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What is really causing global vaccine disparities?

Despite many nations' pledges to donate vaccine doses to countries in need, vaccination disparities between wealthy and low-income nations remain stark. Why? Analysts have identified one major contributing factor.

Covid-19 tested national health systems—and they responded largely as designed

'We have fallen short of the mark'

The number of people vaccinated against the coronavirus varies widely around the world. According to the Our World in Data project at the University of Oxford, roughly 75% of distributed coronavirus vaccines have been administered in wealthier countries, and just 0.6% of doses have been administered in low-income countries, the New York Times reports.

On Wednesday, Secretary of State Antony Blinken urged wealthy countries, pharmaceutical companies, and international institutions to "step up" and address global vaccine inequity.

"How can it be that in the United States and Europe we have vaccination rates that on average are probably somewhere around 60%? In Africa, it is under 14%," Blinken said. "It's not only wrong. It's a huge problem."

And while Blinken acknowledged the life-saving innovation of vaccine manufacturers, he called out the inequitable distribution of doses. The pharmaceutical companies who produced coronavirus vaccines, such as Johnson & Johnson (J&J), Moderna, and Pfizer-BioNTech, "have performed miracles," Blinken said, but "[w]hen it comes to distribution, with all the different actors involved—governments, companies, international organizations—we have fallen short of the mark."

Blinken said vaccine distribution may have been more equitable had pharmaceutical companies shared their intellectual property. However, for his part, Pfizer CEO Albert Bourla on Tuesday said inequitable vaccine distribution could not be blamed on the company, noting that vaccine doses were made available to every country—but more developed nations were quicker to place orders.

The U.S. has pledged to donate at least 1.1 billion doses

As a part of the global vaccination effort, the United States pledged to donate at least 1.1 billion doses to low-income countries before 2023.

So far, the United States has delivered 216.5 million doses worldwide, shipped 18 million doses that have not yet been delivered, and has 865.5 million remaining doses pledged to low-income countries, the Kaiser Family Foundation (KFF) reports.

Of the delivered doses, 141 million have gone to lower middle-income countries, 46.9 million have gone to upper middle-income countries, 21.4 million have gone to low-income countries, and 7.3 million have gone to high-income countries. According to KFF, 46% of these delivered doses were Pfizer-BioNTech, 31% were Moderna, 16% were Janssen Pharmaceuticals (the division of J&J that developed the company's vaccine), 2% were AstraZeneca, and 5% were unknown. 

In addition, Blinken on Wednesday announced the debut of the Global Covid-19 Access Tracker, a platform that compiles global data on vaccination and ICU rates, according to the Times. He also announced that the United States and J&J reached a deal to distribute additional vaccine doses to "conflict zones," the Times reports.

"We need to ensure that people who cannot be reached by government vaccination campaigns aren't left out of our efforts," Blinken said. "They need to be protected, too."

Why the global coronavirus vaccine disparity persists

Despite these donation pledges from the United States and other wealthy nations, the analytics company Airfinity has identified one reason for the global vaccine inequality: Wealthy nations appear to be buying more doses of the coronavirus vaccines than they are using.  

While countries and pharmaceutical companies have not disclosed the details of their vaccine purchase contracts, Airfinity compared wealthy nations' coronavirus vaccine production numbers with the number of vaccines those countries have used.

Every month, wealthy countries—including Canada, Japan, the United Kingdom, the United States, and nations in the European Union—have produced a significantly higher number of doses than they have actually used. According to Airfinity, between a third and a half of these wealthy countries' vaccines are going unused—some of which are on the verge of expiration, NPR's "Goats and Soda" reports.

And while the World Health Organization (WHO) previously called for countries to hold off on administering booster shots until every country was at least 10% vaccinated, the unused stockpile among wealthy nations is projected to continue to grow into next year, even after accounting for the additional doses used for boosters and vaccinating children.

The surplus is estimated to reach roughly 1.2 billion doses by the end of the year, NPR's "Goats and Soda" reports. However, Airfinity's CEO Rasmus Bech Hansen also noted that, by December, about 600 million doses will be donated to other countries—about 300 million of which will come from the United States.

Notably, Hansen said the stockpile of doses would have been enough to meet the WHO goal of vaccinating at least 40% of the population of lower-income nations, a goal Hansen said is growing "increasingly unlikely."

Separately, Rachel Silverman of the Center for Global Development argued that the excess doses in wealthy countries should be distributed overseas. "The logistics as I understand it are somewhat complicated," she said, "but do-able." She added, the world needs to "figure out how to fix it." (Gandel, New York Times, 11/10; Kaiser Family Foundation Tracker, 11/11; Montague/Jakes, New York Times, 11/10; Aizenman, "Goats and Soda," NPR, 11/10)

Advisory Board's take

How political realism stunted global equity in Covid-19 vaccination

Vidal SeegobinBy Vidal Seegobin, Managing Director

The slowing of global vaccine distribution around the world is a sad but entirely predictable phenomenon. It’s important to remember that while vaccine development, payment, and distribution can feel like technical issues—at the end of the day it comes down to national politics.

Leaders in the wealthiest countries in the world have learned there are real political costs to not having enough vaccines on hand for their voting constituencies. And there are still major outstanding questions on what Covid-19 will look like entering the northern-hemisphere winter.

Most of their commitments to the global south were made early on when we had several vaccine candidates in development. Distribution arrangements like COVAX looked good on paper even if they were non-binding.

But 19+ months into the pandemic, where we have basically four vaccine options for public use (with a hierarchy of public preference) and a global supply chain that had some early hiccups, the political calculation gets simple. Global vaccination would take longer than my political news cycle, and if we’re being brutally honest, no one political leader will get any credit for global herd immunity. Instead, what each individual leader can bet on is guaranteeing stockpiles for voters—even if it means waste. It’s an unfortunate case of short-term, self-interested thinking that shows that political realism in international affairs is alive and well.  

For a deep dive into how Covid-19 tested national health systems (including an analysis of their responses), read our thoughts here. Additionally, you can check out our global Covid-19 vaccination scenario planning guide to learn about ten hurdles—which cover regional coordination, resource constraints, and public willingness to receive vaccinations—that experts foresee making vaccination more challenging for health systems, regardless of country or when the first vaccines were approved.







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