More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry’s Role in Widening the Access Gap

Document Type : Original Article


1 School of Public Health, University of Nevada Reno, Reno, NV, USA

2 Department of International Relations, Federal University of Paraiba, João Pessoa, Brazil

3 Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA


An effective response to the coronavirus disease 2019 (COVID-19) pandemic entails a comprehensive strategy that ensures equitable access to all COVID-19-fighting technologies. To achieve this goal, the international community has acknowledged immunization as a public good. However, a trend of grossly unequal dose distribution emerged, owing, among other factors, to pharmaceutical companies’ profit-driven actions, jeopardizing the mechanisms built to increase vaccine access. The contradiction between public health interests and corporate discretion in determining vaccine dose distribution poses critical concerns about the health risks associated with lengthening the duration of the pandemic and the eventual liability of companies for violations of human rights.

To evaluate the risks posed to the COVID-19 immunization program, data on vaccine allocation and delivery, vaccine dose application, immunized populations, and the volume of Advanced Purchase Agreements (APAs) between countries and pharmaceutical companies were compiled and assessed. A descriptive analysis was then conducted to analyze the role of pharmaceutical companies in providing equitable access to COVID-19 vaccines.

When the data is broken down by income (as of June 2021), it shows that high-income countries (HICs) have already crossed the COVID-19 Vaccine Global Access (COVAX) 20% immunization threshold. However, countries of all other income levels have yet to achieve this mark for fully vaccinated people. Upper-middle-income countries (UMICs) have approximately 3%, low- and middle-income countries (LMICs) have approximately 2% and low-income countries (LICs) have less than 0.1% of fully vaccinated people per hundred. The supply shortage is expected to last until the second half of 2021.

As a result of the COVAX failure, a health gap emerged with countries living in a pre-immunization period for an extended time. The existing conflict between the international response to tackle COVID-19 and corporate profitdriven behavior contributed to prolonging pandemic, especially in Africa. Accordingly, there is a need to approve an international treaty that targets the activities of all actors, including the pharmaceutical companies, in protecting human rights and the right to health realms.


Main Subjects

  1. World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Published 2021. Accessed June 4, 2021.
  2. Lakner C, Yonzan N, Mahler DG, Castaneda Aguilar RA, Wu H. Updated Estimates of the Impact of COVID-19 on Global Poverty: Looking Back at 2020 and the Outlook for 2021. World Bank Group; 2021.
  3. Hunger Hotspots. FAO-WFP Early Warnings on Acute Food Insecurity: March to July 2021 Outlook. Published 2021. Accessed May 12, 2021.
  4. Migration Factsheet No. 6 – The Impact Of COVID-19 On Migrants Synthesis Analysis Drawing on IOM’S World Migration Report Series. Published 2021. Accessed May 15, 2021.
  5. Office for the Coordination of Humanitarian Affairs (OCHA). Global Humanitarian Response Plan COVID-19. OCHA; 2021.
  6. World Health Organization. Resolution WHA 73.1: COVID-19 Response. Published May 19, 2020.
  7. United Nations. International Cooperation to Ensure Global Access to Medicines, Vaccines and Medical Equipment to Face COVID-19. A/RES/74/274. United Nations; 2020.
  8. United Nations. Global Solidarity to Fight the Coronavirus Disease 2019 (COVID-19). A/RES/74/270. United Nations; 2020.
  9. Statement by UN Human Rights Experts Universal Access to Vaccines Is Essential for Prevention and Containment of COVID-19 around the World. OHCHR; 2021. Published 2021.
  10. Committee on Economic, Social and Cultural Rights (CESCR). Statement on Universal and Equitable Access to Vaccines for the Coronavirus Disease (COVID-19). CESCR; 2021.
  11. Wouters OJ, Shadlen KC, Salcher-Konrad M, et al. Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Lancet. 2021;397(10278):1023-1034. doi:1016/s0140-6736(21)00306-8
  12. COVID-19 Technology Access Pool (C-TAP). Accessed April 5, 2021.
  13. COVAX Facility. Published 2021. Accessed April 29, 2021.
  14. WHO chief warns against COVID-19 ‘vaccine nationalism’, urges support for fair access. Published 2021. Accessed May 17, 2021.
  15. US NIH licenses to C-TAP.
  16. World Trade Organization (WTO). Waiver from Certain Provisions of the Trips Agreement for the Prevention, Containment and Treatment of COVID-19. WTO; 2021.
  17. World Trade Organization (WTO). Draft Ministerial Decision on the TRIPS Agreement. WTO; 2022.
  18. Suárez-Álvarez A, López-Menéndez AJ. Is COVID-19 vaccine inequality undermining the recovery from the COVID-19 pandemic? J Glob Health. 2022;12:05020. doi:7189/jogh.12.05020
  19. Engebretsen E, Ottersen OP. Vaccine inequities, intellectual property rights and pathologies of power in the global response to COVID-19. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.57
  20. Abbott FM, Reichman JH. Facilitating access to cross-border supplies of patented pharmaceuticals: the case of the COVID-19 pandemic. J Int Econ Law. 2020;23(3):535-561. doi:1093/jiel/jgaa022
  21. Wettstein F, Giuliani E, Santangelo GD, Stahl GK. International business and human rights: a research agenda. J World Bus. 2019;54(1):54-65. doi:1016/j.jwb.2018.10.004
  22. Ruggie J. Protect, respect and remedy: a framework for business and human rights. Innov Technol Gov Glob. 2008;3(2):189-212. doi:1162/itgg.2008.3.2.189
  23. UN Office of the High Commissioner for Human Rights (OHCHR). Guiding Principles on Business and Human Rights: Implementing the United Nations “Protect, Respect and Remedy” Framework. OHCHR; 2011.
  24. World Health Organization (WHO). Human Rights Guidelines for Pharmaceutical Companies in Relation to Access to Medicines A/63/263. WHO; 2008.
  25. Moon S. Respecting the right to access to medicines: implications of the UN Guiding Principles on Business and Human Rights for the pharmaceutical industry. Health Hum Rights. 2013;15(1):E32-43.
  26. Muzaka V. The Politics of Intellectual Property Rights and Access to Medicines. 1st ed. Palgrave Macmillan; 2011.
  27. Friedman EA, Gostin LO. Pillars for progress on the right to health: harnessing the potential of human rights through a Framework Convention on Global Health. Health Hum Rights. 2012;14(1):E4-19.
  28. Lee JY, Hunt P. Human rights responsibilities of pharmaceutical companies in relation to access to medicines. J Law Med Ethics. 2012;40(2):220-233. doi:1111/j.1748-720X.2012.00660.x
  29. Davitti D. Refining the protect, respect and remedy framework for business and human rights and its guiding principles. Hum Rights Law Rev. 2016;16(1):55-75. doi:1093/hrlr/ngv037
  30. Bonnitcha J, McCorquodale R. The concept of ‘due diligence’ in the UN Guiding Principles on Business and Human Rights. Eur J Int Law. 2017;28(3):899-919. doi:1093/ejil/chx042
  31. Rutschman AS. The Reemergence of Vaccine Nationalism. Saint Louis U. Legal Studies Research Paper No. 2020-16.
  32. Kickbusch I. Addressing the interface of the political and commercial determinants of health. Health Promot Int. 2012;27(4):427-428. doi:1093/heapro/das057
  33. Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Glob Health. 2016;4(12):e895-e896. doi:1016/s2214-109x(16)30217-0
  34. de Lacy-Vawdon C, Livingstone C. Defining the commercial determinants of health: a systematic review. BMC Public Health. 2020;20(1):1022. doi:1186/s12889-020-09126-1
  35. Gostin LO, Monahan JT, Kaldor J, et al. The legal determinants of health: harnessing the power of law for global health and sustainable development. Lancet. 2019;393(10183):1857-1910. doi:1016/s0140-6736(19)30233-8
  36. Our World in Data. Coronavirus.
  37. COVAX: CEPI’s response to COVID-19.
  38. Vaccine Manufacturing - Launch and Scale Speedometer. Published 2021. Accessed June 5, 2021.
  39. Sallam M. COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates. Vaccines (Basel). 2021;9(2):160. doi:3390/vaccines9020160
  40. Coronavirus: WHO chief criticises “shocking” global vaccine divide. Published 2021. Accessed April 10, 2021.
  41. Allocation Round 3: Pfizer-BioNTech Vaccine, April-June 2021. GAVI; 2021.
  42. Exclusive-WHO vaccine scheme risks failure, leaving poor countries with no COVID shots until 2024. Reuters. Published 2021.
  43. Corum J, Zimmer C. Tracking Omicron and Other Coronavirus Variants. The New York Times. May 24, 2022.
  44. Cullet P. Patents and medicines: the relationship between TRIPS and the human right to health. Int Aff. 2003;79(1):139-160. doi:1111/1468-2346.00299
  45. Abbott FM. The Doha declaration on the TRIPS agreement and public health: lighting a dark corner at the WTO. J Int Econ Law. 2002;5(2):469-505.
  46. Abbott FM, Reichman JH. The Doha round's public health legacy: strategies for the production and diffusion of patented medicines under the amended TRIPS provisions. J Int Econ Law. 2007;10(4):921-987. doi:1093/jiel/jgm040
  47. Erfani P, Binagwaho A, Jalloh MJ, Yunus M, Farmer P, Kerry V. Intellectual property waiver for COVID-19 vaccines will advance global health equity. BMJ. 2021;374:n1837. doi:1136/bmj.n1837
  48. Chaudhary T, Chaudhary A. TRIPS waiver of COVID-19 vaccines: impact on pharmaceutical industry and what it means to developing countries. J World Intellect Prop. 2021;24(5-6):447-454. doi:1111/jwip.12198
  49. Thambisetty S, McMahon A, McDonagh L, Yoon Kang H, Dutfield G. The TRIPS Intellectual Property Waiver Proposal: Creating the Right Incentives in Patent Law and Politics to End the COVID-19 Pandemic. 2021.
  50. UNICEF COVID-19 Vaccine Market Dashboard. Accessed June 7, 2022.
  51. Sharun K, Dhama K. COVID-19 vaccine diplomacy and equitable access to vaccines amid ongoing pandemic. Arch Med Res. 2021;52(7):761-763. doi:1016/j.arcmed.2021.04.006
  52. Dyer O. COVID-19: countries are learning what others paid for vaccines. BMJ. 2021;372:n281. doi:1136/bmj.n281
  53. Light DW, Lexchin J. The costs of coronavirus vaccines and their pricing. J R Soc Med. 2021;114(11):502-504. doi:1177/01410768211053006
  54. Rackimuthu S, Kazmi Z, Elmahi OK, et al. Antiviral and antiretroviral drug shortages amidst COVID-19: how Africa is struggling. Innov Pharm. 2021;12(4):7. doi:24926/iip.v12i4.4328
  55. Mercurio B. The IP Waiver for COVID-19: bad policy, bad precedent. IIC Int Rev Ind Prop Copyr Law. 2021;52(8):983-988. doi:1007/s40319-021-01083-5
  56. Kuchler H, Williams A. Vaccine Makers Say IP Waiver Could Hand Technology to China and Russia. Finacial Times; 2021.
  57. OEIGWG Human Rights Council. Draft Report - Legally Binding Instrument to Regulate, in International Human Rights Law, the Activities of Transnational Corporations and Other Business Enterprises. 2021.
  58. Borges LC, Menezes HZ, Souza IML. Dilemmas in the implementation of the World Health Organization Framework Convention on Tobacco Control. Cad Saude Publica. 2020;36(2):e00136919. doi:1590/0102-311x00136919
Volume 11, Issue 12
December 2022
Pages 3101-3113
  • Receive Date: 14 November 2021
  • Revise Date: 16 July 2022
  • Accept Date: 01 August 2022
  • First Publish Date: 02 August 2022