The detection of the Omicron variant has brought renewed attention, and a new urgency, to the worldwide Covid-19 vaccination campaign, which experts say remains among the most powerful tools at our disposal when it comes to preventing dangerous new variants.
Most wealthy countries have vaccinated significant shares of their populations and have rapidly moved into the booster-dose phase. But one year into the global vaccine rollout, the gap between vaccination rates in high- and low-income countries is wider than ever.
Poorly vaccinated countries face several challenges. Early in the rollout process, some countries were not able to secure enough doses to inoculate their residents, and many still face shortages. In others, supply is only part of the story. A New York Times analysis of available data highlights the countries where infrastructure issues and the public’s level of willingness to get vaccinated may pose larger obstacles than supply.
Which countries have used the highest share of doses delivered to them?
Sources: Delivered dose data from Airfinity; administered dose data from Our World in Data. Note: Data as of Dec. 2, 2021, when the global average vaccination rate was 45 percent. Circles are sized by country population. Figures marked with an asterisk * were calculated using an administered dose count that was last reported more than two weeks ago. Countries that have not reported dose data in the past 30 days are not shown.
Some countries that have below-average vaccination rates are using most of the vaccine doses they have on hand, and some are not. Most countries with high vaccination rates have used most of the doses delivered to them; they are clustered to the right side of the chart above.
If a country is using most of its available doses but still has a low overall vaccination rate, that is a sign of a supply problem, experts say: The country is not receiving an adequate number of doses to immunize its willing population. Those countries fall further to the right side of the below-average vaccination section of the chart.
If a country with a low vaccination rate is using a smaller share of the doses it has on hand, it suggests that demand in the country is weak, experts say, or that it lacks the infrastructure to distribute vaccines. Those are countries that fall further to the left.
“There may be varied reasons for low vaccine uptake,” said Dr. Amesh Adalja, an infectious disease specialist at the Johns Hopkins Center for Health Security. “The most obvious is just lack of doses, and that would be represented by those countries who use everything they get.”
Share of available doses used in least-vaccinated countries
Countries with vaccination rates below the global average rate are shown.
100 doses have been delivered per 100 people
Sources: Delivered-dose data from Airfinity; administered-dose data from Our World in Data. Note: Data as of Dec. 2, 2021, when the average global vaccination rate was 45 percent. Figures marked with an asterisk * were last reported more than two weeks ago. Countries that have not reported dose data in the past 30 days are not shown.
In the early days of the pandemic, when drug makers were just starting to develop vaccines, wealthier countries were able to pre-order enough to cover their populations several times over, while others had trouble securing any doses.
Now, experts say those early purchases have led to continued gaps in vaccination rates.
“In terms of equity, things are worse than six months ago as we see the disparities in vaccine purchases translate into disparities in vaccination coverage,” said Andrea Taylor, a researcher at Duke University who has studied the purchase agreements.
Wealthier countries’ head start on vaccination has kept them in the lead
Circles are sized by country population.
Sources: Vaccination data from local governments via Our World in Data; income classifications and gross domestic product data from the World Bank. Figures marked with an asterisk * were last reported more than two weeks ago.
Wealthier countries, including the United States, have donated more than 700 million doses to lower-income countries, according to UNICEF. Experts say the donations are crucial to improving vaccination rates around the world and slowing the evolution of the coronavirus and, in turn, new variants, which can cause outbreaks in even highly vaccinated populations.
“We are entering a third calendar year of Covid-driven cycles of lockdowns and reopenings, sparked largely by regular and predictable emergences of new variants,” said Benjamin Schreiber, the deputy chief of UNICEF’s global immunization program. “The longer the virus continues to spread unchecked, the higher the risk of more deadly or contagious variants emerging. Vaccine equity is not charity; it is an epidemiological necessity.”
What hesitancy looks like
Weak demand simply means that people in a given country who have good access to vaccines are not showing up to get vaccinated. Experts say the reasons people have for refusing the shot vary widely around the world.
“Each country and each community has its own issues and there is no one-size-fits-all approach,” Mr. Schreiber said.
For some, hesitancy is less about mistrust in vaccines than mistrust in their governments, said Kaveh Khoshnood, an epidemiologist at Yale University.
“There are countries around the world where the people just don’t trust their government,” he said, “because the governments lie sometimes, they are not transparent, they don’t really share information with the public at large.”
Others may be more skeptical about where their vaccines are coming from, such as those who have access only to vaccines from China, Dr. Khoshnood said. “The population might be somewhat hesitant or reluctant or not fully trust the Chinese vaccine, because they don’t feel like there’s enough information out there about the efficacy,” he said.
Turning doses into immunizations
It is also possible for a country to have strong demand and adequate supply “but struggle to deliver those doses to the population because of constraints on transportation, cold chain storage” and other logistical problems, said Bill Moss, the director of the International Vaccine Access Center at Johns Hopkins University.
In countries with large rural populations, the success of a vaccine rollout can come down to the number of people available to give shots. In other words, the “human infrastructure,” said Dr. Sheela Shenoi, an infectious disease specialist at Yale University.
“Similar to what we’ve experienced here in the U.S., any health care delivery system is going to be dependent on the numbers and types of skilled individuals to deliver services,” she said. “Even if there’s vaccine supply, if you don’t have the people to deliver that supply, it’s not going to succeed.”