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Beginning the global COVID-19 vaccine rollout 100 days after the virus was sequenced could have saved more than 8 million lives by the end of 2021, most of them in lower-middle-income countries, according to modeling evidence brought together in a new policy brief from the United Nations University Institute for Water, Environment and Health (UNU-INWEH). The authors argue that fair vaccine-sharing rules should be established before the next pandemic, rather than negotiated during the crisis itself.

Best Practices in Global Vaccination Roll-Out to Reduce Health Inequity, written by researchers from UNU-INWEH, the University of Oxford, Imperial College London, the London School of Hygiene and Tropical Medicine, King's College London, Nagasaki University, Japan Institute for Health Security, Public Health Foundation of India and the Middle East Liver Disease Center, argues that international commitments to vaccine equity have not yet produced the operational mechanisms needed to deliver timely access across countries.

It proposes an "equity-by-design" framework that links vaccine development to financing, procurement, manufacturing, allocation, delivery, uptake, safety monitoring and accountability. It presents six recommendations as practical pillars for delivering on the WHO Pandemic Agreement, adopted in May 2025, and the amended International Health Regulations, in force for most states parties since September 2025.

The 8 million estimate comes from a modeling study reviewed in the publication, which assumes that the public health measures followed their historical course.

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