Domestic vaccine manufacturing pays off

Countries that manufacture COVID-19 vaccines tend to outperform their peers on vaccine coverage

Does domestic vaccine manufacturing help boost vaccine coverage? This post compares the evolution of vaccine coverage in nations that manufacture and export COVID-19 vaccines. Focusing on six of them (China, Cuba, India, Russia, United Kingdom and United States), it compares their performance over the course of the pandemic with that of non-manufacturing peers. As it turns out, there is a home bias advantage among most vaccine manufacturers: domestic vaccine manufacturing pays off. 

Don't compare apples and oranges

We explore the evolution in total vaccine coverage ratio across countries.  “Total” because we account for the 12.7 billion primary doses and the 2.5 billion boosters that have been administered to date. The total vaccine coverage ratio adds primary and booster doses and expresses this sum as a ratio to population. 

But to make such comparisons across countries accurately, there are two issues that we need to take into account: the variety of vaccine protocols and the diversity in the development level of countries. 

Variety of vaccine protocols

The global vaccine landscape includes vaccines that require the administration of 1, 2 and 3 doses to complete the primary protocol. If we do not make any adjustment when calculating the total doses administered, progress in countries that rely mainly on 3-dose vaccines (such as Cuba) is easily overestimated. Conversely, for those countries relying disproportionately on 1-dose vaccines, progress is easily underestimated. 

To fix this, we bring all primary shots on a level playing field by converting them into double-dose equivalents. That amounts to multiplying shots of 1-dose vaccines by 2 and shots of 3-dose vaccines by 2/3. As a result, primary vaccine coverage reaches a maximum of 200 adjusted primary shots per 100 people, irrespective of the particulars of the vaccine mix a country uses. 

Diversity of country development levels

We will be looking at the performance of six COVID-19 vaccine manufacturing nations: China, Cuba, India, Russia, United Kingdom and United States. The selection is motivated by the fact that these manufacturers not only produce vaccines for the domestic market but also export them overseas. Our interest is to figure out whether the orientation of such manufacturers to the home markets has helped the progress made on the domestic vaccination front. 

The six countries differ in so many dimensions, including their overall level of development. When making comparisons across countries, it makes sense to compare performance relative to peers of similar development as this will help control for a number of variables relating to production, allocation, affordability and deployment. We will do so by using the World Bank income classification, which divides the world into high, upper-middle, lower-middle and low income countries (HIC, UMIC, LMIC and LIC). 

The home bias advantage in vaccination

In the chart below, we plot the total vaccine coverage ratio against time and we facet the chart by World Bank income group. Within each panel, we compare the selected manufacturers with their peers, where we show a population-weighted average for all non-manufacturers within that income group. The group of low income countries, unfortunately, does not include a major vaccine manufacturer, so we just represent the low income group as such: the population-weighted average of all low income countries. 

The main take-aways from the chart are as follows:

  • All major vaccine manufacturers except Russia have enjoyed a home bias advantage at some point over the course of the pandemic. This result can be seen by comparing the colored lines with the dashed ones, which capture the progress in the income aggregates without the manufacturers. Russia appears to have been the exception here as its vaccine coverage ratio is persistently below that of the group of the other UMICs (as well as that of the group of HICs, to which Russia belonged from July 2014 through July 2016). 
  • The home bias advantage in the UK and the US took the form of an earlier start. Both countries performed vastly better than their high income peers up until the summer of 2021. After that, the group of other HICs caught up and performed in line with the UK. The US however started to lag, reflecting the increasing weight of limiting demand-side factors. 
  • Cuba, China and India maintained a consistent advantage throughout the entire pandemic period. Unlike Cuba, China and India had an early start. Soon, however, Cuba managed to dramatically accelerate vaccine coverage. As of today, Cuba is the most vaccinated country among its peers as well as the #3 worldwide, which is the result of being #2 on primary vaccine coverage and #12 on booster coverage (see here for more details on the Cuban vaccine landscape).

For further granularity, we can unpack the peer groups into individual countries. The chart below shows how the selected vaccine manufacturing countries compare with the full range of countries within their peer group (these are represented by the light gray lines).

The chart shows the same result as before: the selected manufacturers did indeed perform better than “most” peers over some part of the pandemic period (with exception again of Russia). But now we have additional insights about the dispersion of non-manufacturing countries around the earlier group average. 

This shows us that the result of the home bias advantage is not absolute. There are several and, indeed, many other non-manufacturing countries within each peer group that are doing better, even though the previous result shows that this is not true on a population-weighted basis. The exception here, again, is Cuba, which performs as the absolute best among its UMIC peers and is surpassed by only few countries worldwide. 

The patterns of vaccine coverage are of course explained by many variables other than whether a country manufactures. The control by income group is but a rudimentary way to account for them as there are important variations within income groups that are not explained across. A key element here are the various factors that drive hesitancy in vaccine uptake, which is credited to explain the low vaccine coverage rates in Russia (see here and here) but also the United States (see here).

In conclusion

The above charts seem to support the home bias advantage of domestic vaccine manufacturing. The example of Russia and also later the US however shows that being a major vaccine manufacturer is no guarantee for high up-take eventually. Other factors are clearly at work, such as hesitancy on the demand side. Yet, the examples shown here, including those of China, Cuba and India among developing countries, show that a domestic manufacturing base can lead to much better vaccination outcomes than observed in peers. 

That is an important conclusion in light of the regressive nature of the global vaccination campaign. Having more decentralized nodes of vaccine production does contribute to the more rapid distribution and administration of vaccine doses, which – all else equal – may result in higher and/or faster vaccine up-take. Of course, all else is not equal and countries need to get other ducks in a row. But it is a good start.

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