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Anyone wondering whether Covid-19 vaccines are making a difference to this deadly and persistent pandemic can be in no doubt: they are.

Millions of lives around the world have been saved thanks to the rollout of vaccines that were developed at record speed. Data from several global studies looking at “real world vaccine effectiveness” — which reflects what is really going on as the world continues to battle SARS-CoV-2 — show that in the first year of the vaccination program, 19.8 million out of a potential 31.4 million Covid-19 deaths were prevented worldwide. But this number doesn’t tell the full story in low-income countries, where just over 180,000 deaths were averted. Many more lives could have been saved if vaccines had been distributed more rapidly to many parts of the world and if vaccine uptake could have been strengthened worldwide.

From the time the genetic sequence of SARS-CoV-2, the virus that causes Covid-19, was published online in January 2020, just weeks after the disease first appeared in Wuhan, China, it took only 326 days for scientists, regulators, and manufacturing technicians to develop, approve and start rolling out billions of doses of several different vaccines.

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The annual global output of Covid-19 vaccine doses now numbers 11 billion. In addition to the speed of innovation and scaling up of manufacturing, what gave further hope in the early days of vaccine production and rollout was that deliveries of the first doses arrived in Accra and Abidjan around the same time as they were arriving in Tokyo. There was hope that global solidarity would prevail.

That quickly faded.

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By April 2021, just a few months into vaccine production, deliveries to many lower-income countries, including many in Africa, dried up no sooner than they had started while rich countries like the United States had sufficient doses to vaccinate their whole adult population five times over. It took until December 2021, for the first 1 billion doses to be distributed to poorer nations through COVAX.

In short, science and biopharma companies delivered what should have been a free flow of vaccines, but global solidarity did not.

Allowing that kind of global imbalance to occur makes no sense in the face of a highly transmissible virus that doesn’t respect borders.

A big problem at the outset was that COVAX — the initiative established to make vaccines universally available — was at the back of the queue to secure vaccine orders because it lacked the spending power of high-income governments. A further blow was that, having ordered millions of vaccines from India, the Indian government imposed export bans on those deliveries as the country experienced a surge in Covid-19 cases in April 2021.

To find a solution to those immediate challenges, the pharmaceutical industry is offering a proposal for world leaders. In the Berlin Declaration, announced on July 19 by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which one of us (T.C.) leads, the industry commits to setting aside doses specifically for poorer countries at the outset of a future pandemic. For this to work, governments must play their part ensuring funds are available to establish advance purchase agreements and ensure the free flow of vaccines, treatments, and therapeutics, and the raw materials needed to produce them. If supported by world leaders, this proposal would represent a new global social contract in which poorer nations have assurances of reserved vaccine supplies before the next pandemic hits.

Innovation delivered for Covid-19, so much so that developing a vaccine in 100 days — almost three times faster than for Covid-19 vaccines, which was in itself unprecedented — is now within reach. Without something like the Berlin Declaration, a new vaccine against a future pandemic could be ready in 100 days, but it would take a year or more for countries to cooperate to meet the needs of vulnerable people in poorer nations.

Worse still, a 100-day goal for innovation could accelerate governments’ race to secure orders of potential vaccines against future threats, leaving resource-poor countries further behind in the queue than was the case two years ago. Without decisive international action to ensure equitable access to vaccines, medicines, and diagnostic tests, there is a real danger that inequalities could widen rather than narrow when the next pandemic hits.

There are many longer-term issues that need to be addressed to ensure that the world has a system fit for the challenges presented by viral threats. One is the existence of an expanded and more geographically diverse manufacturing base making it possible for lower-income countries to make more vaccines and medicines locally. Projects such as the Africa Vaccine Manufacturing Initiative, as well as commitments made by BioNTech, J&J, Moderna, the Serum Institute, and Pfizer point the way forward, but the key point about these sorts of measures is they will take time to scale-up.

By earmarking production for vulnerable populations, the Berlin Declaration could have a transformative effect right now. It would avoid the kind of “vaccine nationalism” and export restrictions that undermined the initial response to Covid-19, and it can redress the global imbalance in one swift and effective move.

Ultimately, this is a question of political will. The United States and others within the G7 can play a vital role by brokering the necessary agreements between stakeholders, while the G20 can press home the importance of global solidarity. The world has a once in a generation opportunity to transform how it deals with future pandemics and to guarantee mutual security. Now is the time to ensure that the inequity of global Covid-19 vaccine programs is never repeated by securing faster and fairer distribution of supplies to the most vulnerable populations.

Thomas B. Cueni is director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). Richard Hatchett is CEO of the Coalition for Epidemic Preparedness Innovations (CEPI). IFPMA played a leading role in conceptualizing the Berlin Declaration, which has been supported by CEPI and other stakeholders.

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