Mapping our unvaccinated world

If access to health care is considered a human right, who is considered human enough to have that right?

The world counts 2.5 billion unvaccinated people today. A whopping 90% live in the developing world and 71% in the poorer half of the world. This post tracks where the unvaccinated live across countries rich and poor and across geographical regions. As it turns out, the distribution is highly unequal and reflects the regressive nature of the global vaccination campaign.

Where on the map are the unvaccinated?

Where the unvaccinated live can be nicely illustrated with a cartogram. A cartogram distorts the geometry of countries with land mass conveying information about an alternate variable. Taking that variable to be the number of unvaccinated people, the visualizations below show which countries contribute the most to the global tally. 
 

Most of the unvaccinated live in the poorer half of the world

With land mass proportionate to the count of the unvaccinated, the cartogram below colors the countries of the world into the four groups of the World Bank income classification of countries. This divides the world into high, upper-middle, lower-middle and low income countries (HICs, UMICs, LMICs and LICs). The developing world consists of UMICs, LMICs and LICs – in other words, the world minus the group of HICs.

The visualization conveys a clear message: the vast majority of the unvaccinated live in the developing world. We see very little dark green in the visualization, which is the combined effect of two factors: (1) HICs as a group are far less populous than the developing world and (2) the group of HICs has made far more progress in vaccinating its population compared to the group of developing countries. 

Needless to say, the developing world is not only vast but also highly heterogeneous. 

  • UMICs – the richer developing countries depicted in light green – occupy a tiny part of the map despite their huge population size of 2.6 billion. This reflects their stellar vaccination progress, driven in large part by the strong performance of China. Notice what a small area this country occupies relative to its population size.  
  • LMICs and LICs – the poorer part of the developing world that makes up just over 50% of the global population – account for most of the unvaccinated. With 3.4 billion people living in LMICs (red) and 0.7 billion in LICs (orange), it is not surprising that LMICs occupy most of the land mass.  Note how big India is for example.

Sub-Saharan Africa and South Asia dominate the global tally, but their per capita shares are very different

Let us now reproduce the earlier cartogram but use the color scheme to denote “the unvaccinated share” as opposed to World Bank income groups. This share is expressed relative to the total population of each country and thus shows the percentage of people not yet vaccinated in that country. As a result, the cartogram combines the absolute with the relative perspective: land mass represents the absolute number of unvaccinated people and colors show the size of that number relative to the total population.

What stands out in the above visualization are the following two results:

  • In absolute terms, most of the unvaccinated in the world live in Sub-Saharan Africa and South Asia. Other regions are much smaller in comparison. See for example how Latin America and the Caribbean have almost disappeared from the map. 
  • In relative terms, there are important relative differences between the two main contributing regions. Relative to their population, South Asia comes out much better than Sub-Saharan Africa. The challenge of reaching the unvaccinated is much more intense in the latter region. 

How are the unvaccinated distributed across income groups and regions?

The cartograms give us a strong visual impression. In what follows, we provide the actual numbers of the unvaccinated across rich and poor countries (using the four income groups of the World Bank income classification) and across regions (using the seven regions of the World Bank’s regional classification).

The unvaccinated by World Bank income classification

The chart below shows the distribution by World Bank income group of the world population by vaccination status. It lists the number of people who are not yet vaccinated, have been vaccinated with at least 1 dose and have been fully vaccinated as per the primary vaccine protocol. Our interest is in the red bars, which show those who have yet to receive their first shot. 

The chart confirms the following:

  • Globally, 2.5 billion people are completely unvaccinated. This is the global tally as of today based on the latest information available. It represents the total number of people who have yet to receive their first shot.
  • Across income groups, we see large disparities that reflect the combined effects of population size and vaccination status. HICs represent 0.3 billion (10%), UMICs 0.5 billion (19%), LMICs 1.2 billion (49%), and LICs 0.5 billion (22%).  
  • The developing world accounts for 2.2 billion (90%). Note that the developing world is made up by UMICs, LMICs and LICs – in other words, all countries of the world except the rich ones or the HICs.
  • The poorer half of the world claims 1.8 billion (71%). Note that the poorer half of the world consist of the LMICs and LICs, which together represent just over 50% of the global population.

The unvaccinated by World Bank region

We can also check how the world population is distributed by vaccination status across World Bank regions. The World Bank’s regional classification divides the world into seven regions: East Asia & Pacific (EAP), Europe & Central Asia (ECA), Latin America & Caribbean (LAC), Middle East & North Africa (MNA), North America (NAM), South Asia (SAR) and Sub-Saharan Africa (SSA). The red bars in the chart below shows how the unvaccinated are distributed across these regions. 

The chart shows that:

  • Sub-Saharan Africa (SSA) and South Asia (SAR) dominate the global numbers. SSA currently has 0.9 billion unvaccinated people (35% of the global total). SAR has 0.5 billion (35%). SAR.
  • Other regions too make considerable contributions to the global total. Individually, they are much lower than the numbers we see in SSA but together they add up to a large number of unvaccinated people. 
  • SSA is the only region in the world that counts more unvaccinated than vaccinated people. This again illustrates the extremely low vaccine coverage of the region. 

Why is low vaccination in the poorer countries a problem?

The reasons why people are not vaccinated are complex and multiple. They may simply lack the opportunity. Supply-side constraints may inhibit them, such as for example limited access to global vaccine supplies or in-country logistical bottlenecks. Increasingly so, the reasons may include demand-side factors, relating to for example concerns about the efficacy of safety of vaccines or views about the severity of COVID. 

Note that while hesitancy plays a role almost everywhere, it does not offer a dominant explanation for low vaccination in the poorer countries. Keep also in mind that it is hard to distinguish demand and supply-side factor as they tend to interact with each other.  

  • For example, if a large part of society dismisses COVID as a threat or considers vaccines as lacking benefits, politicians and policymakers may be discouraged to address supply-side constraints. 
  • Consumer interest may be in turn affected by supply conditions. Think of cases where vaccines were delivered that were close to their expiry data. Similarly, limited take-up may be motivated by consumer selectivity if the vaccines available are of lower efficacy than the alternatives not presently available.

Whatever the underlying reasons – demand or supply – they should not be used to dismiss the fact that the inequality in vaccination that we continue to observe across countries reflects an outright ignominy. The fact that 90% of the unvaccinated population live in the developing world and 71% in the poorer half of the world illustrates the utterly regressive nature of the global vaccination campaign. 

There are two main reasons – a backward- and a forward-looking one – why this regressive outcome is problematic: 

  • Contrary to popular perception, developing countries have been dealt a very serious blow during this pandemic. As discussed here, estimates of cumulative excess mortality per capita are far higher for LMICs than for HICs and those of UMICs and LICs are remarkably similar to those of HICs. Moreover, pandemic mortality has exceeded the leading causes of death before the pandemic in most countries. 
  • The regressive nature of vaccination outcomes serves as a sobering reminder of what could happen in the future if a more dangerous variant were to emerge. The world has shown itself, thus far, to be incapable to quickly manufacture, distribute and administer vaccines at the global scale. These demonstrated weaknesses position us poorly with the respect to future downside contingencies.

Paul Farmer famously noted: “If access to health care is considered a human right, who is considered human enough to have that right?”.  His observation, unfortunately, remains highly relevant today.

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