Too Many Cooks or too many Recipes? An analysis of the institutional landscape and proliferation of proposals for Global Vaccine Equity for COVID-19

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 Organisation's (WHO) COVAX model as part of the ACT-A initiative, the WHO's COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS intellectual property waiver, and other proposed WHO and World Trade Organisation (WTO) technology transfer proposals. We argue that while various individual mechanisms each have their specific 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 the relevant institutions and in particular the WHO and the WTO must be clearer in how various proposed mechanisms could interlink and work together to achieve global vaccine equity. Alongside this, there is now also a clear need for concerted global multilateral action to recognise the complementarities of specific individual models proposed and to provide a pathway for collaboration in attaining global equitable access to vaccines. The institutional infrastructure or proposals to achieve this amply exists at this point in time - but much greater co-operation from industry and clear, decisive and co-ordinated action from States and international organisations is urgently needed.