Which roads lead to access? A global landscape of six COVID-19 vaccine innovation models

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.

Keywords: COVID-19; Equity; Global access; Global health; Innovation; Innovation models; Pandemics; Pharmaceuticals; Public R&D funding; Research and development; Vaccines.

Fig. 1

Selection process

Fig. 2

R&D investments for the selected COVID-19 vaccine developers

Fig. 3

Value of declared advance purchase agreements of selected COVID-19 vaccines

Fig. 4

Distribution of regulatory approvals for each vaccine. The Y-axis represents days since the approval of the first vaccine globally (Sputnik V in Russia)

Fig. 5

Total number of vaccine approvals by innovation model and income level

Fig. 6

Number of manufacturing agreements by income level of the manufacturing partner’s country

Fig. 7

Type of manufacturing agreements

Fig. 8

Doses committed and purchase agreements. Left axis (bar chart) shows the number of doses committed. Right axis (X’s) shows the number of purchase agreements

Fig. 9

Share of vaccines committed by income level of purchasing country

Fig. 10

Time distribution of vaccine agreements. Axis Y shows the number of days since the first purchase agreement signed by each vaccine developer

Fig. 11

Doses by income group of the recipient country

Fig. 12

Timeline of vaccine deliveries for each innovation model and income level of recipient country. Doses are shown relative to the income group’s population for comparability

Fig. 13

Cumulative deliveries relative to the population of the income group in 2021 and 2022. The left side includes all countries. Right side excludes deliveries in China and India

Fig. 14

Vaccine deliveries by type of delivery mechanism

Fig. 15

Average prices per dose per vaccine by income level