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Analysis

Global vaccine rollout going better among wealthy nations

By ATTHAR MIRZA AND EMILY RAUHALA | The Washington Post | Published: April 22, 2021

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The globe is quickly being split into coronavirus vaccine "haves" and "have-nots," creating a gap that may define the next phase of the pandemic.

Using publicly available figures from Our World in Data, The Washington Post found that nearly half — 48% — of all vaccine doses administered so far have gone to just 16% of the world's population in what the World Bank considers high-income countries.

Through the summer and fall of last year, wealthy nations cut deals directly with vaccine-makers, buying up a disproportionate share of early doses — and undermining a World Health Organization-backed effort, called Covax, to equitably distribute shots.

So now, in a small number of relatively wealthy nations including the United States, doses are relatively plentiful and mass immunization campaigns are progressing apace. But much of the world is still struggling to secure enough supply. For many, herd immunity is many months — if not years — away, which could extend the crisis.

A team at Duke University's Global Health Innovation Center found that high-income countries locked up 53% of near-term vaccine supply. They estimate that the world's poorest 92 countries will not be able to reach a vaccination rate of 60% of their populations until 2023 or later.

Israel has so far immunized the largest number of people per capita. As of April 19, nearly 60% of Israelis had received at least one dose and nearly 58% were fully vaccinated, according to Our World in Data. Though Israel was later than some countries to sign vaccine deals, it offered to pay premium prices and give drug companies access to its health-care data. The country reportedly spent $788 million on coronavirus vaccines by March, most notably on a large shipment of Pfizer-BioNTech's RNA vaccine. While Israel has been criticized for neglecting the Palestinian population in its midst, its vaccination campaign has otherwise been deemed a success and has allowed the return of a more normal way of life, including the lifting of outdoor mask requirements.

Britain is another country leading the way. Between developing, buying and administering vaccines, the country will spend about $16 billion, according to a National Audit Office estimate. To stretch supply as far as possible, Britain opted to space doses by several months, meaning that while nearly 50% of the country has had at least one shot, just over 16% is fully vaccinated. The campaign was set back this month when concerns about rare blood clots in people receiving the AstraZeneca vaccine led the government to restrict use in adults under 30. Still, early studies in Britain show significant reductions in infections and hospitalizations after a first dose of the AstraZeneca or Pfizer vaccines. And the country has been able to slowly begin lifting its lockdown.

The United States, after experiencing one of the world's most deadly outbreaks, is now the envy of the world with its abundant vaccine supply and rapidly progressing inoculation campaign. The country spent billions on vaccine development, deals and distribution. About 41% of U.S. residents have received at least one dose and more than 26% are fully vaccinated. As of this week, all Americans over the age of 18 are eligible to get a shot — a milestone that may renew questions about what the country plans to do with its predicted hundreds of millions of surplus doses.

The Biden administration faces growing calls from public health advocates and activists to share, either by donating doses to countries in need, transferring technology to boost manufacturing capacity, or by easing export restrictions that have kept a disproportionate number of shots, as well as critical vaccine materials, in the United States.

Chile is another vaccination standout, though it has not yet escaped the grips of the pandemic. Chile moved quickly to secure a high number of potential doses. It now leads the Western Hemisphere in inoculations per capita, with about 41% of the population having received a dose and more than 29% fully vaccinated. At the same time, new cases of COVID-19 are surging because of new variants, lockdown fatigue and reliance on a Chinese vaccine that's proved less effective than Western offerings.

Hungary, too, bet on as many as vaccines as it could, breaking with the European Union's collective purchasing effort to cut bilateral deals for Chinese and Russian-made vaccines. About 35% of people there have had a dose, but the country is still seeing a spring surge in deaths.

Both Canada and the European Union have much more vaccine than much of the world, but their immunization campaigns are the source of significant anger and political blowback. Despite numerous advance purchase agreements, Canada has struggled to secure and smoothly administer actual doses, leaving residents seething as cases climb. European officials, meanwhile, have faced criticism for taking too long to negotiate deals, leading to a delayed rollout and a variant-fueled spring surge.

Among countries that the World Bank classifies as either lower- or upper-middle income, vaccination campaigns are for the most part going slowly.

Though Serbia — an upper-middle-income country that cut deals for both Chinese and Russian vaccines — has fully vaccinated about 27% of its population, few others come close.

Brazil, a populous, upper-middle-income country, for instance, is losing thousands of people a day to the coronavirus. Less than 12% of the people there have had a dose, and the nation's variant-fueled outbreak is turning into a regional superspreader event.

Another worrying case is India, a leading maker of coronavirus vaccines that is struggling with its domestic rollout amid a surge in cases. Less than 8% of the population has had at least a dose and 1% is fully vaccinated, per Our World in Data estimates.

With supply tight, China and Russia have engaged in vaccine diplomacy, donating or selling doses to countries in need in an apparent bid for influence. Pakistan, for instance, has received doses from Chinese vaccine-makers and is expecting a small shipment of Russia's Sputnik V vaccine. So far, less than 1% of the population has been vaccinated.

For many countries, vaccination campaigns are just getting started.

Covax, the WHO-backed push to distribute doses, aims to deliver enough for 20% of participating countries by the end of the year but may struggle to meet that target. Though shipments have arrived in some countries, the number of doses is limited and upcoming shipments may be delayed.

Ghana received the program's first doses in February, for instance, but like most lower-middle-income economies, has significantly less than it needs. Just about 3% of people have received a dose, according to an Our World in Data estimate from earlier this month.

In Nigeria, where officials are battling both a shortage of supplies and vaccine hesitancy, less than 1% of people had a dose.

A small number of countries, including Tanzania, have indicated they have no need for vaccine — though that may change as the pandemic grinds on.

Vaccination data from Our World in Data, Duke University and the Centers for Disease Control and Prevention. Population data from the World Bank and United Nations, rounded to the nearest million. Country income classifications from the World Bank.