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

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.