COVID-19 research in LMICs – Authors' reply
Authors: Irene Torres, Barbara Profeta, Cristiani Vieira Machado, Osvaldo Artaza, Daniel Lopez-Cevallos, JaHyun Kang
Journal: The Lancet (2021)

We thank Ivan Sisa and colleagues for their comments on our Correspondence,1Torres I Lopez-Cevallos D Artaza O et al.Vaccine scarcity in LMICs is a failure of global solidarity and multilateral instruments.Lancet. 2021; 3971804Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar but we still worry about the marginalisation of scientific production from low-income and middle-income countries (LMICs). Indeed, these nations usually have scarce public resources to invest in science and, consequently, tend to produce fewer indexed publications compared with high-income countries (HICs). However, such metrics restrict the understanding of academic production to the accrual of articles in English-speaking scientific journals based in HICs and, therefore, to an imperfect appraisal of the impact of their discoveries and the value of the science only in relation to their own realities. Similarly, it is quite short-sighted to assess the scientific power of HICs as the amount of knowledge and products that LMICs adopt and buy from them, rather than as the degree of scientific sovereignty that the latter can develop. Furthermore, reducing the concept of innovation to the unilateral transfer of knowledge from HICs to the rest of the world, where vaccines and medicines are tested rather than developed, actually contradicts the very purpose of scientific pursuits. For LMICs to pursue scientific advancement to the same extent as HICs, they would need to dismiss the pluralities of knowledge that make their settings diverse and enriching outside of the laboratory and the clinic. In consequence, LMICs would have to privilege a medicalised version of health and life over other definitions and understandings of health and wellbeing. Even if this path were not pursued, it should not be demanded that LMICs relinquish a key presence on the global stage. Patients, consumers, doctors, and researchers in LMICs should not be required to validate methods and results of trials devised in HICs, without strengthening local capacity in research, technological development, and production of medicines (including vaccines) to become an increasingly equal counterpart across research cycles. Ultimately, appraising scientific innovation in terms of consumable knowledge without regard to local capacities and diverse wellbeing undervalues the importance of scientific sovereignty. Any collaboration between governments, or academic or public and private institutions, across countries with different levels of income should aim towards scientific sovereignty and, eventually, the dissemination of knowledge in the reverse direction. International instruments, agreements, and funders should ensure there are policies in place to promote equity and to ultimately guarantee egalitarian scientific collaborations. Meanwhile, effective vaccines and medicines that are crucial in dealing with public health problems, when available, should be considered global public goods to be distributed across countries swiftly, in accordance with global solidarity mechanisms. We declare no competing interests. Vaccine scarcity in LMICs is a failure of global solidarity and multilateral instrumentsTo address COVID-19 vaccine scarcity, Ivan Sisa and colleagues1 justify placebo-controlled trials in low-income and middle-income countries (LMICs), arguing that these countries have "less capacity to negotiate and purchase vaccines than do high-income countries" and that the global shortage can be overcome with more vaccine producers coming from such trials. We are concerned that this reasoning sets the wrong precedent because approving such a trial should show that evidence can only be reached with this design. Full-Text PDF COVID-19 research in LMICsWe read with interest the Correspondence by Irene Torres and colleagues,1 and agree that the current scarcity in low-income and middle-income countries (LMICs) of vaccine to combat the COVID-19 pandemic is a failure of local governments, global solidarity, and multilateral instruments. However, regarding Torres and colleagues' comment that approving placebo-controlled trials in LMICs "sets the wrong precedent because approving such a trial should show that evidence can only be reached with this design",1 we would like to extend this extremely important discussion. Full-Text PDF