It has been months since the first person received a COVID-19 vaccine and hundreds of millions of doses have been distributed – but the vaccine distribution has not been evenly distributed around the world.
Several countries, including the United States, have made rapid progress in immunizing their populations. Millions of vaccines have been administered to Americans, ranking the United States among the top countries with one of the highest vaccination rates per 100 people.
But because richer countries are getting more doses than their populations need, many poorer countries have yet to report a single dose administered.
“We still have a way to go,” said Krutika Kuppalli, vice chair of the Global Health Committee of the Infectious Diseases Society of America, when asked about current global immunization. “There are still a number of countries that haven’t even started vaccinating people.”
“I’m lucky because I live here in the United States and have access to medication,” Kuppalli said. She says that access to life-saving medicines “shouldn’t be determined because I was born here rather than whether I was born in another country.”
Global COVID-19 vaccination rates
Israel has been the world 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 health system that can identify people at high risk have been major success factors, according to Israeli health experts. The country also has a tradition of periodic emergency preparedness exercises.
The United Arab Emirates were not far behind. It has roughly the same population as Israel and contributes its rapid vaccination rate to coordinated government action, strong leadership, public awareness campaigns and simple vaccination registration procedures to the using an application from the Ministry of Health.
The gap between countries
High-income countries make up only 16% of the world’s population, but some of them have purchased enough vaccines to cover their population more than twice.
According to a study by the ONE political team, the richest countries in the world have collectively bought 1 billion more doses than their citizens need. The rest of the world was only able to get 2.5 billion doses – not enough to immunize their populations.
Immunization coverage by country income level
Soon the United States will have a vaccine surplus, experts say.
“We’re going to have more supply than demand, between now and mid-May,” Ezekiel Emanuel, a health policy expert and professor at the University of Pennsylvania who advised on the transition, told USA TODAY in late March. by President Joe Biden.
Emanuel said the United States should send the excess vaccines overseas. “We cannot stop producing (vaccines) and we cannot rely on our supplies. It makes no sense and it is not ethical, ”he said.
Percentage of population covered by vaccine purchases
“If other countries aren’t vaccinated, it’s not good for the health of the world,” Emanuel said. “And it’s not good to get back to normal, because if you want to get back to normal, part of that is commerce, travel, educational exchange and the like. All of this requires vaccination all over the world. ”
The risk of vaccine inequity
The models suggest that even if high-income countries are fully immunized by the middle of this year, but developing countries only manage to immunize half of their populations, the global economy could lose an estimated 4 trillion dollars. dollars.
Percentage of the population at least partially immunized by income level of the country
Another danger that uneven vaccination rates can pose around the world is the emergence of new variants. The longer the period of sustained community spread, the more likely the virus is to mutate. Mutated variants from the unvaccinated population might be able to infect those from the vaccinated population.
Vaccines that are currently in development or have been approved should provide at least some protection against newer variants of the virus, according to the World Health Organization. However, it is important to limit the spread of the virus in order to prevent mutations that may reduce the effectiveness of existing vaccines. As more and more people get vaccinated, the circulation of the virus is expected to decrease, resulting in fewer mutations.
According to Kuppalli, the infectious disease expert, vaccinated people could travel to another part of the world, be exposed to a new strain of the virus not covered by the vaccine, get infected and pass it on to other people.
“It’s making sure that we protect everyone. It’s not just about life and death, but also about the quality of life of people after being infected with COVID, ”she added.
Low- and middle-income countries have relied heavily on COVAX, a UN-backed and donor-funded program to support the development and delivery of COVID-19 vaccines to low- and middle-income countries. Richer countries can collectively buy vaccines, finance vaccine development and manufacture, and provide immunization in poorer countries.
The fund plans to deliver 2 billion doses by the end of the year, aiming to cover at least 20% of the population of participating countries. But the lowest estimates required for collective immunity start at 70%. There were also delays in vaccine deliveries.
“Infectious diseases do not have borders or barriers. COVID does not discriminate based on socioeconomic status, race, ethnicity. So it can affect anyone, ”Kuppalli said. “Our world will only be safe if everyone is protected. This is how we stop the pandemic. “
China and Russia have sent their vaccines to dozens of countries in the Middle East, Asia and Latin America.
China has approved four of its candidate vaccines, all of which are used by other countries. It has signed purchase agreements with more than a dozen countries and donated part of the doses.
Chinese vaccine manufacturers Sinopharm and Sinovac presented data on their vaccines indicating levels of efficacy compatible with those required by the WHO.
No detailed efficacy data for Sinopharm’s vaccine has been released, but according to its developer, Beijing Biological Products Institute, a subsidiary unit of Sinopharm China National Biotec Group), the vaccine was 79.34% effective in preventing people to develop the disease on the basis of intermediate data.
The Sinovac trials gave different results in different countries with an efficacy between 50.65% and 83.5%.
Russia has approved two vaccines, including one already in use in two dozen countries.
Russian Sputnik V vaccine was 91.6% effective against symptomatic COVID-19 and 100% effective against severe and moderate disease, according to interim analysis of the results of the phase 3 trial of the vaccine published in the British medical journal Lancet.
“We’re definitely seeing vaccine diplomacy, but it’s just part of a larger, well-established notion called ‘soft power’,” said Emanuel, Biden’s former health adviser.
He added that many countries, including the United States, have used “soft power” to strengthen relations between countries, and a good example would be the President’s Emergency Plan for AIDS Relief, a initiative launched under the administration of George W. Bush to help fight the global epidemic.
“It is not new to use health care to improve relations with other countries,” said Emanuel. “The vaccine is just another.”
How much do vaccines cost per dose?
Most vaccines currently in use require two doses for a complete vaccination.
The AstraZeneca-Oxford vaccine is the cheapest at just $ 4 per dose. The company has pledged not to take advantage of the vaccine as long as the pandemic lasts. The vaccine can also be stored in normal refrigerators for up to six months, making it easier to transport and distribute in developing countries.
At the same time, mRNA vaccines from Pfizer-BioNTech and Moderna require a complicated cold chain to deliver them safely. They are also the most expensive vaccines. So far, companies sell the majority of their doses to high-income countries, including the United States, Canada, and the European Union.
Because the trials were conducted differently at different times, the efficacy figures cannot be directly compared.
The vaccines produced by Moderna and the Pfizer-BioNTech partnership appear to be 90% effective in preventing COVID-19 in a real-world setting.
The AstraZeneca-Oxford vaccine was 76% effective in preventing symptomatic COVID-19 two weeks after the second dose and was 100% effective in stopping serious illness and hospitalization in a US-based clinical trial, according to the company .
The J&J vaccine has been shown to be 72% effective in moderate to severe disease and 85% effective in preventing the most severe disease.
Where are other vaccines used?
When will we all be vaccinated?
In the United States, all adults are now eligible to receive a COVID-19 vaccine. At the current rate of vaccine delivery, it will take a few more months for the United States to fully immunize the majority of its population.
According to the analysis of the Duke Global Health Innovation Center, more than 12 billion doses could be produced this year, making it possible to immunize 70% of the world population.
However, it may still take years for the majority of the world’s population to be vaccinated against COVID-19.
Estimates show that there will not be enough doses of the vaccine to cover the entire world population by at least 2023, as only a dozen countries currently have the capacity to produce COVID vaccines. 19.
A proposal to temporarily suspend certain intellectual property rights over COVID-19 vaccines until collective immunity is achieved is now supported 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 the human rights group Amnesty International. Discussions at the World Trade Organization are ongoing.