COVID-19 vaccine dose sparing: strategies to improve vaccine equity and pandemic preparedness

Despite tremendous efforts, worldwide COVID-19 vaccination coverage is lagging. Dose-sparing strategies for COVID-19 vaccines can increase vaccine availability to address the global crisis. Several clinical trials evaluating dose sparing are currently underway. However, to rapidly provide solid scientific justification for different dose-sparing strategies, joint coordinated action involving both public and private parties is needed. In this Viewpoint, we provide examples of approaches to vaccine dose-sparing that have previously been evaluated in clinical trials to improve vaccine availability and reflect on the origin of their funding. With a focus on the current COVID-19 pandemic, we stress the need for expedited testing of vaccine dose-sparing strategies in endemic or epidemic infectious diseases. However, we argue that the establishment of a mechanism through which dose-sparing opportunities are systematically identified, scientifically tested, and ultimately implemented will prove to be valuable beyond the current pandemic for infectious diseases product development and pandemic preparedness in the future.