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 vaccine supply and are hoarding doses — including ones they don’t need. This supply imbalance must be addressed urgently.

But even if more supply becomes available, low- and lower-middle-income countries will need increased support to get shots in arms.

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    The key numbers

    As of 05 December 2021, 8.2 billion vaccine doses have been administered in the world:

    • 56.4 million doses in low-income countries
    • 2.4 billion doses in lower middle-income countries
    • 3.8 billion doses in upper middle-income countries
    • 1.8 billion doses in high-income countries

    African countries have administered 246.2 million doses. That means 7.5% of the population of the continent is fully vaccinated.

    To date, 44.3% of the world’s population has been fully vaccinated. But only 3.2% of people in low-income countries have been fully vaccinated. Lower middle income countries have fully vaccinated 28.4% of their people. That’s a huge difference compared with 68% in high income countries, and 65% in upper middle-income countries.

    Tracking progress against global vaccination targets

    World leaders are aligning around new targets that will help address vaccine inequity. Specifically, they are focusing on a goal to vaccinate 40% of the population in all income categories by the end of 2021 and 70% of the population in all income categories by September 2022.

    But unless things change dramatically, only wealthier countries are likely to meet these targets.

    Just how unequal is the vaccine rollout?

    Look at the red line in the chart below. No, it’s not a mistake. A tiny fraction 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 only about one-quarter of vaccine doses administered so far have gone to people in these countries.

    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.

    How is the rollout going in Africa?

    In African countries, 11 in 100 people have received at least one dose of a COVID-19 vaccine, as of 05 December 2021. Only 7.5% of the population is fully vaccinated. African countries have administered 17.9 doses per 100 people, compared to 130 in European countries or 141 in the US.

    Not all countries in Africa are moving at the same speed. The majority of countries in Africa have vaccinated small portions of their population, but a few wealthier nations are surging ahead.

    To date, supply has been the biggest constraint to scaling up vaccines in Africa. Most countries have done relatively well at administering the doses delivered. However, most countries have received relatively low quantities of doses. Capacity to deliver will become a much bigger issue as supply increases in the coming months.

    COVAX’s latest supply forecast shows that African countries could receive 400 million doses by the end of 2021, more than four times the current number of doses received through the initiative as of October 2021. On average, COVAX AMC countries will need to double their current vaccination rates in order to accommodate the increased supply.

    What is holding up progress?

    Progress towards vaccination goals remains slow because competition — not cooperation — continues to drive the global pandemic response. Cooperation efforts 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 recently increased, it’s happening too slowly to meaningfully change the trajectory of the pandemic.

    Many of the promised doses have not yet hit the ground. Of the 200 million doses allocated to African nations through COVAX, just 88 million had been received as of October. Many nations were also relying on vaccines produced by the Serum Institute of India, a major supplier for COVAX. But exports were delayed when the Indian government restricted exports of doses while the country grappled with its own major outbreak. India, the world’s largest producer of vaccines, resumed exporting COVID-19 vaccines the first week of October. Exports are expected to increase significantly in the next few months.

    Dangerous variants are also driving high-income countries to recommend booster doses, even though 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 goals 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, US$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 vaccination targets.

    Moreover, in-country manufacturing might not always equate to in-country distribution: This fall, 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 its 31 million J&J doses, because the government was reportedly forced to waive its right to impose vaccine export restrictions in the confidential contract signed with J&J. This delay is a key reason that only 7% of South Africa’s population is fully vaccinated.

    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 vaccine access crucial for the COVID-19 responses in all countries?

    Almost two years into this crisis, we are still seeing record numbers of deaths globally, 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:

    Despite these dire consequences, 267.6 million people have received a booster shot in just 65 countries, as of 05 December 2021. That is 6.5 times the total number of people who have received a first dose in low-income countries. Even before booster shots, low-income countries were at a staggering disadvantage: they have administered a total of 56.4 million doses, or 100 times less than the 5.6 billion doses administered in upper middle- and high-income countries.

    Each new infection is an opportunity for mutation. There are thousands 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.

    What needs to happen?

    World leaders are finally aligning around more equitable and global vaccine goals: specifically, they’re agreeing to vaccinate 70% of the world’s population in all income categories by September 2022. To achieve this target, we are calling on world leaders to:

    • Deliver the funding needed to ensure doses are procured and administered in low- and lower-middle income countries by mid-2022.
    • Unlock doses and dismantle barriers to delivery. This means releasing plans for how countries will share doses that have already been committed, including what type of vaccine will be shared, when they will be delivered (by month), and who the intended recipient is (e.g. COVAX, AVATT, bilateral). Leaders must also work with vaccine manufacturers to immediately prioritize and fulfill contracts to low- and lower middle-income countries through bilateral and or regional agreements, or COVAX. And lastly, they must ask manufacturers to provide regular and clear supply forecasts so all countries can better plan their response.
    • Support efforts to scale up regional production of vaccines, including providing the funding, information, and partnership needed to regional manufacturing and production capabilities.

    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.