The governments of the countries where vaccines are produced – the United States, members of the European Union, the United Kingdom, India, Russia and China – must cooperate under the leadership of the United Nations to ensure that a sufficient supply of COVID-19 vaccine doses is reaching the poorest countries. Five steps are particularly urgent.

NEW YORK – The world is at a critical time in the COVID-19 pandemic. Countries that do not have the first cycle of immunization coverage are extraordinarily vulnerable to the highly infectious Delta variant, and are also breeding grounds for new variants that could spread rapidly around the world. The Lancet The COVID-19 Commission, which I chair, is urgently working with the United Nations system to strengthen the multilateral response. The governments of the countries where vaccines are produced – the United States, members of the European Union, the United Kingdom, India, Russia and China – must cooperate under the leadership of the United Nations to ensure that ‘a sufficient supply of vaccine doses reaches the poorest countries.

High-income countries now have more than 50% of their population fully immunized. Yet the fully vaccinated population in Africa remains below 4%. This lack of immunization coverage in Africa, and elsewhere in low-income countries, poses imminent danger to these populations.

US President Joe Biden has called for a vaccine summit on September 22. This is potentially a very important step forward. It is important that the United States organize this meeting in cooperation with China, India, Russia and other vaccine-producing countries, as well as with the United Nations system. Only the United Nations, with its universal membership and operational capacity in low-income countries, has the capacity to coordinate the rapid global scale-up of immunization coverage.

In April 2020, the UN established the COVID-19 Vaccine Global Access (COVAX) facility to provide vaccines to low-income countries. These countries expected COVAX to provide timely deliveries. Yet COVAX has not been able to purchase a sufficient volume of vaccine doses, mainly because high-income countries have repeatedly moved to the front of the queue. In addition, the governments of vaccine-producing countries have imposed export quotas so that COVAX is often unable to obtain even the vaccines for which it has contracts. The shareholders of the company are of course satisfied with these provisions, because the rich countries pay more for the doses than COVAX.

The supply crisis facing low-income countries in Africa and elsewhere will not be resolved. On the contrary, high-income countries are now starting to offer a third dose, even before very vulnerable groups in the poorest countries (the elderly, health workers, immunocompromised and others) have received their primary immunization.

Global opportunities for scaling up vaccine production are also hampered by the continued insistence of some governments to enforce patents on key vaccine technologies, even though these patents are held by government-funded academic institutions (including the United States National Institutes of Health). ). Likewise, public money has funded clinical trials and vaccine deployment. Despite the global emergency of the pandemic, vital public goods have been privatized.

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The World Health Organization has set minimum vaccination coverage targets in each country – at least 10% of the population by the end of September 2021, 40% by the end of 2021 and 70% by the end of June 2022 – that the current vaccine allocation system will not achieve. At this time of great global peril, the governments of vaccine-producing countries should take the following actions:

First, when governments meet this week at the Biden Vaccine Summit, they are expected to chart the course to meet WHO targets in all countries, including 40% global coverage by the end of this year. year. Vaccine producers should cooperate fully by disclosing all existing orders (and prices) in their books, so that the UN and governments can prioritize underserved countries.

Second, the United Nations system, with the full support of governments and businesses, should set delivery times for each low-income country aligned with WHO targets. WHO and COVAX, along with other UN agencies such as UNICEF, should work with recipient countries to scale up “last mile” deployment systems for arrival of vaccine doses.

Third, the new allocation of $ 650 billion in Special Drawing Rights just approved by the International Monetary Fund should be used, along with other emergency financial resources, to ensure that short-term funding constraints. term do not interfere with vaccine supply.

Fourth, the governments of vaccine-producing countries should agree, in line with long-standing public health trade agreements, to waive intellectual property rights and promote technology sharing in order to increase global vaccine production. Promising vaccines that are currently in clinical trials should also be supported by official funding for rapid production and deployment after regulatory approval.

Finally, governments in all countries should educate the public that vaccines alone are not effective enough to suppress community transmission of the coronavirus. Additional public health measures – including face masks, physical distancing, contact tracing and limits on indoor gatherings – are still needed.

The bottom line is that we need to treat universal immunization coverage as a global public good that we urgently need, and not as a possible outcome of market forces. This week’s Biden vaccine summit can provide the vital breakthrough we need, giving the UN the vaccine doses and funding it needs to ensure immunization for all.