Vaccine Equity: Boosting Speeds, Accelerating Equity
Published on 28 September 2022. Click here for previous version from February 2022
Just 66 countries and territories achieved the WHO target of vaccinating 70 percent of their population by June 30, 2022. Inequities in vaccine access and affordability have resulted in zero low-income countries reaching this goal, compared to nearly two-thirds of high-income countries. As a result, more than 500 million of the 665 million people living in low-income countries remain unprotected. An equitable approach to vaccine distribution - both internationally and within countries - remains fundamental to a fair and sustainable global recovery.
Yet, new UNDP estimates suggest that without swift action to address the combination of obstacles[1] limiting the vaccine rollout in low-income countries, inequities in vaccine protection between countries are likely to persist. While some high-achieving low-income countries like Liberia and Rwanda are expected to achieve 70 percent coverage by the end of 2022, it could take until the end of this decade for at least half of the countries in this income group to reach the 70 percent target assuming current vaccination rates. Even then, given the likelihood that the efficacy of the first generation of COVID-19 vaccines will continue to wane, the proportion of people who would be protected against potential future variants is likely to be substantially lower.
Similarly, only one in five lower-middle income countries, including Lao PDR, Nepal, India and the Philippines, are projected to reach 70 percent population coverage by the end of 2022. Under current vaccination rates, it would take until August 2025 for 63 percent of lower-middle income countries to achieve the target - or the same proportion of high income countries that have attained it as of July 2022.
To reach the 70 percent target by the end of 2022, current vaccination rates in 64 low- and lower-middle income countries would need to at least double, and nine countries would require at least 100 times greater speeds. Yet, the task of speeding up varies considerably between countries. For instance, Mongolia would need to accelerate its vaccination rate more than 200 times but, as 66 percent of the population has already been fully vaccinated, this would amount to covering an additional 4,966 people each week. Compare that to Senegal, where only about one in every 16 people is fully immunized, requiring an increase in vaccination rate nearly 170 times to over 443,000 people every week. Countries whose vaccination campaigns are further behind - like Cameroon and Guinea-Bissau - would need to accelerate their current rates more than 500 times.
To mitigate against some of the pandemic’s most devastating effects, WHO has recommended that countries prioritise achieving 100 percent coverage with the primary series and booster doses for the highest risk groups, including healthcare workers, older adults and those who are immunocompromised or have underlying conditions.[2]
There is still some way to go to achieve these goals. As of July 1, 2022, just 8 of the 24 low-income countries with available data had achieved 100 percent primary series coverage for healthcare workers. Among the 19 low-income countries with available data, only Mozambique had achieved 100 percent coverage for older adults. Moreover, in five low- and six lower-middle income countries, coverage among older adults is lower than for the overall population. Our projections show that if low-income countries continue vaccinating at their current rates and maintain their relative shares of older people vaccinated, it would take until April of 2025 for at least half of the countries in this income group to provide primary series coverage to 100 percent of older adults, though due to waning vaccine efficacy the proportion of protected adults would likely be significantly lower.
This would risk further delaying the provision of boosters, which are critical in protecting against the vaccine evasion capabilities of current and potential novel variants of concern and in counteracting waning immunity.
Targeted campaigns to improve coverage for older adults could result in significant gains, even if current overall vaccination rates are maintained. If, through effective targeting, including demand generation and outreach campaigns, countries are able to allocate 6 of every 10 vaccines they administer to older adults, by the end of 2022 they would be able to provide protection to an additional 6.8 million older adults.[3] Moreover, this would allow 8 of the 19 low-income countries analysed to reach 100 percent coverage for this subgroup, and an additional five low-income countries to provided coverage to at least 70 percent of older adults. The benefits of prioritisation are projected to accrue over time under this scenario so that, as compared to current allocation, an additional 10.8 million older adults would be fully vaccinated by the end of 2023. As a result, 92.4 percent of older adults in these 19 low-income countries could be fully immunized, compared to just 63.8 percent under countries’ current allocation shares.
Even in a scenario in which these 19 low-income countries allocate 4 of every 10 vaccines to older adults an additional 4.8 million and 10.3 million older people could receive protection by the end of 2022 and 2023, respectively. Urgent action, under either scenario, would allow countries to make greater progress in immunizing some of the most clinically vulnerable persons by the end of this year than they would if they maintained their current rates until the end of the decade. Enhancing the current vaccination drive, including through booster doses, while prioritizing equity will substantially limit preventable mortality as well as mitigate against socio-economic risks.
Footnotes
[1] Assessing the world’s progress towards the 70 percent goal
[2] Global COVID-19 Vaccination Strategy in a Changing World: July 2022 update
[3] The analysis is based on the 19 low-income countries for which there is vaccination coverage data for older adults: Burkina Faso, Chad, Democratic Republic of Congo, Gambia, Ethiopia, Guinea, Guinea-Bissau, Madagascar, Malawi, Mali, Mozambique, Niger, Rwanda, Somalia, South Sudan, Sudan, Syria, Togo, Uganda, Yemen