key: cord-0920979-anqh7jm1
authors: Torres, Irene; Lopez-Cevallos, Daniel; Artaza, Osvaldo; Profeta, Barbara; Kang, JaHyun; Machado, Cristiani Vieira
title: Vaccine scarcity in LMICs is a failure of global solidarity and multilateral instruments
date: 2021-05-13
journal: Lancet
DOI: 10.1016/s0140-6736(21)00893-x
sha: 8417f6d19bf8687e789e0374d5bd5ddf0168640a
doc_id: 920979
cord_uid: anqh7jm1

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www.thelancet.com Vol 397 May 15, 2021

To address COVID-19 vaccine scarcity, Ivan Sisa and colleagues 1 justify placebo-controlled trials in lowincome and middle-income countries (LMICs), arguing that these countries have "less capacity to negotiate and purchase vaccines than do highincome countries" and that the global shortage can be overcome with more vaccine producers coming from such trials. We are concerned that this reasoning sets the wrong precedent because approving such a trial should show that evidence can only be reached with this design. 2 Furthermore, LMICs should not ignore the urgent need to increase production and distribution 3 of already efficacious vaccines.

In the interest of saving people's lives, vaccine development demands working towards improved capacities on the road from discovery (free of patent restrictions) to manufacturing and equitable distribution. Therefore, clinical trials should be done simultaneously, engaging volunteers and researchers across a broad range of LMICs and high-income countries. Furthermore, study protocols should provide robust assurances that participants will have access to the vaccine when their priority group is eligible in the general population. Finally, emphasis should be made on other pressing issues, such as adopting low dead space syringes to prevent discarding residues, thus improving vaccine volume. 4 Ensuring efficacious vaccines are made widely available and at fair cost, when high-income countries are hoarding up to five times what they need 5 and prices are speculative, would require making alliances with countries (eg, Brazil or India) with the capacity to produce generic vaccines, alongside efficient syringes, and means of storage and transportation. Notwithstanding, LMICs will need support from additional partners in other regions of the world.

We declare no competing interests. The global COVID-19 vaccine roll-out might be the largest public health exercise ever done. COVAX, the vaccines access pillar of the COVID-19 Tools Accelerator, supported by WHO, UNICEF, and others, expects to deliver two billion doses to 190 countries in 1 year. At present, 13 vaccines have received approval in various jurisdictions. The roll-out provides an opportunity, unparalleled in human history, to learn about vaccines.

Global Medicine (MW) and Division of General Internal Medicine (LS)

USA (WL); Center for International Health

The sociology of health and illness: critical perspectives, 7th edn

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