The quest for more effective vaccine markets – Opportunities, challenges, and what has changed with the SARS-CoV-2 pandemic

The past two decades have seen important progress in access to timely, reliable, affordable, and quality-assured supplies of vaccines of global public health importance. The new vaccines developed are powerful tools to fight killers such as pneumonia, diarrhea, and cervical cancer. Global and regional financing and pooled procurement have shortened the lag between access in high- and lower-income countries. The COVID-19 pandemic has shown that by addressing shortcomings and seizing opportunities, we can do even more. In response to COVID-19, vaccine development and access shifted from a sequential, risk-averse paradigm to a rapid approach with maximum compression of time to market while ensuring quality. Vast public investments and innovative technologies were key facilitators. The pandemic has shown that governments play a crucial role in investing in new vaccines and manufacturing capacity and sharing risks with industry. Despite impressive progress, equity in access remains elusive with important moral, economic, and health-related consequences. Global leaders are working on a new International Treaty for Pandemic Prevention, Preparedness, and Response. To apply the lessons of COVID-19, that treaty should include a new paradigm for access to vaccines in which governments agree to: (1).. establish early sharing of information about emerging outbreaks and early, evidence-informed strategic goals and leadership that serve the collective global health interest. (2).. shoulder risks and invest aggressively to address the needs of today and prepare for future emergencies. (3).. strengthen market preparedness by investing in new vaccine technologies, regional research, development and manufacturing hubs, and insurance; by enabling regulatory harmonization; by driving market transparency and oversight; and by ensuring that where public funds are invested there is a contractual obligation to ensure access. (4).. define principles and operational details for collaboration in times of scarcity that enable countries to protect their own citizens while ensuring that no country is left behind. This would ensure that COVID-19 catalyzes a shift toward greater access for all under Immunization Agenda 2030.