Issue Brief

Improving Vaccine development and accessibility in Developing Countries

Introduction

After the COVID-19 pandemic, global public health infrastructure and accessibility to affordable vaccinations became an integral policy motivation for countries and multilateral entities around the world. However, due to a lack of infrastructure and investment in global vaccine dissemination channels, several countries were dependent on external partners and faced difficulties in distributing vaccines to beneficiaries, particularly those located in rural communities or belonging to marginalized populations.

Subsequently, the COVID pandemic improved global awareness on the need to develop medical value chains in the interest of global public health. During India's G20 Presidency in 2023, G20 nations arrived at a consensus to improve and build more resilient, equitable, and sustainable health ecosystems especially in Low and Middle-income Countries (LMIC) and Small Island Developing States (SIDS). Specifically, three key priority areas emerged from these discussions.

First, the G20 India Presidency called on nations to develop and implement Health Emergencies Prevention, Preparedness, and Response (PPR), with a focus on One Health and Antimicrobial Resistance (AMR). The G20 also called for the strengthening of cooperation in the pharmaceutical sector with a focus on ensuring that citizens have availability and access to safe, effective, quality, and affordable Medical Countermeasures-VTDs (Vaccines, Therapeutics, and Diagnostics). Finally, the G20 argued for strengthening Digital Health Platforms to improve and realize Universal Health Coverage and improve Healthcare Service Delivery.

Alongside the initiatives that the G20 India implemented to ensure health equity and improve accessibility to healthcare and vaccines, there have been several positive developments to improve accessibility to Vaccines in LMICs.

Global Immunization Coverage

In the wake of the COVID-19 pandemic, countries increasingly invested in developing rapid response public health infrastructure to readily distribute vaccines in the event of a future public health emergency. Multilateral health focused agencies like the World Health Organization (WHO) have invested significantly into developing vaccine distribution infrastructure in LMICs; however, while there has been progress, there are still significant, persistent gaps between developed and developing countries in terms of ready access to vaccines. In pursuit of democratizing access to vaccines, multilateral, health focused organizations have developed the global Immunization Agenda 2030.

As of 2024, Global Immunization Coverage has varied based on the strain of infection and type of vaccination. For example, diseases such as Hepatitis B have global coverage of approximately 84 percent for the three-dose vaccine; however, there is a significant range of coverage between regions for the single dose vaccine, which is typically administered to newborns within the first 24 hours of life. For the one dose version of the Hepatitis B vaccine, immunization coverage ranges from as high as 79 percent in the WHO Western Pacific Region to as low as 17 percent in the WHO African Region.

Some diseases, like Polio, have been nearly eradicated from the world. As a direct result of targeted interventions like the Global Polio Eradication Initiative (GPEI), polio cases internationally have dropped by 99 percent, and the disease is on the verge of complete eradication. However, two countries, namely Pakistan and Afghanistan, still face challenges related to the spread of wild poliovirus. Other diseases, like the human papillomavirus (HPV), are still a way away from nearing even 50 percent of global coverage. The HPV vaccine, while available in more than 145 countries, has reached a global coverage of 31 percent for the first dose of the HPV vaccine among girls between ages of 9 and 14 as of 2024. However, this figure remains significantly under the targeted coverage of 90 percent by 2030.

Therefore, while there has been progress towards improved vaccine accessibility across the world, there is still significant progress to be made and the G20 has actively taken action to improve vaccine coverage globally.

G20 interventions on Vaccine development and accessibility

In 2024, the G20 Health Ministers Working Group deliberated on improving vaccine accessibility across the G20 nations as well as other countries around the world. In their declaration, the G20 Health Ministers reflected on their deliberations across various cities in Brazil on pandemic preparedness, enhancing regional production of medicines, and building strategic health reserves.

Specifically, the G20 Health Ministers called for increased funding towards health initiatives at a sub-national and multi-national level to align resource mobilization efforts with country-led priorities on achieving Universal Health Coverage (UHC). To this end, the G20 Health Ministers also acknowledged the formation of a Coalition for Local and Regional Production, Innovation, and Equitable Access, which aims to strengthen manufacturing capabilities for local and regional health products and promoting sustainable global production and innovation networks to facilitate better access to vaccines, particularly in LMICs and other developing countries. The declaration states that the Coalition will initially start testing pilot projects to advance commitments related to investments in healthcare and related infrastructure.

In the latest edition of the G20, the G20 South Africa, the Health and Finance Minister's joint statement touched on the decline of developmental assistance and the disproportionate impact that such a reduction has on low and middle-income nations and the importance of pandemic preparedness as well as health coordination. Moreover, from the G20 South Africa Health Ministers statement, the G20 laid out priorities related to advancing vaccine accessibility across the world. Specifically, the statement explicitly places emphasis on stemming the spread of non-communicable diseases (NCD) through improving the accessibility of quality-assured health products to help people. Additionally, further in the Health Minister's statement, there is a dedicated section on pandemic prevention, preparedness and response (PPPR). Within this section, there is a specific recommendation to focus greater resources on promoting equitable access to safe and effective vaccines, therapeutics and diagnostics (VTD).

Overall, there is global consensus, through platforms like the G20, on the importance of vaccine availability to prevent and neutralize persistent global health challenges like COVID-19. Moreover, there is recognition that there are presently significant gaps in accessibility between LMICs and developed nations. Therefore, through targeted interventions based on the G20 recommendations from the last two Secretariats, there is ample opportunity for progress.