Just over 3 years after the start of the COVID-19 pandemic that claimed the lives of millions of people around the world, there is an urgent need to take stock of the lessons learned from the pandemic to address both the threat of future pandemics and the daily challenges to health posed by infectious diseases, many of which can be prevented by existing vaccines. Science has demonstrated its enormous potential in human health by developing effective vaccines just one year after the first cases of COVID-19 were reported in Wuhan, China. The first clinical trial showing that a COVID-19 vaccine provided high protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was published in the New England Journal of Medicine in December 2020 [1]. Throughout the pandemic, despite the emergence of different variants of concern (VOCs) with increasing capacity to escape the action of neutralizing antibodies, vaccines continued to show robust protection against severe SARS-CoV-2 infection 2•, 3•, 4••. However, the scientific success of COVID-19 vaccines was overshadowed by the severe inequity in access to vaccines, which favored economic interests over the right to universal health. By the end of April 2021, more than 1.3 billion doses of anti-SARS-CoV-2 vaccines were administered worldwide, but less than 0.2% of vaccines corresponded to low-income countries 5••, 6. In the period between December 2020 and February 2022, several high-income countries achieved vaccination coverage rates close to 90%, while in low-income countries, less than 15% of people received at least one dose. Today, only 28% of people in low-income countries have received at least one dose, and about three billion people worldwide have not yet received a single dose of vaccination [6]. As recognized by the World Trade Organization (WTO) director Ngozi Okonjo-Iweala “The issue of equitable access to vaccines, diagnostics, and therapeutics is both the moral and economic issue of our time” [7]. Everyone seems to agree that any obstacle that impairs universal access to vaccines must be removed. However, a WTO Trade-Related Aspects of Intellectual Property Rights waiver of intellectual property rights endorsed by more than 100 countries, including South Africa, India, China, and Russia in October 2020, and the transfer of the necessary experience and technology to promote the local production of vaccines in low- and middle-income countries are still pending issues 5••, 8••, 9•. This situation is particularly remarkable considering that pharmaceutical companies have relied heavily on publicly funded research to develop their vaccines 10, 11•, 12.

Expanding vaccine production to low- and middle-income countries will not only lead to more vaccines being available, but also to lower prices. The production of a recombinant hepatitis- B vaccine by the Indian manufacturer Shantha Biotechnics in the 1980s markedly reduced the cost of each dose, allowing the immunization of millions of people worldwide 5••, 13. By contrast, the lack of competition in the vaccine market has resulted in extraordinary profit margins by pharmaceutical companies as exemplified by the case of human papillomavirus vaccines 14, 15.