Vaccine Equity: Assessing the world’s progress towards the 70 percent goal

Assessing the world’s progress towards the 70% goal

Published on 30 September 2022

Overview

Low-income countries have faced continuous supply and distribution challenges on the road to reaching 70 percent vaccination coverage. This has left vulnerable groups largely unprotected.

In mid-2021, the World Health Organization (WHO) called on all countries to vaccinate 70 percent of their population against COVID-19 by the end of June 2022, with an interim milestone of 40 percent by end 2021. This global goal was set to reduce virus transmission, protect people everywhere from severe disease, reduce hospitalization and death rates, and support socioeconomic recovery. Vaccinating the world against COVID-19 has been the largest public health initiative ever, and more than 12 billion vaccine doses have been administered to date. According to a recent study, the vaccines administered in the first year of the global rollout were instrumental in averting an estimated 19.8 million deaths.^[1] However, significant inequities in the accessibility and affordability of vaccines between countries have prevented low-income countries from reaching the 70 percent goal. As a result, they continue to bear the brunt of the pandemic’s devastating effects.^[2]

Learn more about the impact of vaccine inequity on national debt, economic recovery and labour market recovery.

As of June 2022, only 1.3 percent of all vaccines had been administered to people living in the poorest 27 countries, who comprise 8.6 percent of the global population. Two low-income countries have not yet started their vaccination campaigns. Throughout most of 2021, the inequitable distribution of the global vaccine supply among countries was the key constraint. Even with COVID-19 vaccines declared a global public good^[3], vaccine equity has been undermined by factors such as bilateral deals between manufacturers and high-income countries, vaccine hoarding, export bans, and manufacturer refusals to share vaccine know-how. By the end of 2021 only 4 low-income countries (Mozambique, Rwanda, Togo, and Uganda) had received enough doses to fully vaccinate 40 percent of their populations as per the end-of-2021 milestone (see timeline below).

By the beginning of the second quarter of 2021, most high-income countries were receiving the steady supply needed to rapidly vaccinate their populations. The volume of supply and frequency of delivery to high-income countries enabled them to expand vaccination to larger population groups while setting them on track to achieve very high vaccination coverage (i.e. above 70 percent of the total population^[4]). By June 2021, over 95 percent of high-income countries were no longer experiencing any supply constraints. However, as of the second quarter of 2021, all 27 low-income countries were still facing severe supply limitations. As COVAX shipments and donations from higher-income countries began to increase, by November 2021 nearly 60 percent of low-income countries had sufficient supply to fully vaccinate 5 percent of their populations. While these donations may have helped initiate vaccine rollout, their volume was still insufficient, and often too unpredictable, to set low-income countries on track for large-scale vaccination. As of June 2022, this was still the case and only Liberia, Mozambique and Rwanda are fully supply-unconstrained with regards to reaching the 70 percent goal.

While supply has improved significantly in 2022, coverage in low-income countries has not matched it, as countries have faced barriers in turning vaccines into vaccinations.^[5] Consequently, as of June 2022, 64 percent of low-income countries were experiencing constraints in absorbing the vaccines available to them.

As a result of these challenges, hundreds of millions of people living in low-income countries remain unprotected in the face of an evolving pandemic. Moreover, many countries have been unable to ensure vaccine access for groups at highest exposure or clinical risk. The time from administering the first vaccine dose to expanding vaccine eligibility to all adults has been on par across country income groups; however, on average (median), high-income countries had vaccinated 18.6 percent of their total populations before sanctioning broad vaccine eligibility compared to just 0.4 percent for low-income countries. Low-income countries’ decision to expand vaccine access early was likely due to limited supply, hesitancy and distribution barriers. For instance, in Cameroon, which extended vaccine eligibility within two months of administering its first dose, vaccine hesitancy was widespread, with only one in five healthcare workers having accepted the vaccine.^[6] Financial constraints were also impairing the country’s ability to conduct a widespread communication campaign^[7] and to recruit sufficient healthcare personnel.^[8] Thus, in the context of the very limited supply throughout most of 2021, the government was facing the risk of vaccine expiration coupled with significant uncertainty about the arrival of the next vaccine delivery. Similarly, Malawi received a large shipment of vaccines with a short shelf life in the spring of 2021^[9] and, despite immediately deploying it and expanding coverage to all adults just 26 days after initiating its vaccination campaign, was unable to administer nearly 20 percent of the doses before they expired.^[10],[11] These challenges likely contributed to the vaccination of a significantly smaller proportion of highly vulnerable people in poor nations versus rich ones.

For instance, vaccination coverage for healthcare workers in 15 of the 23 low-income countries for which there is available data was still less than 70 percent at the start of July. Still, seven high-achieving countries from this income group had been able to reach the 100 percent coverage for medical workers, a significant step towards achieving WHO’s recommendation in July 2022 for all high-risk groups to complete the primary series and receive booster coverage.^[12]

There are also significant inequities between country income groups in the level of vaccination coverage for older adults, as 14 low-income countries were yet to achieve at least 40 percent coverage at the start of July 2022. Broad vaccine eligibility in 11 of these countries may further impair vaccine access for older adults, who are likely to be disadvantaged in competing for doses.

The emergence and rapid spread of novel variants of concern, including Omicron and its subvariants, underscores the continued importance of achieving the 70 percent goal. The most vulnerable and marginalized groups must be prioritized in line with the WHO strategy update to vaccinate 100 percent of healthcare workers and 100 percent of the highest risk populations with both primary and booster doses.^[13] With continued interventions to support vaccine uptake among vulnerable groups, countries can begin to narrow the equity gaps that the pandemic has exposed and exacerbated. Among others, these efforts should include outreach programs to bring the vaccine to at-risk groups, building community trust and dispelling vaccine misinformation.

To support microplanning, UNDP’s forthcoming Hyperlocal Vaccine Analytics tool will aid policy makers in identifying vulnerable groups using a combination of data, including geospatial data, and understanding the factors obstructing vaccination on a community level.

Moreover, to ensure protection through multiple lines of defense, vaccination needs to be embedded within a broader toolkit which includes antiviral treatments, oxygen, personal protective equipment and enhanced diagnostic capacities.^[14] Strengthening systems for health and ensuring political resolve to better address COVID-19 will yield substantial spillover benefits for a sustainable recovery. These include preparedness and response capacities for other outbreaks as well as more equitable access to health and other basic services.