One lesson from COVID-19: Achieving equitable vaccines distribution globally

A more equitable global distribution of vaccines can benefit the world, while a multilateral benefit-sharing instrument needs to be developed to remove some of the disincentives for early equitable vaccine distribution globally.
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The conclusion from our recent Nature Communications article (Wang et al.) is that a more equitable and balanced global distribution of vaccines would benefit the world from both a public-health perspective and an economic perspective. The take-home message from this article is that rich countries that do not produce vaccines, hold the keys to obtaining globally-balanced vaccine distribution – where vaccine doses are distributed globally according to the needs (defined as the number of citizens in the risk groups in each country). In this scenario, the non-vaccine-producing rich countries need to transfer some of their economic gains resulting from their equitable vaccine distribution strategy to the vaccine-producing countries to provide the vaccine-producing countries with incentives to choose equitable and globally balanced vaccine distribution strategies themselves. Such an international supply-chain benefit-sharing mechanism needs to be developed to motivate vaccine-producing countries to share their vaccines in the early stage of the pandemics.

A supply chain is a connected system of organizations, activities, information, and resources designed to source, produce, and move goods from origination to a destination. The interconnected nature of global supply chains implies the cascading consequences of pandemic interventions across countries, highlighting the need for international collaboration. In reality, however, as demonstrated during the COVID-19 pandemic, there are severe weaknesses in the international system regarding global vaccine distribution, with many low-income countries having only around 10% vaccine coverage during the pandemic.

In our recent Nature Communications article, we analysed the socioeconomic benefits of various idealized COVID-19 vaccine distribution strategies by linking epidemiological and socioeconomic modelling frameworks (Fig. 1 in Wang et al.). We analysed three public health and socioeconomic outcomes: health gains from vaccination (lives saved), lockdown-easing effects from vaccination, and supply-chain rebuilding benefits from vaccination (Fig. 2 in Wang et al.).

Our results show, the vaccine-producing countries will, obviously, prefer the “Producer-first” strategy whereas all other countries will prefer the “Balanced” vaccine distribution strategy (Box 1). However, the global total benefit under the “Balanced” distribution strategy is 6.9% higher than under the “Producer-first” strategy, which highlights that there is room for improvement through international cooperation. If the high-income non-producing countries transfer some of their benefits through the “Balanced” vaccine distribution strategy, the vaccine-producing countries will obtain sufficient incentives for adopting the “Balanced” vaccine distribution strategy (Box 2).

Our results emphasize the importance of equitable vaccine distribution in controlling global pandemics, supporting economic recovery, and rebuilding more internationally balanced supply chains. We further demonstrate that, in order to facilitate the development of such global international collaboration, international benefit-sharing mechanisms need to be developed which remove disincentives for globally equitable vaccine distribution.

Box 1 | Vaccination-benefits under “Producer-first” and “Balanced” scenarios

The vaccination-related benefits of the vaccine-producing countries (VPC), high-income non-producing countries (HNPC), and low-income non-producing countries (LNPC) are 5.31, 2.23, and 0.55 trillion US dollars, respectively, under the “Producer-first” scenario, totalled 8.09 trillion US dollars. While the benefits for the three groups change to 4.58, 3.23, and 0.84 trillion US dollars, respectively under the “Balanced” scenario, totalled 8.65 trillion USD.

The health gains and lockdown-easing effect for vaccine-producing countries in the “Balanced” scenario are substantially reduced due to sharing more vaccines with others in the early stage of the pandemics. Three types of benefits of HNP and LNP will, however, increase a lot from the “Producer-first” scenario to the “Balanced” scenario. Without any benefit-sharing mechanism, vaccine-producing countries are, of course, more willing to choose the “producer-first” mode which is most beneficial to themselves, while other countries have no option but to accept an unequal distribution of vaccines.

 

Box 2 | A potential international supply-chain benefit-sharing mechanism

In a benefit-sharing mechanism, high-income non-producing countries can share part of the additional benefits gained through applying the “Balanced” scenario (e.g., 0.87 trillion US dollars) with vaccine-producing countries in order to motivate vaccine-producing countries to choose the “Balanced” scenario. If the extra cost is less than 1.00 (=3.23-2.23) trillion US dollars, high-income non-producing countries are willing to do so because their benefits will be greater than the benefit in the “Producer-first” scenario after they have paid the cost (still 5.8% higher than under “producer first” scenario).

Meanwhile, if the transfer is greater than 0.73 (=5.31-4.58) trillion US dollars, vaccine-producing countries will choose the “Balanced” scenario because their benefits will exceed those from the “Producer-first” scenario (2.6% higher than under the “Producer-first” scenario). The error bar on the columns shows the range the amount of benefit sharing should adhere within to achieve the “Balanced” equilibrium.

 

Achieving equitable vaccine distribution is challenging

Our quantitative results show that the global COVID-19 vaccination benefits are $8.09 and $8.65 trillion U.S. dollars, respectively, under the “Producer-first” mode and the “Balanced” mode. The benefits of the vaccine-producing countries[1] under the two modes, however, are $5.31 and $4.58 trillion U.S. dollars (Fig. 3b in Wang et al.). These results clearly show why the global COVID-19 vaccine distribution tends to be the “Producer-first” mode rather than the “Balanced” mode, if only economic benefits are considered[2]. Vaccine-producing countries are, of course, more likely to choose the “Producer-first” mode which is most beneficial to themselves, while other countries have no option but to accept an unequal distribution of vaccines.

A benefit-sharing mechanism will facilitate global cooperation

To facilitate a globally balanced distribution of vaccines, we proposed a multilateral benefit-sharing mechanism (Box 2; Fig. 3c & d in Wang et al.). Through the mechanism, high-income non-producing countries can donate vaccine aid via a coordination platform to seek a globally equitable distribution of vaccines; vaccine-producing countries deliver vaccines to the platform and obtain corresponding financial returns; and middle- and low-income countries can actively cooperate through the platform in completing vaccine delivery and capacity building.

We show a potential win-win situation with the proposed benefit-sharing mechanism. In this scenario, vaccination gains for vaccine-producing countries, high-income non-vaccine-producing countries, and low- and middle-income countries increase by 2.6%, 5.8%, and 52.7%, respectively. The benefit sharing mechanism leads all of the countries to another equilibrium point: a balanced distribution mode.

Priority strategies for domestic vaccine distribution to maximize benefits

We also emphasize the importance of considering externalities when designing domestic vaccine allocation strategies to optimize economic recovery. It reveals that prioritizing the elderly (65 years and above) and the workforce in high-exposure industries (such as transportation, accommodation, and catering) provides the highest economic benefits. Prioritizing the elderly results in more lives saved and higher health gains due to their higher infection-mortality rate (Fig. 4 in Wang et al.). After vaccinating the elderly, focusing on high-exposure workforce sectors leads to higher economic benefits through lockdown-easing effects and supply-chain rebuilding. This prioritization creates positive spill-over effects to other production sectors due to inter-sectoral linkages, particularly in well-developed economies with tight associations among domestic sectors (Fig. 4 in Wang et al.).

Concluding remarks

Altogether our study demonstrates the importance of equitable vaccine distribution, which has significant socioeconomic benefits and promotes global economic recovery through spill-over effects in supply chains. It emphasizes the need for a multilateral benefit-sharing mechanism to facilitate global vaccine cooperation, allowing all players to benefit simultaneously. The comprehensive quantification of health gains, lockdown-easing effects, and supply-chain rebuilding benefits helps countries understand their potential payoffs, leading to better decision-making. By considering the supply chain benefits, the public can view vaccine sharing as mutually beneficial rather than a zero-sum game. The study also provides a new perspective on the relationship between efficiency and equity in sustainable development, demonstrating that in some cases, equitable outcomes can also be more efficient. To prepare for future pandemics, a multilateral benefit-sharing instrument should be developed to encourage equitable global vaccine distribution thereby sharing substantial health and economic benefits sustainably.

[1] We group all countries into three categories: (i) the major vaccine-producing countries; (ii) the non-vaccine-producing countries with high-income levels (>US$4046 per year; World Bank high-income and upper-middle-income countries); and (iii) the non-vaccine-producing countries with low-income levels (<US$4046 per year; World Bank low-middle-income and low-income countries). See Wang et al for a detailed list of the three categories.

[2] Political pressure faced by governments of vaccine-producing countries to prioritize their population before exporting, and even the rise of the so-called “vaccine nationalism” during the COVID-19 pandemic can also be one of the major reasons for the unequal distribution situation.

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