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, billions of people 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 rollout the doses they do have.

Just how unequal is the vaccine rollout?

Look at the red line below. No, it’s not a mistake. The inequality in vaccine rollout is astounding: as of May 2021, 80% of doses administered were in high-income and upper-middle-income countries, while just 0.4% have been in low-income countries. This is a problem for everyone. Viruses don’t respect borders and billions of people vulnerable to both COVID-19 and to variants that could resist vaccines could put us all back at square one.

The solution? Rapidly increasing vaccine access and facilitating last-mile distribution. Morocco harnessed a digitized and efficient rollout for its early supply of vaccines, which has rivaled France and other European countries. However, they risk 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, and even fewer have strategies to mobilize and motivate people to take the vaccine. While efforts to increase the global supply of vaccines must continue, more focus is needed on critical funding, infrastructure, and a workforce to get jabs in arms.

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.

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 will reach the tipping point where supply outpaces demand for COVID-19 vaccines by the end of this summer — with many reaching it much sooner. The US will almost certainly reach this tipping point first, followed by Germany, Canada, Italy, France, and the UK.

This all but guarantees we will start to see unused vaccines pile up in these countries by the end of August 2021 without a deliberate effort to share doses with low- and lower-middle-income countries.

The world’s richest countries could vaccinate their entire population and still have over 1.9 billion doses to share — enough to vaccinate the entire adult population of Africa.

How is the rollout going in Africa?

Around 2 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. Young and healthy US citizens are getting the shot before Africa’s frontline health workers, elderly population, and people living with HIV/AIDS even have access to the vaccine. 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 doses that have been allocated or promised have not yet hit the ground. Of the 77.6 million doses allocated to African nations through COVAX, just 14.9 million had been received as of May 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?

ONE’s Vaccine Access Test assesses whether governments, businesses, and multilateral institutions are moving us closer to — or further away from — an end to the pandemic through vaccine equity. We’ve been tracking this since September 2020, and right now, the results show that progress on vaccine access has stagnated.

The Access to COVID Tool Accelerator (ACT-A), which aims to get vaccines, tests, and therapeutics to low-income countries, still has a massive funding gap. There is currently no plan to reach herd immunity globally. Rich countries continue de-facto blockades of exports of vaccine doses and the raw materials required to make them. And Europe and the UK continue to block a proposal to waive intellectual property on COVID-related medicines.

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 at our disposal 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. Already there are over 4,000 COVID-19 variants and some – like the South African and UK 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 begin to plug the gap by fully funding 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.