Notes

inputs, indicating that this was holding up their ability to meet production and delivery targets. Indeed, in such a highly regulated and complex production process, missing one input could have a devastating impact on output. Some of the vaccines also required specialized inputs that may not have been previously manufactured at the volumes needed for commercial scale, let alone pandemic scale. Companies had to bring in a suite of contractors to supply the lipid nanoparticles needed for the mRNA vaccines, for example. • All of the vaccines also needed relatively homogenous ancillary inputs. Examples include vials and glass stoppers for packaging as well as syringes and needles for administering vaccines. Because of cold-chain requirements, refrigeration was also needed to transport mRNA vaccines from the plant to the places where they would be administered.

1. Although not covered in this definition, “other” services are those that complement and facilitate access to medical goods and services. They include health insurance services; wholesale and retail sale of various pharmaceuticals as well as medical and surgical goods and devices (including pharmacies, which are key in the final distribution of testing devices and other products to the population); health education; claims processing or medical transcription services; research and development (R&D) medical sciences; maintenance and repair services for medical equipment; and technical testing and analysis services. 2. For more about trade in services by modes of supply, see Chanda (2017) and WTO (1998, 2017, n.d.). 3. These regulations have “health policy and safety” motivations but also have an impact on the efficiency of distribution and on cost. 4. For data on vaccine supply and the vaccine exports of Korea, South Africa, and other vaccineproducing countries, see the COVID-19 Vaccine Trade Tracker, built on the work of the WTO and the International Monetary Fund: https://www.wto.org/spanish/tratop_s/covid19_s/vaccine _trade_tracker_s.htm. 5. Mode 4 covers individuals who are either service suppliers (such as independent professionals) or are employed by a foreign service supplier, and it does not include job seekers. 6. Major health logistics operators at the global level are the world’s top end-to-end logistics services providers such as DHL, FedEx, UPS, Kuehne + Nagel, CEVA, and the like. 7. Business interruption (including supply chain disruption) has figured as the top business risk identified by 2,650 risk managers in 89 countries and reported in the Allianz Risk Barometer since its launch in 2011 (AGCS 2022). 8. Data on export and import shares of medical goods, by country income group, are from the World

Trade Organization’s Integrated Database and United Nations COMTRADE data. 9. “Chinese Taipei”—defined by the WTO as the “Separate Customs Territory of Taiwan, Penghu,

Kinmen and Matsu”—is used in this report to refer to a jurisdiction admitted to WTO membership since January 1, 2002. See https://www.wto.org/english/thewto_e/countries_e/chinese_taipei_e.htm. 10. Estimates on trade in health services by mode of supply are produced using the WTO Trade in

Services Data by Mode of Supply (TISMOS) methodology (2019, based on the recommendations of UN DESA 2012), further improved in 2021. A new TISMOS dataset is forthcoming. For more information, see WTO, “Statistics on Trade in Commercial Services” (web page): https://www .wto.org/english/res_e/statis_e/tradeserv_stat_e.htm. 11. Data on the shares of medical services, by GATS mode of supply, are from WTO estimates based on the Trade in Services Data by Mode of Supply (TISMOS) dataset.