Abstract

Global vaccine equity remains a central concern in international public health, reflecting long-standing disparities 
in access to life-saving vaccines between and within countries. This narrative review synthesizes historical, 
geopolitical, social, and economic factors shaping vaccine distribution and utilization, focusing particularly on low- 
and middle-income countries (LMICs). Quantitative indicators and qualitative case studies reveal significant 
inequalities across regions and vaccine types, exacerbated during the COVID-19 pandemic. The review examines 
international governance frameworks such as COVAX, Gavi, and WHO-led initiatives, assessing their 
effectiveness and sustainability. Comparative and longitudinal analyses using group-based trajectory and 
multivariate methods offer frameworks for monitoring equity and benchmarking political commitments across 
countries. Case studies from Sub-Saharan Africa, Southeast Asia, and Latin America and the Caribbean provide 
regional insights into systemic barriers, including limited manufacturing capacity, financing shortfalls, and 
governance inefficiencies. Strategies for improving vaccine equity emphasize regional manufacturing hubs, 
technology transfer, flexible financing mechanisms, and strengthened donor coordination. The analysis 
underscores that global vaccine inequity is both a technical and moral challenge rooted in political economy, 
global trade rules, and power asymmetries. Addressing these inequities requires inclusive policy reforms, 
sustainable financing, and regional capacity building to ensure vaccines are accessible, affordable, and available to 
all populations, particularly the most marginalized.