Beyond COVAX: A Multidimensional Governance and Modeling Approach to Optimizing Global Vaccine Equity through a Pathogen Access and Benefit-Sharing (PABS) System

Beyond COVAX: A Multidimensional Governance and Modeling Approach to Optimizing Global Vaccine Equity through a Pathogen Access and Benefit-Sharing (PABS) System | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Beyond COVAX: A Multidimensional Governance and Modeling Approach to Optimizing Global Vaccine Equity through a Pathogen Access and Benefit-Sharing (PABS) System Zihan Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7423776/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background The COVID-19 pandemic revealed catastrophic failures in vaccine equity, thereby exposing profound flaws in the architecture of global health governance. Existing mechanisms, such as the COVAX Facility, proved insufficient to counteract the forces of vaccine nationalism and market dynamics, which highlights the necessity for a new analytical tool to design more resilient and equitable pandemic responses. Methods This study develops the Multidimensional Governance and Access Framework (MGAF), a construct that synthesizes six interdependent dimensions: Accountability, Availability, Affordability, Accessibility, Acceptability, and Adaptability. A quantitative system dynamics model is subsequently applied to compare the market-driven COVAX mechanism with a proposed rules-based Pathogen Access and Benefit-Sharing (PABS) system. Results The MGAF analysis indicates that the failure of COVAX was a cascading event originating from a deficit in accountability, which consequently undermined vaccine availability and affordability. The quantitative model demonstrates that a PABS mechanism mandating benefit-sharing would have substantially reduced global mortality and increased vaccine coverage in low-income countries relative to the COVAX scenario. Conclusion Achieving equity in future pandemics necessitates an integrated approach that transcends isolated solutions. The MGAF provides a comprehensive design framework, and the findings suggest that success is contingent upon legally binding accountability mechanisms like PABS to ensure that life-saving technologies are treated as global public goods rather than market commodities. Global Health Governance Vaccine Equity COVAX Pandemic Preparedness System Dynamics Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 May, 2026 Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviews received at journal 31 Jan, 2026 Reviewers agreed at journal 10 Jan, 2026 Reviewers agreed at journal 01 Sep, 2025 Reviewers agreed at journal 29 Aug, 2025 Reviewers invited by journal 26 Aug, 2025 Editor assigned by journal 23 Aug, 2025 Submission checks completed at journal 23 Aug, 2025 First submitted to journal 21 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7423776","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":508601400,"identity":"6e75e4a7-0fb6-4bb4-91ec-2c09f0ad1bc1","order_by":0,"name":"Zihan Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYBACfv7mgw8SDGzk2NgbiNQiOeNYssGHijRjfp4DRGoxOJCjJjnjzOFEyRkJxNrScIZNmrftcILBzccbbzDU2EQT1MLP3HvYmrctPc/gdlqxBcOxtNwGwracS7zN22ZdbHA7x0yCseEwYS1AvxgAHcacuOHmGeK1GAG975w4cwYPkVqQAhnolwRi/IIUlYc33vhQY0NYC4ojJRJIUQ7RQqqOUTAKRsEoGBkAADxoREN1VNTEAAAAAElFTkSuQmCC","orcid":"","institution":"Tsinghua University","correspondingAuthor":true,"prefix":"","firstName":"Zihan","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-08-21 08:08:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7423776/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7423776/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90527172,"identity":"01ef9b8c-639a-44dd-a297-8bddb4de3459","added_by":"auto","created_at":"2025-09-03 17:15:50","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":752432,"visible":true,"origin":"","legend":"","description":"","filename":"BeyondCOVAXAMultidimensionalGovernance.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7423776/v1_covered_51379618-6eff-4bdf-b6e8-11209ac796c0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond COVAX: A Multidimensional Governance and Modeling Approach to Optimizing Global Vaccine Equity through a Pathogen Access and Benefit-Sharing (PABS) System","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"globalization-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"glah","sideBox":"Learn more about [Globalization and Health](https://globalizationandhealth.biomedcentral.com/)","snPcode":"12992","submissionUrl":"https://submission.nature.com/new-submission/12992/3","title":"Globalization and Health","twitterHandle":"@GHJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Global Health Governance, Vaccine Equity, COVAX, Pandemic Preparedness, System Dynamics","lastPublishedDoi":"10.21203/rs.3.rs-7423776/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7423776/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe COVID-19 pandemic revealed catastrophic failures in vaccine equity, thereby exposing profound flaws in the architecture of global health governance. 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