Abstract
Background: The COVID-19 pandemic underscored the profound disparities in global vaccine access, highlighting the failure of existing market-based incentives to serve low-income countries (LICs). While high-income nations utilized advanced purchase agreements, LICs faced significant delays in procurement and distribution. Objective: This study provides a comparative analysis of economic incentives designed to stimulate vaccine development and ensure equitable access in LICs, evaluating both supply-side and demand-side mechanisms. Methods: Utilizing a comparative framework, we analyzed literature from 1966 to 2022 concerning health expenditure [8], economic burden of disease [11], and vaccine manufacturing sustainability [14]. We examined the efficacy of conditional economic incentives [2] and the role of national absorptive capacity [21] in vaccine uptake. Results: Our analysis indicates that while supply-side incentives like human challenge trials [10] and sustainable manufacturing initiatives [14] are critical, they are often undermined by demand-side barriers including weak health infrastructure and high out-of-pocket costs [30]. Furthermore, ethical tradeoffs in fair availability [1] often conflict with the economic priorities of private developers. Conclusion: Achieving global health security by 2035 [25] requires a shift from temporary relief aid [15] toward structural economic incentives that support regional manufacturing and integrated health systems. Policy interventions must move beyond market-fixing to market-shaping, ensuring that the economic burden of influenza [11] and other pathogens is addressed through sustainable, locally-led vaccine ecosystems.