---
title: Equity of Vaccine Allocation
tags: live-v0.2
permalink: https://c19vax.scibeh.org/pages/vaxequity
---
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# Equity of vaccine allocation

## What is vaccine equity?

[The WHO defines vaccine equity](https://data.undp.org/vaccine-equity/) as equal allocation of vaccines across all countries, regardless of their developmental or economic status. They highlight that allocation of vaccines should be based on the fundamental human right of everyone to have access to the highest standard of healthcare regardless of race, religion, political belief, and economic or other socal conditions. To achieve this, vaccines need to be both accessible and affordable to everyone.

The [WHO](https://www.who.int/campaigns/vaccine-equity) set a target for all countries to vaccinate 10% of their population against COVID-19 by the end of September 2021. 56 countries, most of them in Africa, have been unable to reach this target. Whilst the UK administered its first vaccine dose outside of a clinical trial in December 2020, and had vaccinated more than two thirds of its adult population by October 2021, [Senegal](https://www.gavi.org/news/media-room/first-portuguese-covax-doses-reach-senegal) only received its first supply of vaccines in October 2021.

Most countries are at risk of missing the WHO target of vaccinating 40% of their population by the end of 2021 and 70% by the middle of 2022.

### Inequalities in COVID-19 Vaccine Accessibility

High income countries started vaccinating their populations on average two months earlier than low-income countries. A slower and delayed vaccine rollout in low and middle-income countries has left them vulnerable to the spread of COVID-19, emerging new variants of the virus, and a slower recovery from the social and economic crises. (See our [**Facts about COVID-19**](https://c19vax.scibeh.org/pages/covidfacts) page for more on the impacts of COVID-19).

By monitoring the global roll-out, the WHO has highlighted how inequitably the COVID-19 vaccines have been allocated, with 63.52% (more than 1 in 2) of people in high income countries having been vaccinated compared to 4.75% (1 in 21) in low income countries.

_{_Source: [World Health Organisation](https://data.undp.org/vaccine-equity/)_}

This unequal distribution is also supported by data provided by [Our World in Data.](https://ourworldindata.org/covid-vaccinations)

_{_Source: [Our World in Data](https://ourworldindata.org/covid-vaccinations)_}

### Inequalities in COVID-19 Vaccine Affordability

Accessibility is highly impacted by a country's ability to pay for the vaccines. Data from [UNICEF](https://www.unicef.org/supply/covid-19-vaccine-market-dashboard) and the Vaccine Alliance [Gavi](https://www.gavi.org/) shows that the cost per COVID-19 vaccine is between US$2 - $40. There are also distribution costs; altogether, for a two-dose vaccination purchased via the [COVAX](https://www.who.int/initiatives/act-accelerator/covax) programme, it costs on average US$35 to fully vaccinate one person. This is a significant financial burden for low-income countries, where the average **_annual_** health expenditure is US$41 per person. The rate by which lower-income countries need to increase their healthcare spending, compared to higher-income countries, is disproportionate.

_{_Source: [WHO](https://data.undp.org/vaccine-equity/affordability/)_}

### How has the inequity happened?
The unequal distribution of COVID-19 vaccines has been caused by multiple factors. First, whilst high income countries had the funds available to [place advance orders for vaccines and be at the front of the queue when manufacturing started](https://www.nytimes.com/interactive/2021/03/31/world/global-vaccine-supply-inequity.html), funding challenges faced by low and middle-income countries meant they could not secure their orders and had to wait, leading to a slower and delayed vaccine roll-out.

Added to this, the early vaccines required very specific technologies (e.g., [low temperature storage](https://www.vox.com/21552934/moderna-pfizer-covid-19-vaccine-biontech-coronavirus-cold-chain)) to enable their physical distribution, and manufacturing was limited to those countries which could support these needs.In addition, many manufacturers were initially reluctant to share technology and know-how and publish health-oriented licensing.

To address this, a number of initiatives have started. [The COVAX collaboration](https://www.who.int/initiatives/act-accelerator/covax), co-led by [Gavi](https://www.gavi.org/) and the WHO has been set up to [accelerate the development and manufacture of COVID-19 vaccines and to guarantee fair and equitable access for every country in the world](https://www.who.int/initiatives/act-accelerator/covax). However, as [this article discusses,](https://www.politico.eu/article/coronavirus-vaccine-donations-poor-countries-covax-governments-commit/) despite having the backing of 193 governments and having secured the delivery of over 310 million doses to 143 countries, COVAX is still facing significant challenges.

Two further initiatives are the [COVID-19 Technology Access Pool](https://www.who.int/initiatives/covid-19-technology-access-pool#:~:text=C%2DTAP%20was%20launched,Technology%20Bank%20and%20Unitaid.) which has [received pledges from 18 generic pharamceutical companies](https://www.who.int/news/item/13-11-2020-c-tap-welcomes-open-pledge-by-18-generic-companies-to-increase-access-to-covid-19-health-tools) and the [mRNA vaccine technology transfer hub](https://www.afro.who.int/news/towards-africas-first-mrna-vaccine-technology-transfer-hub), which is now moving ahead in South Africa to help boost and scale up vaccine production in Africa.

## COVID-19 Vaccine Equity --- a global crisis

By the end of September 2021, almost 6-and-a-half billion COVID-19 vaccine doses had already been administered worldwide. With global vaccine production in late 2021 at nearly 1.5 billion doses per month, there is enough supply to achieve the WHO's vaccination targets, provided the vaccines are distributed equitably. This is not a supply problem: it’s an allocation problem.

Contracts are in place for the remaining 5 billion doses. But it’s critical that those doses go where they are needed most. [Data from UNICEF](https://www.unicef.org/supply/covid-19-vaccine-market-dashboard) highlights that these 5m doses are not prioritised for the nations most in need.


_{Source: [UNICEF](https://www.unicef.org/supply/covid-19-vaccine-market-dashboard)}

There are enough doses of vaccines globally to drive down transmission and save many lives---if they go to the people who need them most around the world. Worldwide access to COVID-19 vaccines offers the best hope for slowing the coronavirus pandemic, saving lives, and securing a global economic recovery.

The WHO's vaccination targets can be achieved if the countries and companies that control vaccine supply put contracts for [COVAX](https://www.who.int/initiatives/act-accelerator/covax) and the [African Vaccine Acquisition Trust (AVAT)](https://www.un.org/africarenewal/magazine/august-2021/our-goal-speedy-vaccination-800-million-africans) first for deliveries and donated doses. UNICEF has launched a 'No-one is safe until everyone is safe' campaign with a [**video calling for action**](https://www.youtube.com/watch?v=Zi-_adczAv4).

After the October 2021 [G20 summit](https://www.voanews.com/a/g-20-countries-face-down-vaccine-inequity-/6288800.html), the issue of vaccine equity made headlines across the world. Whilst regulators and health authorities all agreed that there is an issue, there was criticism of high income countries who had the funds to advance order vast quantities of vaccines which some reports say are now at risk of being 'dumped' as they will be out of date [and a call for these stockpiled vaccines to be distributed to poorer counties before they reach their expiry date](https://www.euronews.com/2021/09/20/uk-health-coronavirus-brown-vaccines).

Whilst [developed nations](https://www.bbc.co.uk/news/world-55795297) have made [pledges to donate](https://www.who.int/news/item/13-06-2021-g7-announces-pledges-of-870-million-covid-19-vaccine-doses-of-which-at-least-half-to-be-delivered-by-the-end-of-2021) vaccines to low-income countries via the [Gavi Covax scheme](https://www.gavi.org/covax-facility?gclid=CjwKCAjwoP6LBhBlEiwAvCcthE2Yo07wFoMBJscCJAOBUTtysrJTGMAjMEKOW1FgTozaxlAnAtFH8RoCeIoQAvD_BwE), there are [media reports](http://www.chinadaily.com.cn/a/202110/11/WS61643844a310cdd39bc6e2f6.html) which estimate that around 100 million doses purchased by G7 nations and EU members will expire by the end of 2021, even taking into account booster shots. [News reports](https://www.theguardian.com/world/2021/oct/24/uk-falling-behind-most-g7-countries-in-sharing-covid-vaccines-figures-show) also criticise governments for not meeting their donation pledges. In addition, [issues have also been highlighted in the contracts](https://www.ilfattoquotidiano.it/2021/09/25/vaccini-le-promesse-di-grandi-donazioni-di-dosi-non-cancellano-i-diritti-dei-paesi-poveri/6331359/) with the pharmaceutical organisations which in some cases state that each government must ask for authorisation from the manufacturers before donating vaccines.

## A global call to improve equity

A recent publication by the WHO details [five steps to solving the vaccine inequity crisis](https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000032).

1. Countries that have contracted high volumes of vaccines should swap near-term delivery schedules with COVAX and the African Vaccine Acquisition Trust (AVAT).
1. Vaccine manufacturers should immediately prioritise and fulfill their contracts to COVAX and AVAT and provide regular, clear supply forecasts. [The lack of ransparency or accountability around vaccine contracts has led to poorer countries sometimes paying more for vaccines than richer countries.](https://www.theguardian.com/world/2021/jan/22/southafrica-paying-more-than-double-eu-price-for-oxford-astrazeneca-vaccine)
1. [G7 and all dose-sharing countries must fulfill their pledges urgently](https://www.who.int/director-general/speeches/detail/who-directorgeneral-s-opening-remarks-at-the-media-briefing-on-covid-19—8-september-2021), with enhanced pipeline visibility, sufficient product shelf-life and support for supplementary supplies.
1. All countries must [eliminate export restrictions and any other trade barriers](https://www.worldbank.org/en/topic/agriculture/brief/food-security-and-covid-19) on vaccines and the inputs involved in their production.
1. All of this takes leadership, economic capital and a realisation; for a fast moving pathogen, the only way out is for [world leaders to work together.](https://www.whitehouse.gov/briefing-room/speechesremarks/2021/09/22/remarks-bypresident-biden-at-virtual-global-covid-19-summit/)

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_{Page contributors: Michelle Barden}

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