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Does local 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: local vaccine manufacturing pays off.
We explore the evolution in total vaccine coverage ratio across countries. “Total” because we account for the 13.6 billion primary doses and the 2.8 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.
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.
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 local 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.
The main take-aways from the chart are as follows:
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 #7 worldwide, which is the result of being #5 on primary vaccine coverage and #18 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 local 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 countries engaged in local vaccine manufacturing 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 of local vaccine manufacturing 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).
The above charts seem to support the home bias advantage of local 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 local 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.
Disclaimer: Posts by the Center for Global Development reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions. Likewise, views expressed do not necessarily reflect those of the United Nations, the United Nations Development Programme, its programmes/projects or governments. The designations employed do not imply the expression of any opinion whatsoever concerning the legal status of any country, territory or area, or its frontiers or boundaries.
