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Two years into the COVID-19 pandemic, it feels like we are stuck in an endless cycle. When a new variant like omicron pops up, the world reacts by enforcing questionable travel bans and lockdowns and 

While it's likely that COVID will stay with us in one form or another, vaccines remain our biggest hope for 

protection of the vulnerable against hospitalization and death

, especially for individuals at increased risk of severe COVID-19 due to conditions like diabetes, high blood pressure and obesity, or simply their age. Once those at highest risk everywhere are protected from severe disease — and if no other vaccine-evasive variant emerges — COVID will hopefully join the ranks of the other cold and flu viruses with which we live.

Yet governments – especially those in high-income nations – continue to hoard vaccines, leaving many individuals elsewhere vulnerable to the virus. Although more than 60 percent of the world's population has received at least one dose of vaccine, most who are protected live in rich countries. In fact, just 

10.1 percent of the people on the African continent

 are vaccinated, according to the World Health Organization.

So how do we get vaccines to everyone? The good is news is that we already have the resources, knowledge and systems to make and distribute vaccines around the globe. Here are five steps that world leaders must take to make this happen.

 by rich countries has plagued the global effort to get shots into arms in low-income countries, where supply remains 

 1 billion doses per year to give to poor nations, this is not nearly enough. A 

 by a group of public health advocates and scientists estimated that in order to ensure every person has access to mRNA vaccines – the type of vaccine that currently appears to be most effective – the world needs to produce 

 than the 7 billion doses currently planned for 2022.

While this may sound like a tall order, the U.S. has the capability to expand its vaccine manufacturing – quickly and at a reasonable cost. The production facility for the Moderna-NIH vaccine in New Hampshire, for example, was set up in just 4 months, suggesting we could do the same for other facilities if desired.

At the current production cost of the Moderna-NIH vaccine, it would cost 

$12 billion to produce 15 billion doses of vaccine

, without even accounting for savings from economies of scale. This is just a drop in the ocean compared to the lives saved, COVID restrictions averted and 

trillions of dollars of economic productivity gained

The Biden Administration could also speed up production by immediately implementing a government-owned, contractor-operated model. If the government hires manufacturers to produce the vaccine, those manufacturers would not have to repeat some of the clinical trials that were completed by the original vaccine manufacturers, saving months of time and accelerating the production timeline.

The U.S. can help other nations make vaccines, too – by waiving intellectual property protections for coronavirus vaccines that prevent other manufacturers from using the recipe. In May 2021, the Biden Administration 

 for such a plan, but despite this early rhetorical support, they failed to deliver.

In contrast, Russian and Chinese manufacturers have not only shared their technologies, but have 

provided essential ingredients, supervised the manufacturing process

As vaccine supply increases, high-income countries and global institutions must help low-income nations get vaccines through their "last mile" – the final steps in the supply chain to get vaccines from shipping containers to medical facilities and into people's arms.

But transporting and storing vaccines requires money and logistics. Africa, for example, needs 

 in operational costs to deliver COVID vaccines, according to WHO.

These funds will go toward transport costs, staff – including truck drivers, distribution coordinators and community health workers – as well as 

 necessary for a cold-chain. The global experience rolling out a temperature-controlled supply chain for the pneumococcal vaccine in Africa 

 highlights that challenging environments are no excuse for inaction.

Without the necessary logistical supports, we cannot ensure that the vaccines will get to the people who need them.

Step 3: Set bold global vaccination goals

Once the world has a plan to make vaccines and get them to people, the next priority is to set an ambitious vaccination target so that we can hold national leaders and multilateral institutions to account. Setting goals – as the global community has done with 

 – helps to advocate for funding, track progress and drive political commitment.

Sadly, the aspirations set by global agencies for low-income countries have been disappointingly low. At the same time that wealthier nations, 

., set their vaccine coverage goals at 70 percent, COVAX, the global COVID vaccine-sharing program, aimed to vaccinate 

 of each country's population. This is not enough to protect those susceptible to severe disease.

We need more ambitious goals if we want to achieve vaccine equity and protect individuals at high risk. For example, 

39 percent of people in the world are challenged by overweight and obesity

 have diabetes. Ensuring vaccines for individuals with these conditions — along with their caregivers and close family members — would likely require a coverage rate of closer to 70 percent, the same goal set by high-income countries.

While COVAX updated its goal to 40 percent of each country's population by the end of 2021, only 

 managed to achieve this, largely due to vaccine supply shortages and logistical issues.

Now, we must convince more people who can benefit from vaccines to get vaccinated.

 most impactful global health interventions, yet significant numbers of people in the world are distrustful of them. Some of that reluctance stems from lack of faith in the government or the health-care system. Some fear the vaccine will harm them. Others are confused by conflicting sources of information and cannot make a well-informed decision.

One way to address this is to reach out to under-vaccinated communities to help them better understand the vaccine's safety and benefits. Last year, for example, the advocacy group Health Care for All 

 to improve vaccine uptake in 20 marginalized communities in Massachusetts. The group deployed trained, trusted community members to go house to house and talk to local residents about the COVID vaccine. The volunteers listened to and addressed their queries – some were concerned that getting vaccinated would compromise their citizenship status – provided information about the vaccine and explained how to make a vaccination appointment.

The program showed an impressive increase in immunization, especially among Black and Hispanic communities. Imagine if we could adapt this community-led approach in different parts of the world. Trust in vaccine has to be built from the ground up, one neighborhood at a time.

Step 5: Ensure vaccines benefit people, not just companies

Vaccine equity isn't just about getting doses to everyone who needs them. It's also about ensuring that we are making ethical decisions about who can benefit from them – that is, basing vaccine policy on the best available, highest-quality scientific evidence and not simply on the desire of the industry to maximize their returns.

, have made the cycle of booster shots part of their business plans. In April 2021, Moderna told investors they expected to 

reap the benefits of a robust "variant booster" market

 months before the there was any evidence that supported the use of boosters and before the delta strain became widespread. In December 2021, despite the absence of any data and just 12 days after omicron emerged, Pfizer CEO Albert Bourla said "

Doling out endless booster shots for all in high-income countries may be good for the pharmaceutical industry, but it leaves us stuck in a revolving door of variants and boosters. Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, characterized it as "

benefits of subsequent doses outweigh any risks

 for those most vulnerable to COVID-19 is to run clinical trials that look at real-world outcomes — like hospitalizations, intensive care admissions and deaths — rather than on data solely generated from studies done in laboratory test tubes. Although they are useful to inform early decision-making, laboratory-based data sometimes do not reflect the results we see in humans.

In order to provide people the best and most durable protection against COVID, we also need to invest in research on novel vaccines – such as those that 

 of COVID-19 – as well as vaccines that can be easily scaled up and produced at a low cost in other parts of the world. One example of a scalable, patent-free vaccine is 

, recently developed by the Baylor College of Medicine, whose final efficacy results are still pending.

If we can get these five steps right, we can protect the vulnerable and end the constant state of pandemic.

Any COVID-related death in 2022 represents the world's moral, economic and political failure to ensure that the tools at our disposal to combat COVID are fairly distributed across the world.

Scientists have played their role in developing powerful vaccines, now global leaders must prioritize the seemingly more challenging task of getting vaccines into the arms of those who need them.

Dr. Edward Cliff and Dr. Isaac Chan are resident physicians currently based at the Harvard T. H. Chan School of Public Health. Dr. Salmaan Keshavjee is a professor of global health and social medicine at Harvard Medical School and director of the Center for Global Health Delivery. 

Health

COVID-19

Edward Cliff

Author

Isaac Chan

Salmaan Keshavjee

Three doctors present their proposal to get vaccines to everyone in the world. "We already have the resources, knowledge and systems," they write. Global leaders just have to make it happen.

Opinion: 5 steps we must take to vaccinate the world's vulnerable — and end the pandemic

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