Pfizer, the pharma firm behind the mRNA COVID-19 vaccine, has announced the launch of an “accord for a healthier world", pledging to supply all current and future patent-protected medicines and vaccines to 45 low-income countries on a not-for-profit basis.

Speaking at the World Economic Forum (WEF) annual meeting in Davos this week, Pfizer chairman and CEO Albert Bourla said that he anticipates other pharmaceutical companies to join the accord.

“I’m certain that the other pharmaceutical companies will follow,” he said. “I’ve spoken to several of the CEOs and they want to be part of it.”

The first person in the world to receive a COVID-19 vaccination was a UK woman named Margaret Keenan, who received her first dose on December 8, 2020. Within a year, the number of vaccines delivered to high- and upper-middle-income countries across the world was so high that it could vaccinate the populations of those countries twice.

Today, nearly 12 billion doses have been administered around the world, and places like Australia and the UK are quietly mulling the idea of rolling out a fourth dose. But compare that with vaccine uptake in lower-income countries, and the picture is stark: even now, more than two years into the pandemic, fewer than one in six people in low-income countries have received even one dose of the lifesaving prophylactics.

This has led to something of a PR nightmare for companies like Pfizer, whose near-unprecedented profit margins over the past year have led to accusations of “pandemic profiteering.”

“Pfizer [made] a killing while its vaccines have been withheld from so many,” Tim Bierley, a pharma campaigner at Global Justice Now, told The Guardian in February.

“Pfizer is now richer than most countries; it has made more than enough money from this crisis,” Bierley said. “It’s time to suspend intellectual property and break vaccine monopolies.”

This latest announcement from the pharma giant certainly falls short of those demands, but it’s clear the company has heard its critics’ calls for vaccine equity: “We are living in a time where science is increasingly demonstrating the ability to take on the world’s most devastating diseases,” Bourla said. “Unfortunately, there exists a tremendous health equity gap in our world that determines which of us can use these innovations and which of us cannot.”

The announcement was lauded by figures such as Paul Kagame, the president of Rwanda, who appeared alongside Bourla and praised the move as “a new standard which we hope to see emulated by others.” Likewise, Lazarus Chakwera, the president of Malawi, called it a “historic and unprecedented accord” that “is not a handout but a real partnership.”

But will it be enough? Critics of vaccine inequity may point out that cost is only one aspect of the problem, and it’s arguably not the most important one. Even for countries with plenty of resources and infrastructure to cope with the pandemic, nationwide vaccine rollouts have proved logistically tricky, and those problems are magnified in places that lack the capability to manufacture or transport vaccines locally. Vaccines donated through the COVAX program have consistently failed to reach targets, and frequently wind up in the trash pile due to being donated too close to their expiry date to make administration feasible.

And despite these shortcomings, it’s worth noting that for some countries, COVAX may still be a better option than Pfizer’s new offer. A recent report from the Center for Global Development found that in Ethiopia, one of Pfizer’s 45 low-income countries, purchasing vaccines would only prove cost-effective with a price lower than $6 per dose. COVAX donation prices sit comfortably below this line, at around $1.60-$3.10 per dose, but Pfizer’s mRNA vaccine, even without its estimated 60-80 percent profit margin, sails way over the limit.

But according to Bourla, Pfizer’s new program will aim to address at least some of these issues alongside the price reduction.

“As we learned in the global COVID-19 vaccine roll-out, supply is only the first step to helping patients,” he said. “We will work closely with global health leaders to make improvements in diagnosis, education, infrastructure, storage and more. Only when all the obstacles are overcome can we end healthcare inequities and deliver for all patients.”

While it won’t satisfy experts calling for pharma companies to waive vaccine patents and share technology with lower-income countries, for now, the feeling is one of cautious optimism.

“Pfizer’s commitment covers the right products by looking across the entire portfolio of patented products, the right countries by focusing on the poorest countries and the right partnerships by working with governments and international health organisations,” chief executive of the Netherlands-based independent group Access to Medicine Foundation Jayasree Iyer told The Guardian.

“But we need to see how it pans out; the commitment needs to move us forward, from vaccine to vaccination, from medicine to treatment.”