Major drugmakers and rich nation leaders faced up on Friday to the startling global imbalance in fighting Covid-19 and made big pledges to up supplies of cut-price vaccines to poorer regions.
Lavishly-funded mass inoculation campaigns are helping the West and others slash infections, but few shots have reached poorer nations where the virus is still raging, sometimes uncontrollably, drawing accusations of "vaccine apartheid".
More than 80% of the first billion shots went to wealthy countries, compared to just 0.2% for low-income nations, US philanthropist Bill Gates told a special Group of 20 summit focussing on the global health crisis.
"If we do not close this immense gap, more people will die needlessly. There are two immediate actions countries can take: share dollars and doses," he said.
The summit was to call for voluntary licensing and technology transfers to boost vaccine production, but will sidestep a push from the United States and other nations to waive valuable patents, a joint declaration showed.
The European Union promised to invest 1 billion euros ($1.2 billion) to set up vaccination manufacturing hubs in Africa.
At the Italian- and EU-hosted virtual summit, Pfizer and BioNTech also pledged to make available 1 billion cut-price doses this year to poorer nations. Another 1 billion vaccines would be provided next year, Pfizer boss Albert Bourla told the summit.
Johnson & Johnson promised 200 million doses of its vaccine to COVAX, a vaccine-sharing programme co-led by the World Health Organization (WHO).
"As we prepare for the next pandemic, our priority must be to ensure that we all overcome the current one together. We must vaccinate the world, and do it fast," Italian Prime Minister Mario Draghi said.
China's President Xi Jinping pledged $3 billion in aid over the next three years to help developing countries recover from the pandemic and proposed setting up an international forum to promote fair distribution of vaccines.
US President Joe Biden was not among the speakers, organisers said. His administration has backed calls from many developing countries for a waiver of patents for Covid-19 vaccines, in the hope that would boost production and allow for more equitable distribution.
However, the final declaration seen by Reuters did not mention such a mechanism. It has been contested by some European nations, who have instead called for the removal of US trade barriers that they consider the main bottleneck preventing a ramping up of vaccine production.
European Commission President Ursula von der Leyen said existing global agreements already allowed countries to force companies to share their licences in an emergency.
She added that the EU will make a proposal to facilitate the use of those clauses and added that Europe would donate at least 100 million doses to poorer nations by the end of the year, including 30 million each from France and Germany.
In their declaration, the world leaders noted the importance of the so-called ACT-Accelerator, a tool of the WHO to distribute Covid-19 vaccines, drugs and tests across the world.
However, dashing initial expectations, the declaration did not include a clear commitment to fully fund the programme, which is still $19 billion short.
Leaders agreed that one option to help poorer nations was sharing vaccines that wealthy countries have already purchased, but there were no firm commitments on this in the final text.
The COVAX program, which is dedicated to equitable global vaccine distribution, was mentioned as one option for providing donated doses to countries.