BMJ  |  November 1, 2023

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Within a year of the first reported covid-19 cases, effective vaccines were approved in Europe and North America using technology that would win the Nobel prize.12 Yet just 1% of all vaccines produced in the first year went to low income countries. Much the same happened in the early years of HIV treatment. Breakthrough antiretroviral therapy slashed mortality in high income countries, but drugs were priced out of reach for people in Africa, Asia, and Latin America until intellectual property and production barriers were overcome and generic versions arrived. In both cases, remarkable scientific victory was undermined by similarly remarkable equity failure. The pandemics were prolonged, took many more lives, and had highly unequal impacts because of inequitable distribution.

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