Production, affordability, global allocation, and deployment of COVID-19 vaccines are 4 dimensions of the global vaccination challenge, as discussed in a health policy paper published the Lancet.

It is not enough for vaccines to be developed and produced at a rapid speed; they must also be approved or authorized for emergency use by stringent regulatory authorities or the World Health Organization and then be produced at scale. Expanding production capacity to achieve widespread roll-out of effective vaccines and efficiently distributing them to administration facilities is the current difficulty as the global demand is much higher than vaccine supply.

Vaccine affordability and access must be secured for low- and middle-income countries and for poor and marginalized populations in high-income countries, says study authors. Some companies that greatly benefited from public-sector investments have committed to selling their vaccines at low prices while other manufactures plan to sell them at a premium in private markets in various countries, compromising fair accessibility. Sustainable funding is also necessary to avoid distorted health budgets with long-term health and economic development consequences caused by diverting resources from other vaccination programs or essential healthcare services to pay for COVID-19 vaccines and programs.

Study authors emphasize that short supply and large pre-orders made by wealthier countries prevent timely global access and could potentially increase the risk of further viral mutations that make existing vaccines ineffective.

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In April 2020, the World Health Organization announced a global allocation mechanism called the COVID-19 Vaccine Global Access (COVAX) Facility, which prioritizes specified populations to receive the vaccine first. This program aimed to have no country vaccinate more than 20% of its population until all countries have vaccinated 20% of their populations. However, threats to this equitable allocation include:

  • Further substantial funding needed. Currently, it is estimated that an additional $6.8 billion is required to procure and deliver 2 billion doses by the end of 2021
  • National procurement strategies undermining COVAX via high-income countries pre-ordering vaccines for their entire population and other countries following suit
  • Uncertainty regarding supply earmarked for COVAX, which is dependent on the vaccine performance in clinical trials

As a result, COVAX hopes to aid countries procure doses at lower prices and launch their vaccination campaigns earlier instead.

Smooth deployment requires robust data infrastructure and strong coordination to prioritize the appropriate patients as well as logistically deliver the doses under temperature requirements. Low- and middle-income countries lack delivery programs and immunization registries required to ensure timely and efficient administration. Vaccine hesitancy from the public will also hinder the acceptance and post-marketing surveillance of COVID-19 vaccines.

“The distinct characteristics of leading COVID-19 vaccines across each of these dimensions generate trade-offs, which mean that both globally and nationally, the availability of diversified sets of vaccine options is likely to be needed to bring the global pandemic under control,” the study authors concluded.


Wouters OJ, Shadlen KC, Salcher-Konrad M, et al. Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Lancet. Published online February 12, 2021. doi:10.1016/S0140-6736(21)00306-8.

This article originally appeared on Infectious Disease Advisor