More than one in five Americans are now fully vaccinated against Covid-19, while in dozens of countries not a single person has received a shot. The early distribution of the vaccine has followed a predictable pattern: 86% of the doses administered to date have been given to people in high- and upper-middle-income countries. This inequity threatens to prolong both the pandemic and the economic recovery. At a Make Business Better event on April 7, Quartz gathered experts in global public health and the pharmaceutical industry to discuss what needs to happen to ensure that vaccines and other critical medications are distributed quickly and fairly, both across borders and within countries. You can watch the whole conversation by clicking on the image above and read brief excerpts below. The scale of the challenge “If 14 months ago you’d gotten a dozen virologists and said, can you imagine 14 months from now having 12 vaccines for which there is production capacity of 12 billion doses worldwide, and that is 70% to 90% effective, they would have said no, no, not in the world I know,” Dr. Jonathan Quick, managing director of pandemic response, preparedness, and prevention at the Rockefeller Foundation, said. “But in the current trajectory, we’re going to be lucky if we get even 20% of low- and middle-income populations immunized by the end of this year. It’ll take years at the current rate to get the entire population. This is unacceptable from a moral and humanitarian point of view.” Lessons from the fight against HIV/AIDS Dr. Joia Mukherjee, chief medical officer at the health nonprofit Partners in Health, compared the global response to Covid-19 to the decades-long fight against the HIV/AIDS pandemic. “We had treatment in the north since 1996. There was no treatment in the global south,” Mukherjee said. “And what excuses we heard: This is complicated technology. There is no way pharma can scale this up quickly enough to meet the demand and in scaling this up or sharing patents, it will kill innovation. And none of these things turned out to be true. What we’ve learned is that scarcity is a myth. Scarcity is a created situation.” Pharmaceutical companies and governments are making those same arguments today, she said. Solutions to scarcity “We are on the cusp of being able to end this pandemic. We have the tools, but there’s lots we need to do in order to put those tools into practice on the ground around the world,” said Quick. The Rockefeller Foundation estimates that it would cost $44 billion to vaccinate 70% of the population of all lower- and middle-income countries by the end of 2022. That funding already exists, Quick said, but it needs to be released by the IMF. Both Quick and Mukherjee pointed to AstraZeneca’s vaccine as a good model for the kind of cooperation between companies and governments that’s needed to expand the world’s supply of vaccines. “The expectation should be that in the context of a pandemic, companies that have the technology will not just release their IP and say go to it, but do a low-cost and no-cost license combined with technical transfer of technology to produce it,” Quick said. Despite buying more vaccine doses than its population needs, the US has run into its own drug shortages during the pandemic, including medications needed to treat Covid-19 patients in ICUs. “Covid-19 exposed substantial supply chain challenges globally,” said Dr. Eric Edwards, CEO of Phlow, a pharmaceutical company that manufactures ingredients for essential medicines in the US. Advanced manufacturing technologies can increase countries’ capacity to produce pharmaceutical ingredients domestically to withstand disruptions in global trade, like the recent blockage of the Suez Canal and the pandemic itself, while improving quality and decreasing costs, he said. Watch the full discussion to hear more of our panel’s ideas.