Vaccination of priority groups

This chart provides a global snapshot of vaccination progress across countries and by World Bank income classification. It measures whether the vaccines administered are sufficient to be able to cover priority groups , which is a key element in the analysis of vaccine equity.  The priority group in this context refers to medical professionals and people aged 60+.  An equitable allocation on the basis of the need to protect this vulnerable priority group would occur when all countries can administer sufficient vaccines to protect the priority group.  In that case , the chart would like look a blue donut, with no gaps across or within countries.

Extensive and intensive margins

The chart distinguishes between the extensive and intensive margins of vaccination progress. The extensive margin captures the extent to which countries are participating in vaccination efforts. This can be observed in the circular progress bar, which shows the share of countries, by income group, that report nonzero vaccination data.  The visualization also colors the country codes of countries in the outer circle according to whether positive vaccination data is being reported (blue means yes; grey means no). 

The intensive margin measures vaccination progress within countries. The outward-oriented bars capture their efforts to raise the coverage ratio all the way to 200%  (on the vertical axis). The data are censored at this level to indicate that the country has administered enough vaccines to be able to cover the priority group population as defined in this setting.

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.

Ability to cover

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. 

The data does not measure actual vaccination of the priority group, which is currently impossible to consistently assess at the global level given data gaps. Instead, it describes on the basis of the size of the priority group and the number of doses administered the extent to which the priority group could have been covered through the vaccination efforts up through the latest available data point.

This assumption relies on governments acting as “benevolent social planners” interested to vaccinate their most vulnerable groups first. It also requires common agreement about who the most vulnerable groups are. In the context of this chart, it furthermore requires that the vulnerable group concept adopted coincides with the definition of the priority group of medical professionals under 60 and the entire 60+ population. In sum, there are  plenty of reasons why actual coverage of priority populations may differ.

Vaccine protocols

An additional complication pertains to the treatment of doses. 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 vaccination coverage in terms of single doses at full dosage as per the treatment protocol and 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.

Since the analysis here focuses on the ability to fully vaccinate the priority group (which, again, requires 200% coverage), the real-world distinction between people fully or partly vaccinated makes no difference. The thought experiment here indeed abstracts from real-world possibilities where, for example, preference is given to partly vaccinating the full population as opposed to fully vaccinating the priority segment. In this thought experiment, the priority group gets full priority and no one receives a single shot until this group is fully vaccinated under the existing protocols of whatever vaccine is being administered.

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).

Finally, note that for visualization purposes we censor the priority group coverage ratio at 200%. Given the double-dose equivalence transformation, this is when the country achieves universal coverage of the priority group population.  Since the coverage ratio is censored at 200%,  the area can be entirely blue with several countries exceeding the the maximum coverage ratio by several multiples. This may be the case for example where the elderly population represents a small share in the total population. For the purpose of this analysis, however, we abstract from such considerations. There are obviously many more dimensions to vaccine equity than the ones examined here. 

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.