RR:C19 Evidence Scale rating by reviewer:
Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.
This paper is an opinion piece about a controversial topic. While I find most claims generally credible given my own knowledge of the literature, the paper’s main weakness lies in its under-provision of academic references and pointers to empirical findings.
Some claims are not substantiated, although they are generally believed to be accurate. In particular, the claim that “there is simply not enough infrastructure (manufacturing facilities and equipment) nor raw materials (the components needed to manufacture and deliver vaccines) to produce and distribute COVID-19 vaccines as predicted under current waiver proposals” is central to the authors’ message and should be backed by references. Similarly, the claim that “Countries in the Global South have had to implement intellectual property regimes that largely codify the commercial interests of the Global North” is a personal opinion that is not backed by references. Note also that the web links substantiating some claims did not work.
The paper clearly explains the detrimental effects of a waiver but does not explain how a waiver could help or, perhaps more judiciously, the conditions under which a waiver would help. That is, if a waiver were implemented, what would be needed (in particular regarding technology transfer and know-how sharing) to make it work. Answering this question would have produced a more balanced and constructive paper. Along these lines, I feel that the authors could have given more space to the question of whether a waiver would spark or hinder technology transfer (or, again, describing the conditions needed for a waiver to spark technology transfer).
The concluding paragraph is a personal opinion.
The remainder answers key questions of RR:C19 criteria.
Does the manuscript confirm previous work or refute the current understanding?
The article provides an informed decision about an important policy question. Many of the arguments put forward by the authors have been heard recently, so the message as such is not entirely novel.
How well does the manuscript position the work within the current literature/understanding?
The manuscript starts by emphasizing the two opposing views regarding the waiver. It also explains the basics of the patent system as it applies to vaccines in particular. However, the paper does not cite current literature to a sufficient extent.
Is there clarity regarding the recommended actions that result from the findings?
The article is well-structured and well-written, with a clear message and some practical policy recommendations.