@article{Ruiz:318763,
      recid = {318763},
      author = {Ruiz, Adrián Alonso and Bezruki, Anna and Shinabargar,  Erika and Large, Kaitlin Elizabeth and Vieira, Marcela and  Slovenski, Iulia and Liu, Yiqi and Agarwal, Surabhi and  Becker, Anna and Moon, Suerie},
      title = {Which roads lead to access? a global landscape of six  COVID-19 vaccine innovation models},
      address = {2024},
      number = {ARTICLE},
      abstract = {BACKGROUND: Unequal and inequitable access to Covid-19  vaccines in low- and middle-income countries (L&MICs) was a  major political, ethical and public health failure in the  pandemic. However, vaccine developers' practices were not  monolithic, but rather, took diverse approaches to  supplying different countries, with important implications  for global access. RESULTS: Using data on R&D investments,  regulatory approvals, manufacturing and purchase  agreements, and vaccine deliveries, we identified six  distinct innovation models that apply across the 14  COVID-19 vaccines with more international presence from  2020–2022. “Western Early Arrivers” Pfizer/BioNTech and  Moderna supplied the largest volumes quickly and  prioritized high-income countries (HICs) from registration  to vaccine delivery. “Western Latecomers” Janssen and  Novavax supplied intermediate volumes later, also  prioritizing HICs but with a greater proportion to L&MICs.  “Major Chinese Developers” Sinopharm and Sinovac supplied  intermediate volumes early, primarily to middle-income  countries (MICs). “Russian Developer” Gamaleya completed  development early but ultimately supplied small volumes,  primarily to middle-income countries (MICs). “Cosmopolitan  Developer” Oxford/AstraZeneca supplied large volumes early  to HICs and MICs at the lowest prices. Finally, “Small MIC  Developers” CanSino, Bharat Biotech, Medigen, Finlay  Institute and the Center for Genetic Engineering and  Biotechnology (CGEB), exported relatively small volumes to  a few MICs. Low-income countries (LICs) were not targeted  by any developer, and received far fewer doses, later, than  any other income group. Almost all developers received  public funding and other forms of support, but we found  little evidence that such support was leveraged to expand  global access. CONCLUSIONS: Each of the six innovation  models has different implications for which countries get  access to which vaccines, how quickly, and at which prices.  Each offers different strengths and weaknesses for  achieving equitable access. Our findings also suggest that  Western firms had the greatest capacity to develop and  deliver vaccines quickly during the pandemic, but such  capacity is rapidly becoming more globally distributed with  MICs playing a significant role, especially in supplying  other MICs. Given the critical role of public support in  enabling pandemic vaccine development and supply,  governments have both the capacity and responsibility to  craft international rules that will make responses to  future pandemics more equitable and effective.},
      url = {http://repository.graduateinstitute.ch/record/318763},
      doi = {https://doi.org/10.1186/s12992-024-01017-z},
}