Many low- and middle-income countries have suffered, and continue to suffer, from inequities in access to medical countermeasures during different international health emergencias, such as the COVID-19 pandemic, or the current mpox emergency. Nevertheless, many of these countries generate and share the data and biological samples that help develop these essential products. This is why these countries demand that, in exchange for sharing pathogen data and biological samples, they are guaranteed equitable access to the fruits of the resulting research.
The negotiations for a Pandemic Treaty are now debating the form this system will take, known as the Pathogen Access and Benefit-Sharing (PABS) Instrument. This system could help promote a fairer and more equitable approach to pandemic preparedness and response. One mechanism being negotiated, that could improve access is the requirement for product developers using information accessed through the PABS Instrument to contribute a variable percentage of their production to be redistributed according to public health and need-based criteria. The percentage under discussion has become a point of contention, with several countries proposing a 20% production quota, while others (notably high-income countries) seek to lower or avoid establishing a fixed percentage.
Salud por Derecho has simulated the impact a PABS instrument might have had during COVID-19, and proposes suggestions to make this mechanism more equitable.
How Would COVID Vaccine Access Have Changed with Redistribution?
Our simulation shows that, with a 20% redistribution of produced doses, low-income countries could have fully vaccinated their populations with one dose in 19 months. It is important to recall that, in reality, these countries only obtained enough doses to provide one dose to 60% of their population. For lower-middle-income countries, this redistribution would have allowed them to reach two doses per capita within two years—a target they never achieved in the actual analysis period.
High-income countries, on the other hand, would have experienced a delay of just one month to achieve full coverage with one dose, and four months to reach coverage with two doses.
To achieve one-dose coverage across all countries within similar timelines (10-12 months), a redistribution of 35% of monthly doses would have been necessary. This is just one example of how a stronger PABS system could reduce access gaps and enable a more equitable response to future pandemics.
Key Elements for an Effective PABS System
While the data show that a 20% contribution from vaccine production could have improved vaccine access during COVID-19, this would clearly be insufficient. In addition, vaccine stockpiling by many countries may jeopardize the effectiveness of this system.
For these reasons, we not only advocate for a higher contribution percentage, but also call for the inclusion of additional tools in a PABS instrument to improve access to medical countermeasures. Specifically, we support language in the treaty that would allow developers using PABS data to agree to non-exclusive and sublicensable licenses during a pandemic. These licenses would increase global production capacity, enable production across multiple locations, and ensure faster and more decentralized access.
Salud por derecho is participating in INB 12, where we will be sharing our findings and calling on negotiators to commit to a fair, equitable, and effective pathogen access and benefit-sharing system.
- Access the database here.
- Read our statement at the INB here.
Methodological note:
The database used for this analysis comes from the academic article “Which roads lead to access? A global landscape of six COVID-19 vaccine innovation models,” published in the journal Globalization and Health (Alonso Ruiz, A., Bezruki, A., Shinabargar, E., et al. Which roads lead to access? A global landscape of six COVID-19 vaccine innovation models. Global Health 20, 25 (2024). https://doi.org/10.1186/s12992-024-01017-z).
The calculation was performed by subtracting 20% or 35% (depending on the scenario) from the monthly deliveries of all vaccines in all countries. This percentage was then redistributed monthly among low- and lower-middle-income countries based on their population size. To maintain the model’s simplicity, upper-middle-income countries were excluded from the redistribution due to the difficulty of controlling for distortions caused by the significant production capacity and large vaccine intake in certain countries within this group, such as China.
Foto: WHO.
