Carel IJsselmuiden1, Francine Ntoumi2, James V Lavery3, Jaime Montoya4, Salim Abdool Karim5, Kirsty Kaiser6. 1. Council on Health Research for Development, Geneva 1218, Switzerland; School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa. Electronic address: carel@cohred.org. 2. Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of the Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany. 3. Rollins School of Public Health and Center for Ethics, Emory University, Atlanta, GA, USA. 4. Philippine Council for Health Research and Development, Manila, Philippines. 5. Centre for the AIDS Programme of Research in South Africa, Durban, South Africa. 6. Council on Health Research for Development, Geneva 1218, Switzerland.
Nicole Lurie and colleagues argue that “[m]any gaps…must be bridged to establish a truly efficient and effective end-to-end R&D [research and development] preparedness and response ecosystem. Foremost among them is a global financing system”. While obviously essential, it is unlikely that global financing, in itself, will address the immoral inequity on display in the global distribution of COVID-19 vaccines. The R&D systems of low-income and middle-income countries (LMICs) need to be strengthened with equal force and funding for pandemic preparedness to succeed.The authors refer to China, Russia, and India as countries with “remarkable scientific expertise”. In reality, had COVID-19 struck 20 years ago, these middle-income countries could not have contributed substantively to curbing the pandemic. Now, because of their own investments in R&D, the world is unlikely to control COVID-19 without these countries’ vaccines, which are filling a critical equity gap for LMICs, even in the absence of improved global R&D financing. By contrast, central Africa continues to suffer from Ebola and other outbreaks, while health research capacity in the region remains the lowest in Africa, nurturing the potential for future pandemics.We need to think differently about the strategic value of investment in R&D systems in LMICs. Fairness in research partnerships is both a global value and a strategy for diversifying investments in global health in ways that expand global R&D capacity by more efficiently mobilising the extraordinary intellectual, social, and economic capacity within LMICs. LMICs have to embrace and invest in science with matching support from global R&D funds, including for the manufacture of diagnostics and vaccines.We declare no competing interests.