Vaccine scarcity in LMICs is a failure of global solidarity and multilateral instruments.

To address COVID-19 vaccine scarcity, Ivan Sisa and colleagues justify placebo-controlled trials in low-income and middle-income countries (LMICs), arguing that these countries have “less capacity to negotiate and purchase vaccines than do high-income countries” and that the global shortage can be overcome with more vaccine producers coming from such trials. We are concerned that this reasoning sets the wrong precedent because approving such a trial should show that evidence can only be reached with this design. Furthermore, LMICs should not ignore the urgent need to increase production and distribution of already efficacious vaccines.

In the interest of saving people's lives, vaccine development demands working towards improved capacities on the road from discovery (free of patent restrictions) to manufacturing and equitable distribution. Therefore, clinical trials should be done simultaneously, engaging volunteers and researchers across a broad range of LMICs and high-income countries. Furthermore, study protocols should provide robust assurances that participants will have access to the vaccine when their priority group is eligible in the general population. Finally, emphasis should be made on other pressing issues, such as adopting low dead space syringes to prevent discarding residues, thus improving vaccine volume.

Ensuring efficacious vaccines are made widely available and at fair cost, when high-income countries are hoarding up to five times what they need and prices are speculative, would require making alliances with countries (eg, Brazil or India) with the capacity to produce generic vaccines, alongside efficient syringes, and means of storage and transportation. Notwithstanding, LMICs will need support from additional partners in other regions of the world.