Description

Building on the concept of “revealed comparative advantage” (RCA) in trade analysis, this chart defines “revealed vaccine inequity” (RVI) as discrepancies with respect to the ratio of the group share in global vaccines to the group share in the global priority population. It shows the evolution of RVI over time. 

The global priority population is defined to consist of all people aged 60+ as well as medical workers (specifically physicians, nurses and midwives on the basis of the WHO’s Health Workforce Accounts) who are under 60 (to avoid double counting). Various refinements are possible to include those with pre-existing conditions.

High-income countries account for about 29% of the global priority group as shown here.  If the RVI ratio is 2, that means that the share of high-income countries in global vaccine dosages administered would be double their share in the global priority group. 

The global vaccination campaign is still at an early stage. Even so, this indicator measures, as we go along, the extent of unevenness in vaccination trajectories. HICs have managed to make an early start and are well ahead of the other income groups.  As mentioned in several other parts of this site, developing countries are younger than HICs but their elderly (and therefore priority group) populations are much larger in the absolute.  As the chart shows, the supply of vaccines does not correspond to the needs of developing countries. 

Technical details

Priority group

Definitions of priority groups vary across countries. To arrive at a globally consistent concept, the tracker includes all people aged 60+ as well as medical workers (specifically physicians, nurses and midwives on the basis of the WHO’s Health Workforce Accounts) who are under 60 (to avoid double counting). Various refinements are possible to include those with pre-existing conditions.

We use the World Development Indicator data set of the World Bank on Health, Nutrition and Population Statistics to retrieve global information on physicians, nurses and midwives and filter out the latest observation. The WHO’s Health Workforce Accounts are then used to calculate the share that is younger than 60 (to avoid overlap with the 60+ population, which is separately included). 

A number of adjustments are made to deal with data gaps. In cases where information is missing on the 55-64 or 65+ buckets, we apply the share of that age cohort observed in peer groups. For this purpose, we calculate the median share by income classification and apply that to the missing values.  Finally, since the Health Workforce Accounts do not provide more granular data of the 55-64 age cohort, we divide this cohort into 2 to get an estimate of the 60- group within this cohort. 

More refined estimates of the health workforce will undoubtedly be available at the country level. In the interest of building a global dataset we rely however on this method which has the advantage of imposing transparent assumptions on all countries in an equal way.

Distribution of vaccine doses

The distribution of vaccine doses across countries is described on the basis of data on the actual doses administered. The reasons why the numbers may be low can vary widely and include international vs domestic factors as well as supply versus demand factors.  At this moment in time, however, the most likely reason for low numbers is related to international supply bottlenecks. 

An additional complication pertains to the differences in treatment protocols across vaccines. The vaccine landscape is diverse with different treatment protocols in terms of the number doses that need to be administered, the dosage of each dose and the length of time between them. Vaccines differ in terms of their efficacy and deviations from the prescribed protocol dilute efficacy in uncertain ways.  This matters as countries consider to speed up vaccination by e.g. changing, reducing or delaying doses.

The approach taken here in the face of this diversity of possibilities is to express vaccines in double-dose equivalents. We convert all vaccines to a common denominator of the double-dose protocol. This means that for the purpose of considering whether someone has achieved full vaccination we require that two doses have been administered.

Double-dose equivalence is imposed on single-dose vaccines by simply multiplying the number of single-doses administered by two. In this way, when adding up single doses of single-dose protocols and single doses of double-dose protocols, we can keep the threshold of 200% vaccine coverage as indicating full coverage (shown in other charts).

As of early March 2021, this adjustment makes virtually no difference as there is only 1 country (South Africa) in the universe of countries considered here that is administering a vaccine that has a single-dose protocol (Johnson&Johnson).

Universe of countries

The FY2021 World Bank income classification lists a total of 218 countries/economies, where the term country, used interchangeably with economy, does not imply political independence but refers to any territory for which authorities report separate social or economic statistics. This lists includes a number of territories and dependencies with populations above 30,000 people, as per the World Development Indicators database.

We narrow this list down to 196 countries/economies by retaining only the member states of the UN, one non-member state with observer status (the State of Palestine listed as West Bank and Gaza in the income classification) and two members/observers in UN Specialized Agencies  (Kosovo and Chinese Taipei listed as Taiwan, China in the income classification). The Holy See, Cook Islands and Niue are excluded as they are not included in the WB income classification.  A further 22 territories and dependencies (21 HIC and 1 UMIC) are excluded from the WB income classification because they are not identified as members or observers of the UN and UN specialized agencies.

Note that the vaccination data is pulled from Our World in Data, which utilizes a slightly different universe of locations. In sticking with the above 196 countries and economies, we have made the following adjustments relative to the OWID universe:

  • Given their UN membership status, we extract the following UN members from US totals and list them separately:
    • Federated States of Micronesia;
    • Marshall Islands;
    • Republic of Palau.
  • Conversely, given that they are not identified as separate members of the UN or UN specialized agencies, we do not separately mention the following entities but instead include their data into the totals of the country they are a territory or dependency of:
    • Hong Kong SAR and Macao SAR are added to China totals;
    • Faroe Islands and Greenland are added to Denmark totals;
    • Curaçao are added to the totals of The Netherlands;
    • Data for Anguilla, Bermuda, Cayman Islands, Falkland Islands, Gibraltar, Guernsey, Isle of Man, Jersey, Montserrat, Saint Helena and Turks and Caicos are add to the totals of the United Kingdom.