Vaccines, therapeutics, and diagnostics for covid-19: redesigning systems to improve pandemic responseRohit Ramchandani and colleagues propose a framework to ensure essential public health tools are fairly distributed in future pandemics V accines, therapeutics, and diagnostics are key public health tools for controlling the covid-19 pandemic, yet many countries, particularly low and middle income countries (LMICs), have had inadequate access. Many have yet to determine, for example, when and where they will be getting their vaccines from, and only 3% of people in low income countries had received at least one dose by October 2021. 1 The Access to COVID -19 Tools Accelerator (ACT-A) is a multilateral coordination mechanism set up to accelerate development, production, and equitable access to covid-19 tests, treatments, and vaccines globally. The concept brings together governments, scientists, businesses, civil society, philanthropists and global health organisations. Despite its bold vision, ACT-A has thus far fallen short of its expectations. Covax, the vaccines pillar of ACT-A, has been responsible for less than 6% of the 6.82 billion covid-19 vaccines administered as of October 2021. 2 3 The first outstanding efficacious treatment to which ACTA's therapeutic pillar has contributed is molnupiravir, which was shown to reduce the risk of hospital admission or death in October 2021. 4 Oxygen therapy, still one of the best treatments available for severe cases, initially struggled from a lack of strategic prioritisation despite its critical importance. Testing did receive political attention but has been a bottleneck in many countries. 5• Agreements around technology transfer and intellectual property licensing, regional trial networks, inclusive governance, and substantial predictable financing are essential on 26 December 2021 by guest. Protected by copyright.