Global access to COVID-19 vaccines: a scoping review of factors that may influence equitable access for low and middle-income countries

Abstract

ObjectiveTo identify the factors contributing to equitable access to COVID-19 vaccines for low and middle-income countries (LMIC).MethodsWe conducted a scoping review following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and a five-stage framework for scoping studies. We performed systematic searches for published peer-reviewed literature in five databases: Medline, Embase, Web of Science, Global Index Medicus and COVID-19 Evidence Epistemonikos (August 2020, updated May 2021).ResultsSystematic selection according to predefined criteria resulted in the final inclusion of 45 peer-reviewed articles, with no limitations on study design or publication type. We derived four key factors that potentially influence equitable access to COVID-19 vaccines in LMICs: (1) collectively agreed global mechanisms or frameworks; (2) bilateral purchasing, contracting, and vaccine prices; (3) vaccine manufacturing that is supported by sharing know-how; and (4) countries’ strength in implementing vaccination programmes.ConclusionsThis scoping review highlights the ongoing challenges for the international community in ensuring equitable access to COVID-19 vaccines for LMICs. The literature suggests that vaccine manufacturing can influence the supply of vaccines, as can the role of patent holders who can influence global governance through their role in the distribution of COVID-19 vaccines. Our findings indicate that including the principles of equitable access throughout vaccine research and development, procurement, scale-up and distribution processes can support equitable access for LMICs. Advances made with mRNA vaccines may have additional benefits in relation to expanding the manufacturing of other vaccine. Finally, the exploration and scale-up of such capacities of LMICs are likely to prove to be a valuable investment, even after the pandemic.

COVID-19 Management Missteps

“…At the onset of the vaccine distribution, federal and state health officials agreed that early distribution of the vaccine should first target high-risk frontline health care workers and staff at long-term care communities. However, researchers found that these two high-priority groups were among the most reluctant to receive the COVID-19 vaccine [17]. The combination of the vaccine supply is limited, and the hesitancy of the groups who had vaccines reserved for them can cause further delays in the distribution of the vaccine.…”

Sustained Antibody-Dependent NK Cell Functions in Mild COVID-19 Outpatients During Convalescence

“…The study of the responses mounted by convalescent individuals against the virus is critical to better characterize effective naturally evolved strategies to overcome disease. The relevance of this new information is highlighted if the limited scope of prophylactic vaccination efforts in developing countries is taken in count (62). For instance, regarding the extent of longterm responses, even without segregation of individuals due to the severity of their COVID-19 symptoms, it has been shown that the majority of SARS-CoV-2 infected individuals develop serum Abs that last for several months (63)(64)(65), even beyond a year after infection (66,67).…”

Una panorámica sobre patentes, vacunas y covid-19

“…Una de las iniciativas más sonadas para promover las licencias voluntarias para COVAX, a su vez, se enfoca en lograr tres objetivos: acelerar rápidamente el desarrollo de vacunas para COVID-19 proporcionando respaldo financiero a una variedad de candidatos prometedores, el uso de mecanismos de financiación de "incitación y disuasión" (push and pull) para estimular la inversión en riesgo en la capacidad de fabricación y asegurar el acceso equitativo a nivel mundial (Mark Eccleston-Turner & Upton, 2021). COVAX se marcó como meta asegurar al menos dos mil millones de dosis de la vacuna COVID-19 para finales de 2021, donde más del 60% serían destinadas a 92 países de bajos ingresos (Forman, Shah, Jeurissen, Jit, & Mossialos, 2021;McAdams, et al, 2020;Peacocke, et al, 2021). A fecha de octubre de 2021 "solo se han enviado 371,1 millones de dosis… queda por ver si esta meta se alcanzará en 2022" (Krishtel & Hassan, 2021).…”

“…Este último punto ha despertado críticas por no haberse distribuido las vacunas según la gravedad de la situación o la resistencia de los sistemas de salud afectados por aumentos repentinos de nuevos brotes (Asundi, et al, 2021). El hecho es que los países con un poder adquisitivo mayor han recibido más del 87% de las vacunas mientras que los países con ingresos medianos o bajos solo el 0,2% (Peacocke, et al, 2021). Además, como muchos países priorizan en su vacunación nacional frente a la internacional la meta de COVAX se ha visto obstaculizada (van de Pas, et al, 2021).…”