It has been months since the first person received a COVID-19 vaccine, and hundreds of millions of doses have been distributed – but the distribution of vaccines has not been equal throughout the world.
Several countries, including the U.S., have been making fast progress immunizing their populations. Millions of shots have been given to Americans, ranking the U.S. as one of the top countries with one of the highest vaccination rates per 100 people.
But as richer countries are securing more doses than their populations need, many poorer countries are yet to report a single dose administered.
“We still have a ways to go,” said Krutika Kuppalli, vice chair of Infectious Diseases Society of America’s Global Health Committee, when asked about the current global vaccination. "There's still a number of countries that have not even started vaccinating people.”
“I'm lucky because I live here in the United States, and I have access to medications," said Kuppalli. She says that access to life-saving medicine "should not be determined because I'm born here versus whether I'm born in another country."
World vaccination rates for COVID-19
Israel has been the global leader in vaccinating its population against COVID-19, followed by the United Arab Emirates and Chile. More than half of the Israeli population has been at least partially vaccinated.
The country's well-trained health care providers and a digitized community-based health system that can identify high-risk persons have been major factors in the success, according to Israeli health experts. The country also has a tradition of periodic emergency preparedness exercises.
The United Arab Emirates hasn’t been far behind. It has about the same population as Israel and contributes its rapid vaccination pace to coordinated government action, strong leadership, public awareness campaigns, and simple vaccination registration procedures using a Health Ministry app.
The gap between countries
High-income countries represent only 16% of the world’s population, yet some of them have bought enough vaccines to cover their population more than twice.
According to a ONE's Policy team study, the world’s richest countries have collectively bought 1 billion more doses than their citizens need. The rest of the world has only been able to secure 2.5 billion doses – not enough to vaccinate their populations.
Vaccination coverage by country income level
Soon, the U.S. will have a vaccine surplus, experts say.
“We're going to have supply exceeds demand, sometime between now and mid-May,” Ezekiel Emanuel, a health policy expert and professor at the University of Pennsylvania who advised President Joe Biden’s transition, told USA TODAY in late March.
Emanuel said the U.S. should send the excess vaccines overseas. “We can't stop producing (vaccines) and we can't sit on our supply. That makes no sense and that's not ethical,” he said.
Percent of population covered by vaccine purchases
“If other countries aren't vaccinated, it's not good for the world's health,” Emanuel said. “And it’s not good for returning to normal because if you want to return to normal, part of that is trade, travel, educational and other exchanges. All of that requires vaccination around the world.”
The risk of vaccine inequity
Models suggest that even if high-income countries are fully vaccinated by the middle of this year but developing countries manage to vaccinate only half of their populations, the global economy could lose around $4 trillion.
Percent of population at least partially vaccinated by country income level
Another danger that unequal vaccination rates around the world may pose is the emergence of new variants. The longer the period of sustained community spread, the more likely the virus will mutate. The mutated variants from the unvaccinated population might be able to infect those in the vaccinated population.
The vaccines that are currently in development or have been approved are expected to provide at least some protection against new virus variants, according to the World Health Organization. However, it’s important to limit the spread of the virus in order to prevent mutations that may reduce the efficacy of existing vaccines. As more people get vaccinated, the virus circulation is expected to decrease, which will then result in fewer mutations.
According to Kuppalli, the infectious diseases expert, vaccinated people could go to another part of the world, get exposed to a new strain of the virus not covered by the vaccine, become infected, and transmit it to other people.
“It's making sure that we protect everybody. It's not just about life or death but it's also thinking about the quality of life that people have after they've been infected with COVID,” she added.
Low- and middle-income countries have been largely relying on COVAX, a UN-backed, donor-funded program to support the development and delivery of COVID-19 vaccines to low- and middle-income countries. Richer nations can collectively purchase vaccines, fund vaccine development and manufacturing and ensure vaccination in poorer countries.
The fund plans to provide 2 billion doses by the end of the year, with the aim of covering at least 20% of the population of participating countries. But the lowest estimates required for herd immunity start at 70%. There also have been delays with vaccine deliveries.
“Infectious diseases don't have any boundaries or barriers. COVID doesn't discriminate based on socioeconomic status, race, ethnicity. So, it can affect anybody,” said Kuppalli. “Our world will not be safe unless everybody is protected. That is how we stop the pandemic.”
Vaccine diplomacy
China and Russia have been sending their vaccines to dozens of countries across the Middle East, Asia, and Latin America.
China has approved four of its vaccine candidates, all of which are being used by other nations. It has secured purchasing deals with more than a dozen countries and is donating some of the doses.
Chinese vaccine makers Sinopharm and Sinovac have presented data on their vaccines indicating levels of efficacy that would be compatible with those required by the WHO.
No detailed efficacy data of Sinopharm's vaccine has been released but according to its developer, Beijing Biological Products Institute, a unit of Sinopharm subsidiary China National Biotec Group), the vaccine was 79.34% effective in preventing people from developing the disease based on interim data.
The Sinovac trials have yielded different results across different countries with effectiveness ranging between 50.65% and 83.5%.
Russia has approved two vaccines with one already used in two dozen countries.
The Russian Sputnik V vaccine was 91.6% effective against symptomatic COVID-19 and 100% effective against severe and moderate disease, according to an interim analysis of the vaccine's Phase 3 trial results published in the British medical journal Lancet.
“We're definitely seeing vaccine diplomacy, but it's just part of a larger notion that is well established called ‘soft power,’” said Emanuel, the former Biden health adviser.
He added many countries, including the U.S., have used the “soft power” to enhance the relationship between countries, and a good example would be the President's Emergency Plan For AIDS Relief, an initiative launched under George W. Bush’s administration to help fight the global epidemic.
“It's not new to use health care to improve relationships with other countries,” Emanuel said. “The vaccine just happens to be another.”
How much do vaccines cost per dose?
Most of the vaccines currently in use require two doses for a full vaccination.
The AstraZeneca-Oxford vaccine is the cheapest at only $4 per dose. The company has committed not to profit from the vaccine while the pandemic lasts. The vaccine also can be stored in normal refrigerators for up to six months, which makes it easier to transport and distribute in developing countries.
At the same time, the mRNA vaccines from Pfizer-BioNTech and Moderna require a complicated cold chain to safely distribute them. These are also the most expensive vaccines. So far, the companies have been selling the majority of their doses to high-income countries, including the U.S., Canada and the European Union.
Because trials were conducted differently at different times, effectiveness figures cannot be directly compared.
Vaccines produced by Moderna and the Pfizer-BioNTech partnership appear to be 90% effective in preventing COVID-19 in a real-world setting.
AstraZeneca-Oxford vaccine was 76% effective at preventing symptomatic COVID-19 two weeks after the second dose and was 100% effective in stopping severe disease and hospitalization in a U.S.-based clinical trial, according to the company.
The J&J vaccine was shown to be 72% effective in moderate to severe disease and 85% effective in preventing the most severe disease.
Where other vaccines are being used?
When will we all be vaccinated?
In the U.S., all adults are now eligible to receive a COVID-19 vaccine. At the current pace of vaccine administration, the U.S. will take a couple more months to fully vaccinate the majority of its population.
According to the analysis from the Duke Global Health Innovation Center, more than 12 billion doses could be produced this year, making it possible to vaccinate 70% of the world population.
However, it might still take years for the majority of the world’s population to become immunized against COVID-19.
Estimates show that there will not be enough vaccine doses to cover the world’s entire population until at least 2023, as only about a dozen countries currently have the capacity to produce COVID-19 vaccines.
A proposal to temporarily suspend certain intellectual property rights on COVID-19 vaccines until herd immunity has been reached is now backed by around 100 countries.
It is also supported by a coalition of organizations called the People’s Vaccine Alliance, which includes the United Nations’ HIV/AIDS agency UNAIDS and human rights group Amnesty International. The discussions at the World Trade Organization are underway.
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