Disparities Abound as Global Covid Vaccine Roll-out Begins

During a visit to the National Institutes of Health on February 11th, President Joe Biden announced the purchase of 200 million doses of the Covid-19 vaccine from Pfizer and Moderna. This most recent development brings the United States’ total vaccine supply to 600 million doses, and comes with a promise from President Biden to have every American vaccinated by mid to late summer of 2021. Several other countries are setting a vaccination pace similar to that of the US, with the United Kingdom currently possessing about 360 million doses, France holding more than 225 million, and Canada boasting a supply of 400 million. Across the globe, an estimated total of 9.59 billion doses of vaccine have been reserved, and 200 million have already been administered in more than one hundred countries. This may sound like a cause for celebration; however, in reality, since Pfizer’s and Moderna’s FDA approval in mid December, the rollout of Covid-19 vaccines worldwide has been hindered by competition, hoarding, and prioritization. 

Although the global distribution process of Covid-19 vaccinations appears effective on the surface, in truth just ten countries – including all of those aforementioned – have been responsible for 75% of all vaccines administered thus far. While this handful of nations – all with gross domestic products numbering in the trillions – have had virtually unmitigated access to vaccines, many nations are struggling both to access and afford doses for their own citizens, and one hundred and thirty countries still have yet to receive a single vial of the vaccine. That amounts to 2.5 billion people, or more than 30% of the world’s population that have been completely left out of the global vaccination campaign. 

To make matters worse, the world’s wealthiest nations have not only gathered enough vaccines to inoculate their populations, but are also purchasing extraordinary surpluses. For example, while the United States currently holds 300 million doses of Moderna and Pfizer each, some reports estimate that the country’s total bid for vaccines could be closer to 2.6 billion – a supply four times greater than necessary to vaccinate the American public. Canada’s purchases are even more vexing, with enough vaccines gathered to immunize their population six times over. The US and Canada aside, a handful of the world’s other wealthiest nations have similarly gathered more than 100% of the vaccines needed to completely immunize their populations, leaving poorer nations to fend for themselves. 

On top of the problems in roll-out created by vaccine hoarding by wealthy nations, there have also been dramatic discrepancies in the efficacy rates of the vaccines different countries have access to. As of now, there are eight vaccines that have been approved for use globally: Pfizer-BioNTech, Moderna, CanSino Biologics, Novavax, Sinovac Biotech, Russia’s Sputnik V Vaccine, Johnson & Johnson, and AstraZeneca-University of Oxford. Among these, efficacy rates (especially among Covid-19 variant strains) vary widely, with the most effective vaccines claiming rates around 95% prevention, while some have a success rate hovering closer to 50%. Thus far, the only approved vaccines with a clinical trial efficacy rate above 90% are the Pfizer, Moderna, and Sputnik V Vaccines. The European Union, United States, United Kingdom, Canada, and Japan currently possess the majority of these. Among the least effective vaccines are the CanSino vaccine (65.7% effective), the Sinovac vaccine (50.38% effective), and the Johnson & Johnson vaccine, whose efficacy rate is still being determined, but has varied from 57-85% in clinical trials. The bulk of these vaccines’ orders have come from the African Union, Brazil, Indonesia, and other areas of Latin America. These glaring access inconsistencies have resulted in the formation of several organizations dedicated to increasing less wealthy nations’ negotiating power with drug companies in control of the vaccine supply, among them the Covax initiative. So far this organization, backed by the World Health Organisation (WHO) and a host of global vaccine advocacy groups, has had 189 countries sign onto their program in the hopes of securing vaccines for their citizens. Since fall 2020, a number of wealthy nations, including the United Kingdom, Canada, Germany, Italy and Sweden, have donated nearly US$ 1.7 billion to the Covax initiative. In early February 2021, the United States followed suit under the Biden administration, donating US$ 4 billion to the cause. Prior to February, the United States had chosen to opt out of contributing to the program. 

As of early this February, Covax has secured 2.3 billion doses of vaccines for distribution this year. Of that 2.3 billion, over half will be made specifically available to 92 of the world's poorest countries. Most recently, Covax has begun administering AstraZeneca-University of Oxford vaccines (estimated to be around 70% effective) in Ghana and Côte d’Ivoire, providing each country with a supply of around 500,000 doses and marking the first formal vaccination campaign in Africa. These vaccine deliveries mark a hopeful turning point in global vaccine roll-out, and herald the start of what may become the greatest, most expeditious and complex global rollout of vaccines in history.

Even so, while the United States is on track to inoculate 100% of its citizens within the next few months, the entire continent of Africa is projected to immunize just 35% of its population by the end of this year even with the help of Covax. On top of that, between powerful nations overstocking vaccines and Covax working to assist less wealthy nations, there are still many countries that have been left to fend for themselves. These nations, lacking the sway of wealthy countries like the US or Canada but too well-off financially to qualify for Covax support, are struggling to secure even a fraction of the vaccines they need for their citizens. For these countries, both cost and accessibility are factors. South Africa, for example, intended to purchase enough of the Oxford-AstraZeneca vaccine to vaccinate 40 million of its 58.5 million people, but has only succeeded in securing an order with enough vaccines for just 10 million. To make matters worse, South Africa is paying $5.25 per vaccine, more than twice the price paid by the European Union. Mexico is in a similar position, having ordered 230 million doses of various Covid-19 vaccines, but only receiving enough to administer 750,000 doses. Both of these countries have raised objections regarding the global distribution of vaccines, with Mexico filing a complaint at the UN Security Council, and South Africa’s President, Cyril Ramaphosa, calling attention to the nations responsible for stockpiling vaccines at the World Economic Forum. 

The true irony in all of the issues surrounding the global rollout of Covid-19 vaccines is that for all the vaccines the world’s most well off nations can accumulate for themselves, these nations would stand to receive huge economic benefits if they allocated their resources towards funding the COVAX initiative and ensuring all countries had the access they need to the vaccines. Currently, the cost to fully finance the COVAX program is roughly US$ 2 billion. A study commissioned by the Chamber of Commerce Research Foundation found that a failure to provide COVAX with these funds could result in up to US$ 9.2 trillion in economic losses. Further, no less than half of these expenses would fall on wealthy nations. 

Knowing this, the fair distribution of vaccines becomes not only a pressing moral issue, but an economic one as well. In order to fully lift the world from the depth of the devastating effects of Covid-19 and prevent further crises, support for Covax must continue to increase, vaccines must be made equally available to all countries, and the world’s most well-off nations must be willing to cooperate.