The World Health Organization’s (WHO) Global Vaccine Market Report 2022, which was published recently, shows that inequitable distribution is not unique to COVID-19 vaccines, with poorer countries consistently struggling to access vaccines that are in-demand by wealthier countries.
Limited vaccine supply and unequal distribution drive global disparities. The human papillomavirus (HPV) vaccine against cervical cancer has only been introduced in 41% of low-income countries, even though they represent much of the disease burden, compared to 83% of high-income countries.
Affordability is also an obstacle to vaccine access. While prices tend to be tiered by income, price disparities see middle-income countries paying as much – or even more – than wealthier ones for several vaccine products.
“The right to health includes the right to vaccines,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “And yet this new report shows that free-market dynamics are depriving some of the world’s poorest and most vulnerable people of that right. WHO is calling for much-needed changes to the global vaccine market to save lives, prevent disease and prepare for future crises.”
Approximately 16 billion vaccine doses, worth US$ 141 billion, were supplied in 2021, almost three times the 2019 market volume (5.8 billion) and nearly three-and-a-half times the 2019 market value (US$ 38 billion). The increase was primarily driven by COVID-19 vaccines, showing the incredible potential of how vaccine manufacturing can be scaled up in response to health needs.
Although manufacturing capacity worldwide has increased, it remains highly concentrated. Ten manufacturers alone provide 70% of vaccine doses (excluding COVID-19). Several of the top 20 most widely used vaccines (such as PCV, HPV, measles and rubella containing vaccines) each currently rely mainly on two suppliers.
This concentrated manufacturing base leads to risk of shortages as well as regional supply insecurity. In 2021, the African and Eastern Mediterranean regions were dependent on manufacturers headquartered elsewhere for 90% of their procured vaccines. Entrenched intellectual property monopolies and limited technology transfer further limit the ability of building and using local manufacturing capacity.
The health of markets is also concerning for several of the vaccines commonly needed for emergencies, such as against cholera, typhoid, smallpox/monkeypox, Ebola, meningococcal disease, where demand surges with outbreaks and is hence less predictable. The continued limited investment in these vaccines could be devastating for people’s lives.
The report highlights the opportunities for more alignment of vaccine development, production and distribution with a public health agenda, towards achieving the Immunization Agenda 2030 (IA2030) goals and informing pandemic prevention, preparedness, and response efforts.
COVID-19 proved that vaccines can be developed and distributed rapidly, with a process lasting an average of ten years but never less than four years, compressed to 11 months. The pandemic also exposed the long-standing need to recognise vaccines as a fundamental and cost-effective public good rather than a commodity.
To drive ambitious action to deliver equitable access to vaccines, the report calls on governments to act on: clear immunization plans and more aggressive investment and stronger oversight of vaccine development, production and distribution; regional research and manufacturing hubs; and pre-agreeing rules for government collaboration in times of scarcity on issues such as vaccine distribution, intellectual property and the circulation of inputs and goods.
Recommended actions for industry include: focusing research efforts on WHO priority pathogens, ensuring transparency, facilitating technology transfer, and committing to specific equity-driven allocation measures. International organizations and partners should prioritize Immunization Agenda 2030 goals, support country-driven initiatives and push for the application of resolutions on market transparency.