Why was the COVID-19 vaccine rollout 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.

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.

Vaccine supply must remain available and predictable over the long term to support in-country needs as the COVID-19 response continues to evolve.

What was the impact of unequal access to COVID-19 vaccines?

COVID-19 was left to circulate unchecked in large parts of the world for far too long. This allowed the virus 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.
• Some estimates suggest that there were nearly 15 million excess deaths associated both directly or indirectly with COVID-19 between January 2020 and December 2021.

Where does COVID-19 vaccination stand globally?

Over half of the people on Earth live in the world’s poorest countries, but only 2.5% 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.

How is COVID-19 vaccination going in Africa?

In African countries, 38.9 in 100 people have received at least one dose of a COVID-19 vaccine, as of 14 August 2024. Only 32.4% of the population is fully vaccinated.

Until early on in 2022, supply had been the biggest constraint 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.

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 have reported 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.