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Analysis of the institutional landscape and proliferation of proposals for global vaccine equity for COVID-19: too many cooks or too many recipes?
  1. Susi Geiger1,
  2. Aisling McMahon2
  1. 1 School of Business, UCD, Dublin, Ireland
  2. 2 Department of Law, Maynooth University, Maynooth, Ireland
  1. Correspondence to Dr Aisling McMahon, Department of Law, Maynooth University, Maynooth, W23F2H6, Ireland; aisling.mcmahon{at}


This article outlines and compares current and proposed global institutional mechanisms to increase equitable access to COVID-19 vaccines, focusing on their institutional and operational complementarities and overlaps. It specifically considers the World Health Organization's (WHO’s) COVAX (COVID-19 Vaccines Global Access) model as part of the Access to COVID-19 Tools Accelerator (ACT-A) initiative, the WHO’s COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS (Trade-Related Aspects of Intellectual Property Agreement) intellectual property waiver and other proposed WHO and World Trade Organization technology transfer proposals. We argue that while various individual mechanisms each have their specific individual merits—and in some cases weaknesses—overall, many of these current and proposed mechanisms could be highly complementary if used together to deliver equitable global access to vaccines. Nonetheless, we also argue that there are risks posed by the proliferation of proposals in this context, including the potential to disperse stakeholder attention or to delay decisive action. Therefore, we argue that there is now a clear need for concerted global multilateral action to recognise the complementarities of specific models and to provide a pathway for collaboration in attaining global equitable access to vaccines. The institutional infrastructure or proposals to achieve this amply exist at this point in time—but much greater cooperation from industry and clear, decisive and coordinated action from states and international organisations are urgently needed.

  • COVID-19
  • ethics- medical
  • policy
  • resource allocation

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  • Contributors Both authors contributed equally to all arguments and discussions for this paper. The authors drafted the paper together, contributed to finalising the paper and both approved the final submission.

  • Funding Dr Aisling McMahon has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Prof Susi Geiger gratefully acknowledges funding received from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No 771217) while co-authoring this manuscript.

  • Disclaimer The views expressed here are the authors’ own and are not representative of AMI.

  • Competing interests AM and SG are members of Access to Medicines Ireland (AMI), a voluntary membership group of Comhlámh. The views expressed here represent the authors' views and are not representative of AMI. AM and SG act as joint guarantors for the paper.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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