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The final phase 3 clinical data for CanSino Biologics' adenovirus type 5 vector vaccine show that Ad5-nCoV is efficacious.1 However, emergency approval was granted in ten countries before data on its efficacy were available, even though other vaccines were already approved.1 If the results of the trial had been unfavourable, millions of people would have been vaccinated and granted a false sense of protection. If this scenario had happened, the decision to approve the vaccine for emergency use would have been an unforgivable one, given other proven vaccines existed at the time. The authorisation of the unproven vaccine at the time, an already criticisable decision, was the consequence of the COVID-19 pandemic (and governments) aggravating the previously existing health inequities between and within countries.1, 2 Apart from Chile and Hungary, the countries that granted emergency use approval were low-income and middle-income countries according to the World Bank.1 With other vaccines, such as those based on mRNA technology, repeatedly out of stock or sold overpriced, the question was not which vaccine to buy, but whether there was any vaccine to buy.2, 3 Even towards the end of 2021, a time when many low-income and some middle-income countries had very low vaccine rates, high-income countries were proceeding with the third and fourth doses.2, 4 The approval and purchase of vaccines without phase 3 results is a symptom of inequity in vaccine access, which has the unfortunate potential to increase this problem.

many low-income and some middle-income countries had very low vaccine rates, high-income countries were proceeding with the third and fourth doses.2, 4 The approval and purchase of vaccines without phase 3 results is a symptom of inequity in vaccine access, which has the unfortunate potential to increase this problem. For the World Bank data see https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups For the World Bank data see https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups