Health experts say that for vaccines to do their job, countries need to bolster their efforts to counter disinformation and prioritize support to low-income countries that are battling diseases—from production to distribution. Meanwhile, in the United States, the head of health policy, Robert F. Kennedy Jr., known as RFK, is shifting the country away from a history keeping vaccines squarely on the U.S. public health agenda by canceling vaccine recommendations and contracts and dismissing expert officials.

The bodies that steer vaccine use and development are country-specific. National regulatory agencies have the final word on whether a vaccine can be used within a country’s borders; in the United States, that’s the Food and Drug Administration (FDA). Generally, the process follows a path along the lines of: research and discovery, testing, manufacturing, approving, recommending for use, and monitoring safety after approval. 

There are some distinctions country-to-country. For example, the United Kingdom’s review process operates on analysis provided by the vaccine makers, while in the United States, regulators do their own analysis using raw data. In several countries, such as those in the European Union (EU), it’s common to have developers do their own rigorous testing in three rounds of trials growing in sample size, and then regulatory authorities do scientific evaluation. Many low- and middle-income countries heavily rely on WHO prequalifications to determine which medicines to use. 

The WHO can list a vaccine for recommended use. The agency gives this stamp when an inoculation is proven to have an efficacy rate of 50 percent or higher. It cannot approve a drug for use in any one country, but vaccine makers can request prequalification with the WHO to ensure it gets a significant endorsement for countries to follow. It can also help with disbursement; a principle goal of the WHO is to help countries achieve global coverage of at least 90 percent for essential vaccines by 2030.