The key numbers

As of 30 January 2023, 13.3 billion vaccine doses have been administered in the world:

  • 260.2 million doses in low-income countries
  • 4.8 billion doses in lower middle-income countries
  • 5.4 billion doses in upper middle-income countries
  • 2.8 billion doses in high-income countries

African countries have administered 746.8 million doses. That means 28.2% of the population of the continent is fully vaccinated.

To date, 63.8% of the world’s population has been fully vaccinated. But only 23.1% of people in low-income countries have been fully vaccinated. Lower middle income countries have fully vaccinated 58.3% of their people. That’s a huge difference compared with 74.9% in high income countries, and 78.1% in upper middle-income countries.

Why are we moving so slowly?

We have a growing arsenal of tools to fight COVID-19. But we still lack the political will and systems needed to ensure everyone on earth has access to them over the long-term.

Safe and effective vaccines are widely available, so why aren’t vaccination rates increasing everywhere in the world? It comes down to three factors: demand, distribution, and last-mile logistics of getting shots into arms. 

Rich countries bought the majority of the initial supply of vaccines, leaving low- and lower middle-income countries out of the market for far too long. It wasn’t until demand for vaccines dropped in high-income countries that the global supply of vaccines meaningfully increased in other  places. 

So, now that the supply of COVID-19 vaccines has increased, efforts to vaccinate the world should be easy, right?  Wrong. 

It took so long for vaccines to be reliably available in the world’s poorest countries that many people lost hope or interest in trying to get vaccinated. For low- and lower middle-income countries to increase demand, supply must become reliable and predictable. 

Also, access to other tools like treatment and diagnostics must be scaled in low- and lower-middle income countries to protect life and ensure the world has a long-term sustainable response to the virus.

Tracking progress against global vaccination targets

In September 2021, world leaders aligned around the target of vaccinating 70% of the population in all countries by September 2022. The world’s wealthiest countries met and exceeded this target. Lower-middle income countries saw significant progress but still fell short of the global goal.  And low-income countries were left the furthest behind. 

Only wealthier countries met the September 2022 target

Here’s another way to look at it: Over half of the people on Earth live in the world’s poorest countries, but only 38.3% of vaccines administered so far have gone to people in these countries.

When vaccination campaigns started, over 90% of doses were administered in high-income countries. Now, the majority of doses are being administered in upper middle-income countries, a group which includes China.

Proportion of COVID-19 Vaccine Doses Administered by Income Level

How is the rollout going in Africa?

In African countries, 34 in 100 people have received at least one dose of a COVID-19 vaccine, as of 30 January 2023. Only 28.2% of the population is fully vaccinated.

Vaccination in African countries has been much slower than in any other region of the world

Until early on in 2022, supply had been the biggest constraints to scaling up vaccines in Africa. Most African countries have done relatively well at administering the low quantities of doses delivered.

As supply increased,  improving and supporting the logistics of getting doses into arms and building vaccine confidence have been a strong focus of vaccination efforts throughout much of 2022.

Why has the vaccine rollout been so unequal?

Early in the pandemic, high-income countries had the purchasing power to be first at the negotiating table with pharmaceutical companies. This allowed them to monopolize the supply of vaccines for their own use. At the same time, high-income countries were slow to support mechanisms like COVAX that were created to purchase and distribute doses to lower-income countries.

High-income countries had a 6 month head start on purchasing doses while slow-walking funding for COVAX

This chart shows the cumulative number of deals signed by high-income countries and COVAX. By February 2021, high-income countries had made 48 deals, whereas COVAX had only managed to secure 4 deals. Confirmed purchase agreements are from publicly reported vaccine purchase agreements for all COVID-19 vaccine types, numbers do not reflect when doses were delivered to each country. High-Income Countries include US, UK, EU, Canada, Japan, and Australia. EU values do not include deals made by individual countries. Chart last updated October 2021.

As a result, high-income countries  purchased 2.7 times more doses than COVAX, even though COVAX is serving a population three times the size of that in high-income countries. Similarly, high-income countries purchased more than 20 times more doses than the African Union’s COVID-19 Africa Vaccine Acquisition Trust (AVAT), even though they are both serving populations similar in size.

This situation created a lot of unpredictability and unreliability in supply to low- and lower-middle-income countries, making it difficult for countries to mobilise resources and plan for the long term distribution of vaccines. In order to address issues of unpredictable supply, COVAX, AVAT, and Africa CDC released a joint-statement in November 2021 with guidelines on how to create more predictable supplies.

Since the pandemic began, cooperation efforts have largely fallen flat, and governments continue to look inward with their planning and policies. Efforts to share essential COVID-19 vaccines began increasing in earnest in August 2021, once high-income countries had already vaccinated much of their population with two and, in some cases, three doses.

Wealthier countries committed to share over 2.7 billion doses with low- and lower middle-income countries through 2022. As of August 2022, 1.6 billion of these doses had been delivered and demand for these shared doses had dried up. A major lesson from the COVID-19 experience is that sharing doses from high- to low-income counties is an inefficient and unjust way to scale up vaccination globally.

Pledges did not become doses delivered

Addressing today’s barriers to vaccine rollout

As vaccine supply becomes increasingly stable, barriers to getting “shots in arms” have led AVAT to seek a pause in COVID-19 vaccine donations until later in 2022. This will provide countries the opportunity to address other challenges slowing vaccine uptake. Remaining challenges include:

Logistics: Global and in-country last-mile delivery efforts and plans to get shots into arms must address and budget for infrastructure and logistical challenges. These include cold storage capacity at vaccination sites and the availability of needles, syringes, and disinfecting swabs.

Low demand and vaccine hesitancy: Many initiatives to improve vaccine confidence and address misinformation on COVID-19 vaccines in Africa are already underway:

  • The #MythOrVax campaign launched in 2021 in partnership with ONE, UNICEF, the African Union, African celebrities, and TikTok is back for part two this year. Using online quizzes and interactive mythbusting on TikTok, the campaign aims to dispel myths, challenge misinformation, and raise awareness for COVID-19 and COVID-19 vaccines.
  • Ghana’s Misinformation and Rumour Management Taskforce has been working at the national and regional levels to address false claims.
  • Senegal’s toll-free call centers provide facts to people who are uncertain about receiving a vaccine.
  • Botswana surveyed its population to understand risk perception and launched a social media campaign called #ArmReady to increase public demand for vaccinations.
  • The Africa Infodemic Response Alliance (AIRA), hosted by WHO, brings together African fact-checking organizations, big data, AI and innovation bodies, and other organizations to share facts about COVID-19 and vaccines.

Lack of resources: Understanding and addressing the demand side challenges of getting shots into arms will require significant and urgent funding for countries to help in-country and global initiatives respond to these challenges. Countries need at least US$52 billion to fund the overall global pandemic response in 2022. This includes funding for vaccines, therapeutics, diagnostics, and health systems strengthening.

Grant financing by donor countries accounts for at least US$27.7 billion, or 53%, of this. ACT-A estimates that at least US$6.8 billion is needed to support in-country delivery costs of getting shots into arms. As of June 2022, US .8 billion has been committed by donor countries both bilaterally and through ACT-A across all pillars for the 2021-2022 funding cycle.

COVAX raised US$4.8 billion in April 2022 through donor pledges, innovative financing mechanisms, and from multilateral development banks. Though the fundraising effort fell just short of COVAX AMC’s ask of US$5.2 billion, the financing will help kick start COVAX’s efforts to help countries boost vaccinations. It will also support the creation of a Pandemic Vaccine Pool to help participant countries procure future doses should they be needed.

The amount committed to date is just a drop in the bucket compared to what is needed for  vaccines, therapeutics, diagnostics, and health systems strengthening. Donors must act quickly to fill the funding gap in 2022 to sustain progress in the fight against COVID-19.

COVID-19 wasn’t that bad in Africa, right?

We have known little about the pandemic’s true impact in African countries, due to low testing and reporting. By the summer of 2022, only 1.9% of COVID tests since the pandemic began had been conducted in African countries. We lack access to hospitalization data for most countries, and mortality statistics can lag for many years.

But the impact is likely much worse than what is seen in official reporting. A number of serological studies that measure the presence of antibodies are reporting that high percentages of the population in Africa have been exposed to or infected by some strain of the coronavirus. A  WHO study published in April 2022 suggested that up to 65% of all Africans had been infected by COVID-19 by September 2021. This would put true infections on the continent 97 times higher than reported confirmed cases over the same time period.

While the official cumulative death toll due to COVID-19 in Africa is 257,588, the Economist’s excess deaths model estimates over 2,234,861 cumulative deaths due to COVID-19. If these projections are true, COVID-19 killed more people in Africa in 2020 than malaria (602,000), HIV/AIDS (460,000), and tuberculosis (379,000).

Is test and treat the way forward?

With more testing, safe and effective oral therapeutics can be used more widely to prevent severe health outcomes from COVID-19. Oral therapeutics can be self-administered and provide a more cost-effective option, if distributed equally around the world.

But greater access to diagnostics and therapeutics is needed for this approach to be scaled globally.

Current trends suggest that oral therapeutics will not be available equitably across the world.

Even before regulatory authorisations are granted, high-income countries are already dominating the market for the two most promising drugs for preventing severe infection — Pfizer’s Paxlovid and Merck’s Molnupiravir.

While production and delivery have not ramped up yet, there are early signs of an equity gap in access to therapeutics. African countries are being left out of pre-purchase agreements. Global mechanisms that are leading the ACT-A therapeutics pillars have only been able to purchase a small fraction of the available supply of treatment courses.

The US has secured most of the Paxlovid courses purchased by high-income countries, spending over US$500 per course when generic versions could have a production cost of US$20 per course. But generic production will not be available to low- and lower middle-income countries until the end of 2023 at the earliest.

For example, Gavi could start to include COVID-19 vaccines in their menu of routine immunizations available to partner countries. 

Why does equitable access to COVID-19 tools still matter?

The world will continue experiencing waves of infections, which are opportunities for the virus to mutate. There are thousands COVID-19 variants, and some – such as Omicron and Delta – proved to be more transmissible than other strains. Various sub-variants of Omicron are already spreading and could spark a new wave.

How successive waves compare to the Delta wave

As of 30 January 2023, there were 1,155 daily confirmed cases in Africa (-8.7% in the last week), and 8 daily confirmed deaths (+47.4% in the last week)

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:

  • Unequal vaccine distribution could cost the global economy a total of US$5.3 trillion over the next five years.
  • Developed economies could bear 34% of the global economic loss between 2022-25 if vaccine inequity continues.

Increased global vaccine access should be used together with diagnostics, treatments, and other measures that help lower and manage the risk of infection.

World leaders must continue cooperating, working across borders, and taking the “global” part of this pandemic seriously. Otherwise, we risk being stuck in an indefinite cycle of booster shots and uncertainty.

What needs to happen?

COVID countermeasures like vaccines, testing and treatment need to be mainstreamed into routine care for people everywhere. The virus has not yet transitioned into an endemic phase. And as such, efforts to vaccinate the world and end the threat of COVID-19 must not be abandoned.

We are calling on world leaders to take immediate and urgent action to:

  1. Support the multilateral, regional, and national efforts to ensure COVID countermeasures like vaccines, testing and treatment become mainstreamed into routine health care for people everywhere. 
  2. Provide funding to support  health systems strengthening in the world’s poorest countries to ensure COVID countermeasures can be delivered over the long-term.
  3. Support efforts to scale up regional production of vaccines and  therapeutics including providing the funding, information, and partnership needed to regional manufacturing and production capabilities.