Overcoming barriers to medical countermeasures: Strengthening global biosecurity.

The COVID-19 pandemic revealed global disparities in accessing medical countermeasures, as high-income countries prioritised their own interests while disregarding low- and middle-income countries. Despite global efforts to ensure an equitable pandemic response, these initiatives largely failed to achieve their objectives for LMICs due to systemic inequalities. This review critically examines these disparities, identifying that excessive stockpiling by HICs, fragmented international coordination, inadequate research and manufacturing capacity, restricted access to emergency research funding, intellectual property constraints, unequal participation in clinical trials, and inadequate regulatory harmonisation collectively hinder LMICs ability to respond effectively. By analysing diverse case scenarios and global response strategies, all plausible key shortcomings that contributed to the failure of coordinated pandemic preparedness were highlighted. Based on these insights, actionable strategies are proposed to address these gaps in LMICs so as to ensure affordability, accessibility, and equitable distribution of vaccines, diagnostics, and biotherapeutics in future public health emergencies, strengthening global biosecurity.