The author is the co-chair of Bill & Melinda Gates Foundation. The opinions expressed here are his own. Check out more reviews on CNN. Today, 46% of the world's population has received at least one dose of a Covid-19 vaccine . It's hard to overstate how remarkable this is. Mankind has never manufactured and distributed a vaccine for a disease faster than it has for Covid-19. He accomplished in 18 months something that took a decade or more. But in this suthis incredible, there is a surprising disparity: hardly more than 2% of people in low-income countries have received vaccines against Covid-19. And the gap will be more difficult to close because the richest governments in the world buy extra doses to serve as reminders . Bill Gates People are right to be unhappy with the inequity here. Vaccines make Covid-19 largely preventable - and survivable in all but the rarest cases - and it is heartbreaking to know that people are dying from a disease not because it cannot be stopped, but because they live in a low income country . Unfortunately, this injustice is not new. It is not even the worst discrepancy in sanityglobal tee. There have been health disparities shocking long before any of us had heard of Covid-19. Each year, over 5 million children die before their fifth birthday, mostly from infectious diseases, and almost entirely in low- and middle-income countries. A child from northern Nigeria is over 20 times more likely to die before the age of 5 than a child from a rich country. This is simply unfair and reducing this injustice has been the top priority of the Gates Foundation for over 20 years. Find out more How to protect pregnant women from Covid-19 If you step back and look at the trends, however, there is some good news. Since 1960, the infant mortality rate has been reduced by over 80% , largely due to the invention and distribution of childhood vaccines around the world. The fact that routine childhood vaccines reach so many people is one reason to believe that Covid-19 vaccines can too. Providing them to anyone who needs them is one of three crucial steps to control this pandemic, as well as contain the virus so that it does not roar back and coordinater the global response. At the same time, we can learn from the inequalities that were so clear during this pandemic so that we can do a better job of closing the gap in the next. (Assuming there's a next pandemic. I think it's possible to prevent them altogether. But that's a topic for another time.) How might we achieve vaccine equity in a future pandemic? I see two ways: Changing the way the world allocates doses What would the optimal allocation look like? It's not just a question of proportional representation, where if your country has X percent of the world's population, you get X percent of the vaccines. There are two different b benefits to consider, and both are important. One benefit is for the person who is immune; they are protected from the virus. The more likely you are to get infected - the more seriously you are likely to get sick orto die if you are infected - the longer you get a vaccine. Pediatrician: What I want this Covid vaccine to do for my grandchildren A 70 year old Covid-19 patient is 90 times more likely of dying than a Covid patient by elsewhere in good health in their twenties. From a world In perspective, it is neither fair nor wise to protect this young person before the old one. Second, when an individual is vaccinated, society has benefit of reducing the risk of the person transmitting the disease to others. This is the heart of the argument for immunization of health workers and people working in care facilities for the elderly, because even when 'a lock is eInstead, they can transmit the virus to people at high risk. When a virus spreads, we need to maximize both benefits: saving lives and stopping transmission. This means that, when stocks are insufficient, we must prioritize immunizing people who are both at high risk of death and who live in places where the virus is spreading the fastest. They will not necessarily be low income countries. When Covid-19 vaccines first became available, many of the more serious outbreaks were found in rich and middle income country. Covid vaccines are a modern miracle. We couldnot having them without these protections The most serious inequity, even more than immunizing the rich before the poor, immunizing the young in the rich countries before the elderly in the income countries intermediate with bad epidemics, such as South Africa and most of South America. To their credit, rich countries have pledged to share more than a billion doses with the poorest countries during the Covid-19. But they have yet to fully deliver on those commitments, and even if they had, the gap would still be huge. While dose sharing should be part of the solution, it will never be enough to solve the problem. On the one hand, the number of doses will not be high enough. And will future politicians always be ready to tell young voters that they cannot get the vaccine because the doses go in aanother country, at a time when schools are still closed and people - including a few young people - are still dying? This is why it is so important to find ways to produce more doses in less time. The world should aim to be able to make and live with enough vaccines for everyone on the planet within six months of detecting a potential pandemic. If we could do this, then the supply of doses would not be a limiting factor, and how they are allocated would no longer be a matter of life and death. Take more doses As limited as the supply of Covid-19 vaccine is, the situation could have been even worse. We are fortunate that mRNA vaccines work so well, as it is the first disease for which mRNA technology has been used.isee. If they hadn't, our situation would have been much worse. How to disrupt American history by renaming disinformation to 'science ' It's also great that some vaccine companies have entered into second-source deals, which has allowed other companies to manufacture huge volumes of their vaccines. It was a critical and remarkable milestone. (It's as if Ford is letting Honda use its factories to build Accords.) Just one example: In less than two years, only one automaker, AstraZeneca, has signed second-source deals involving 25 factories in 15 countries .You may have heard the argument that lLifting intellectual property (or IP) restrictions would have made a difference. Unfortunately, this is not true in this case. IP disclaimers and licensing are complicated issues, so I want to take the time to sort them out. There are cases where IP licenses are a great way to do something better and cheaper. For example, in 2017 the Gates Foundation and a number of partners were involved in a agreement to create a new, more effective version of a cocktail of HIV drugs that would be more affordable for the world's poorest countries. Merck's Covid-19 pill is a great onenew but may not be a game -changer In agreement, a pharmaceutical company gave the recipe for the key ingredient of this cocktail to companies specializing in the production of generic drugs . These companies have been able to reduce costs so much that today almost 80% of people who receive HIV treatment in low- and middle-income countries receive the enhanced cocktail. Unfortunately, IP licenses do not work as well with vaccines. Here's why. Many drugs are manufactured using well-defined and measurable chemical processes. If you mix the same ingredients in the right proportions and so on, you will get the same product every time, and you can check your work by examining the chemical structure after the drug is made. The companyA can give a recipe to company B, and company B be able to make the exact same drug consistently. But many vaccines don't work that way. Their manufacture often involves living organisms, from bacteria to chicken eggs. Living things don't necessarily act exactly the same every time, which means that even if you follow the same process twice, you might not get the same product both times. Even an experienced vaccine maker might not be able to simply take another's recipe and reliably reproduce it. Therefore, a blanket waiver of IP protections would not significantly increase vaccine supply. (In the case of Covid-19, however, a narrow waiver that applied to specific technologies that are easily transferable during the pandemic makes sense .) Supply was limited not due to intellectual property rules , but because there are not enough factories capable of handling the more complicated vaccine manufacturing process. JUST LOOKED 'Anger , outrage ': CNN reporter shares heartbreaking story about vaccine inequality Replay More videos ... MUST WA TCH 'Anger, outrage ': CNN reporter shares heartbreaking story about vaccine inequality 03:23 IP licensing - or waiving its rights - only guarantees that company A cannot sue company B. Second-source agreements are far superiorbecause they involve sharing not only the recipe, but also knowledge about its use, as well as personnel, data and biological samples. This was a second source agreement with AstraZeneca - not an intellectual property waiver - which allowed the Serum Institute of India to produce 100 million Covid-19 doses at a very low cost and in record time . So how will the world be able to produce more doses faster the next time around? First, policymakers should take expanding global vaccine manufacturing capacity seriously. In particular, governments and industry need to ensure that there is sufficient capacity to rapidly manufacture huge volumes of mRNA vaccines; now that we know that the mRNA platform is working, it will allowto develop new vaccines faster than any other approach. And if companies that have second-source deals now maintain their relationships with each other, they won't have to start from scratch in the next outbreak. Another step is to develop prototypes of vaccines against diseases most likely to cause future epidemics, and to develop universal vaccines for influenza and coronaviruses, which would protect people against any form of the two pathogens. The National Institutes of Health (NIH) and Coalition for Epidemic Preparedness Innovations (CEPI) are doing a great job on both, but more research is needed. A longer term step is for a more grand number of countries to strengthen their capacity to develop, manufacture and approve vaccines themselves. Historically, the companies inventing new vaccines were based in higher income countries. Because it is so expensive to develop a new product, they are trying to recoup their costs as quickly as possible by selling doses for higher prices than the rich countries can afford. They have no financial incentive to try to reduce their costs (by optimizing the production process, for example) so that the price can be cheap enough for low-income countries. Receive our free weekly newsletter Subscribe to the new newsletter. Join us on Twitter and Facebook The pentavalent vaccine - which protects against the target five diseases (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B) - is a prime example. It was invented in the early 2000s, but there was only one manufacturer, and more than $ 3.50 per dose , it was way too expensive for income countries low or intermediate. Our foundation and other partners worked with two vaccine companies in India - Biological E Limited and Serum Institute of India - to develop a pentavalent vaccine that would be affordable anywhere. Today, this vaccine costs around $ 1, and it is donated at 80 million children per year. This is a 16-fold increase since 2005. We need more examples like this. Pentavalent took years to succeed. If there were more high-volume vaccine manufacturers whose pr If the main goal was to produce low-cost vaccines, Affordable doses would then be available much more quickly. Middle-income countries are a natural home for these businesses, and some have set themselves ambitious goals. For example, a group of African leaders has set a target for the manufacture of 60% of vaccines on the continent of here 2040. Helping middle-income countries build their vaccine manufacturing capacity is something the Gates Foundation has worked for two decades. We have helped commercialize 17 vaccines and we are supporting African efforts to develop theirs by 2040. We have learned that creating a complete vaccine manufacturing ecosystem is a tall order. But obstacles can be overcome. One problem is the need for regulatory approvals. Vaccine factories must be approved by a so-called benchmark regulatory body. India is the only developing country with a benchmark regulatory body; factories in any other developing country must first be approved by their own government and then by the World Health Organization. That takes time. Regional agencies in Africa are working with the WHO and the European Union to create regulationsreference entations on the continent. Governments are also collaborating on regional standards for vaccines, so manufacturers don't have to meet different safety and efficacy requirements in each country. Another challenge: if vaccine makers don't have other products to make between outbreaks, they will go bankrupt. Unfortunately, making existing vaccines is not a viable option, at least for the time being, as the market is already saturated with existing vaccines, and it would be difficult for new entrants to compete on price with established low-cost companies. cost / large volume. But new products are coming that would be ideal products for them. As vaccines become available for diseases like malaria, tuberculosis and HIV, they will create opportunities for producers in middle-income countries. Waiting for, countries can take over the filling and finishing process - putting vaccines made elsewhere into vials and distributing them. To anyone who has lost a loved one to Covid-19, or had to choose between paying rent or buying food, it is not heartwarming to suggest that all has gone well in this pandemic. . But like my friend, the late Hans Rosling, used to say , The world can be both bad and better. The situation today is bad, and as better than it would have been if Covid-19 had arrived 10 years ago. If the world makes the right investments and makes the right decisions now, we can make things better next time. And maybe even make sure there isn't a next time.