Best Practices in Global Vaccination Roll-Out to Reduce Health Inequity

COVID-19 vaccines were developed and deployed faster than any before them, yet countries differed widely in their ability to finance, procure, distribute and administer them. By the end of 2021, high- and upper-middle-income countries had administered at least one dose per person on average, compared with one dose for every three people in lower-middle-income countries and one for every 25 people in low-income countries. Modelling suggests that starting the global roll-out 100 days after the virus was sequenced could have saved more than 8 million lives by the end of 2021, most of them in lower-middle-income countries, and that greater investment in manufacturing and health systems could have saved about 3 million more. Drawing on this evidence, the policy brief proposes an “equity-by-design” framework covering the full vaccine-readiness pathway: financing, procurement, manufacturing, allocation, delivery, uptake, safety monitoring and accountability. Its six recommendations are to prepare before the next health emergency, allocate vaccines equitably between nations, secure timely and equitable procurement, promote transparent data sharing and communication, insulate vaccine decisions from political distortion, and strengthen delivery systems and regional capacity. The WHO Pandemic Agreement and the amended International Health Regulations provide a basis for building these measures into routine preparedness.