LAUSR

Correspondence to Dr Paul A Wilson; pw2101@ columbia. edu © Author(s) (or their employer(s)) 2023. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. The international response to the COVID19 pandemic, despite important successes, has highlighted profound inequities in access to medical countermeasures (MCMs), with many lowincome and middleincome countries (LMICs) receiving lifesaving products, especially vaccines, months or years after highincome countries (HICs). Many efforts are now underway to absorb the lessons from the COVID19 experience and to build a stronger infrastructure for ensuring fair access to MCMs in future disease outbreaks. There have been more than 30 reviews and evaluations of the COVID19 response, negotiations have begun on a pandemic accord, WHO is developing an MCMs ‘platform’, and both the G7 and G20 will focus on pandemic preparedness and response this year. Although there is not yet a clear consensus on the way forward, several themes have emerged, including the need for greater regional autonomy in pandemic response, rapidly accessible funding, greater emphasis on technology transfer, and more inclusive governance of international responses. While understanding and remedying what did not work well in the response to the COVID19 pandemic is crucial, there is also a danger of focusing too much on public health emergencies that closely resemble this one, that is, of fighting the last war. Infectious disease outbreaks come in many kinds and the differences among them have important consequences for efforts to ensure equitable access. We outline here a simple framework, based on characteristics of outbreaks relevant to availability and supply of MCMs, and highlight some important implications for approaches to ensuring supply to LMICs. Disease outbreaks and the pathogens that cause them differ in many ways, including the type of pathogen and mode of transmission, the location of the outbreak and health system capacity to respond. A number of organisations, including WHO, Africa Centres for Disease Control and Prevention (Africa CDC), US National Institutes of Health, the European Commission’s Health Emergency Preparedness and Response Authority and the UK Vaccine Network, have categorised and prioritised pathogens in various and valuable ways. In our work with UNICEF Supply Division, the world’s largest procurer of vaccines and a key supply partner in health emergencies, our focus is on access to MCMs. SUMMARY BOX