagkaris C. 4 COVID-19 Ds to remember when approaching Monkeypox. Ann Med Surg (Lond) 2022; 82:104491. [PMID: 36065430 PMCID: PMC9434952 DOI: 10.1016/j.amsu.2022.104491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 10/25/2022] Open
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