Data dive: The astoundingly unequal vaccine rollout

Now that COVID-19 vaccines are available, the pandemic is almost over, right? Wrong. As the virus spreads across low- and middle-income countries, people everywhere are vulnerable to variants that could resist vaccines and put us back at square one.

So why isn’t the vaccine already available to everyone, everywhere? It comes down to supply and distribution. Rich countries have bought up the majority of the supply and are hoarding even what they don’t need. Meanwhile, low- and middle-income countries are struggling to roll out the doses they do have.

Just how unequal is the vaccine rollout?

Look at the red line in the chart below. No, it’s not a mistake. As of August 2021, just 0.5% of vaccines administered globally have gone to people in low-income countries.

Here’s another way to look at it: Over half of the world’s population live in the world’s poorest countries, which are represented in red and green in the chart below. But less than 20% of vaccines administered so far have gone to people in these countries.

Meanwhile, 82% of doses administered went to people in wealthier parts of the world.

This is a problem for everyone. Viruses don’t respect borders or income status. As long as COVID-19 is allowed to circulate unchecked anywhere in the world, we all remain vulnerable to new variants that could set us back at square one.

The solution? Rapidly increase vaccine access and facilitate last-mile distribution everywhere.

Morocco harnessed a digitized and efficient rollout for its early supply of vaccines, which has rivaled France and other European countries. However, Morocco now risks running out of doses, due to global supply constraints. Other countries, such as the Democratic Republic of the Congo, are struggling to distribute what vaccines they do have because of concern over their side effects and gaps in healthcare infrastructure. This led the DRC to return 1.3 million of their 1.7 million allocated COVAX doses this spring, citing inadequate time and resources to administer them before expiry.

The DRC isn’t alone: Only one-third of low- and middle-income countries have processes in place to train the required number of vaccinators. Even fewer have strategies to mobilize and motivate people to take the vaccine. While efforts to increase the global supply of vaccines must continue, critical funding, infrastructure, and a workforce to get jabs in arms are also crucial.

Rich countries are sitting on enough surplus doses to vaccinate all of Africa

Many countries hedged their bets early in the pandemic by securing contracts for multiple vaccine candidates with the hope that at least one of those bets would pay off. Now, with several safe and effective vaccines on the market, these bets are paying off, and hedging is looking more like hoarding.

Over half of doses projected to be produced in 2021 are monopolized by a small number of wealthy countries. This leaves large swaths of the global population unprotected and allows the virus to circulate unchecked.

The world’s richest countries are monopolizing the global supply of vaccines, having purchased enough doses to vaccinate their entire population and still have 2.8 billion doses left over. After accounting for the nearly 1 billion doses that these countries have committed to sharing over the next year, 1.8 billion doses are still left to share. That’s enough to vaccinate the entire adult population of Africa. While dose sharing is scaling up, the speed and scale of redistribution has not been fast enough to meet the global need.

While you won’t find stockpiles of vaccines in high-income countries yet, that could change in the next few months. ONE’s analysis shows that six countries have already reached the tipping point where supply outpaces demand for COVID-19 vaccines — with Germany expected to reach it by the end of the year.

This makes it more likely that we’ll start to see unused vaccines pile up in these countries by the end of September 2021.

How is the rollout going in Africa?

Around 5 in 100 people in Africa have received at least one dose of a COVID-19 vaccine. By comparison, the US has vaccinated nearly half its population and plans to roll out booster doses in September 2021. That means young and healthy US citizens will have the option to get a third dose before Africa’s frontline health workers, elderly population, and people living with HIV/AIDS even have access to their first dose. Across Africa, limited supply is delaying rollout, but the lack of infrastructure and human resources to transport and administer doses is also a serious constraint.

Most countries in Africa are part of the COVAX Facility. COVAX has pooled demand and bulk purchased vaccines to ensure fast, fair, and safe distribution globally. COVAX aims to deliver 600 million shots — most of them from AstraZeneca — to some 40 African countries this year.

The African Union has also worked to pool demand by entering directly into contracts with pharmaceutical companies. For example, Johnson & Johnson has committed to supply the African Union with up to 400 million doses beginning in the third quarter of 2021. Outside the European Union, this is the only such effort in joint procurement.

However, to date, many of the promised doses have not yet hit the ground. Of the 77.6 million doses allocated to African nations through COVAX, just 15.7 million had been received as of July 2021. Most nations were relying on vaccines produced by the Serum Institute of India, a major supplier for COVAX — but as India grapples with its own major outbreak, the government decided to restrict exports of doses.

At this rate, most countries in Africa will not see widespread vaccination until 2023.

Who is holding up progress?

Progress towards vaccination goals remains slow because competition — not cooperation — continues to drive the global response. Efforts among countries to cooperate on the response have largely fallen flat, and governments continue to look inward with their planning and policies. High-income countries are still monopolizing the global supply of vaccines. And while efforts to share these tools have increased in the past few months, it’s happening too slowly to meaningfully change the trajectory of the pandemic.

Dangerous variants are also driving high-income countries to recommend booster doses, even as much of the world’s population has yet to receive their first dose of a COVID-19 vaccine. At this rate, 60% of the world’s population live in countries that will not see widespread vaccination coverage until 2022 or later. If world leaders don’t start cooperating, working across borders, and taking the “global” part of this pandemic seriously, the world risks being stuck in an indefinite cycle of booster shots and uncertainty.

Scaling up vaccine manufacturing in Africa

With wealthy nations hoarding vaccines, fully manufacturing doses within African countries is an appealing prospect. In April 2021, the African Union and Africa CDC announced that they hope to produce 60% of their vaccines locally by 2040. Several global development groups stepped up with sizable investments to share technologies, build human capital, and address supply and demand constraints. This includes €1 billion from the European Commission, $1.3 billion from The MasterCard Foundation, and a commitment by WHO and COVAX partners to help build a COVID-19 mRNA transfer hub.

These investments are important to fight COVID-19 and other contagious diseases — but only when they are operating at scale. And the timeline to reach that scale is inadequate to meet the WHO’s target to vaccinate 30% of the world’s population by December 2021.

Moreover, in-country manufacturing might not always equate to in-country distribution: In the fall of 2021, Europe is set to receive millions of J&J shots that went through end-stage production in South Africa by Aspen Pharmacare. Meanwhile, South Africa is yet to receive the overwhelming majority of the 31 million J&J doses it ordered from the company, a key reason that only 7% of South Africa’s population is fully vaccinated. The government was reportedly forced to waive its right to impose vaccine export restrictions in the confidential contract it signed with the company.

Former UK Prime Minister Gordon Brown summed it up nicely: “a shocking symbol of the west’s failure to honour its promise of equitable vaccine distribution.”

Why is this crucial for COVID-19 responses in all countries?

Well over a year into this crisis, we are still seeing record numbers of deaths, despite having a growing arsenal of countermeasures to fight the virus.

The longer the virus remains unchecked anywhere on the planet, it will continue to mutate, breach borders, and wreak havoc on communities and the global economy:

  • There could be twice as many deaths from COVID-19 if rich countries continue to monopolize the first doses of vaccines instead of distributing them globally.
  • Vaccine hoarding could cost the global economy up to $9.2 trillion. Rich countries will bear half those costs because of supply chain disruptions and demand shocks.
  • Each new infection is an opportunity for mutation. There are already over 4,000 COVID-19 variants and some – such as the Delta and Lambda variants – are proving more transmissible than other strains. And with each new strain, the higher the risk of the disease evolving to an extent where current vaccines, diagnostics, and treatments no longer work.

The only way to prevent new and possibly more dangerous variants is to dramatically slow transmission of the virus through widespread vaccination. We are calling on wealthy countries to help redress this situation with a comprehensive, coordinated strategy to get to global herd immunity as soon as possible.

This should include increasing the global supply of all COVID tools through investment, policies, and the redistribution of excess doses. Leaders must also agree to a burden sharing model and fully fund ACT-A and COVAX and rapidly fund capacity to deliver doses in-country.

How can I learn more and stay informed?

ONE’s Africa COVID-19 Tracker provides the latest reliable figures, commentary, and analysis on the health, economic, and social impacts of the pandemic on the continent. Sign up for our weekly email Aftershocks and follow @ONEAftershocks.