Data insight

Vaccine equity needs a boost

A huge contrast between those boosting and those lacking first shots

Global challenges require global solutions. So the dictum goes. Yet, here we are: while the richer part of the world has made considerable progress with primary vaccinations and has started booster programs, the poorest countries still lack their first shots. This sheer inequality represents a huge risk – epidemiologically and socio-economically – for any and all of us. Vaccine equity needs a boost.

The chart above illustrates the contrast at its most extreme. 

  • We show primary vaccination progress in the dose space, where full population coverage is achieved when 200 jabs have been administered per 100 people (note that 1- and 3-dose protocols are converted into 2-dose equivalents). That’s the dark blue bar. Within it, we show booster coverage, measured as single shots (whatever the protocol) administered per 100 people. 
  • We compare the 5 countries where booster coverage is highest with the aggregate of low-income countries. Note the sheer contrast: booster coverage in several countries exceeds primary coverage of low-income countries by an enormous margin. 

This is of course an extreme comparison (even though we could have made it even more extreme by selecting individual low-income countries, some of which have vaccine coverage ratios that are close to 0). In what follows, we will make comparisons across country income groups following the World Bank’s income classification. The acronyms stand for high-income (HIC), upper-middle-income (UMIC), lower-middle-income (LMIC) and low-income (LIC) countries. Let’s start off and look at what matters arguably the most: primary vaccination

Primary vaccine coverage of the population

Comparing across the income classification, the chart below shows where we are.  Looking at primary vaccination progress, we see that HICs and also UMICs are doing the best. Coverage ratios for LMICs are lower and for LICs they’re still extremely low.

Averages mask the heterogeneity underneath. This is no different here. The chart below shows the primary vaccination coverage ratios by income group and country. The area of each bubble represents the population size of the country, so we get a feel for the dimension of the problem relative to the global scale. A few conclusions emerge from this comparison:

  • HICs and LICs are more homogeneous than UMICs and LICs, where the difference between HICs and LICs is that HICs are homogeneously rather well vaccinated whereas LICs are homogeneously very poorly vaccinated.
  • UMICs are a very heterogenous group and we can immediately see that the high group average for UMICs is entirely due to the large-sized green bubble at the top. This is China. The point is: China’s vaccination success masks a much slower progression among other UMICs.
  • A similar conclusion, although to a lesser degree, applies to the LMICs, where India – the large blue bubble – pulls up the average. Also here we see huge heterogeneity. 

Primary vaccine sufficiency of the priority group

An often-heard argument is that poorer countries have a generally younger age structure, which provides inherent protection against severe manifestations of the disease. We have addressed that claim in several other posts, including here, here and here, showing that unfortunately this demographic advantage has been largely offset in many developing countries by opposing factors.

For now let us just examine vaccination progress through the lens of the ability of countries to deploy vaccines to their priority groups given the doses that they have administered thus far to the total population (which serves as a proxy of the vaccine supply available). We thus examine the sufficiency of supply relative to the size of the priority group.

We define the priority group as consisting of the population 60+ and the group of health workers that is 60- (to avoid overlaps between the two). This is a restrictive definition but it helps global comparison given data availability issues when we start to broaden the priority group.

The chart below then shows where we are. The good news is that, except in the group of LICs, vaccines administered to the population have been sufficient to be able to cover their priority groups at the country level. We’re not saying they in fact have (data availability issues prevent us from making such global statements). But we can say that their vaccine supply, prima facie, appears to have been sufficient to be able to prioritize their priority groups (prima facie since actual vaccine supply may be larger as some may have gone to waste).

The insufficiency seen in LICs shows the extent of vaccine inequity. Remember that elderly groups make up only a small share of the population in LICs. Add to that the group of health workers and we still get a small share. But even so vaccines are insufficient to cover these groups.

The chart below examines the detail underneath the aggregates. Again we see that there are several countries which continue to face severe challenges to provide elementary protection to their most vulnerable groups. This is almost exclusively so in LICs, but there are also a few LMICs.

Boosters

Meanwhile, many countries have started to ramp up boosting. Boosters are defined as vaccine shots that are administered outside the primary vaccination cycle. This could be a second shot if the first one was a shot under a 1-dose protocol, such as CanSino or Johnson&Johnson. It could also be a fourth shot if the third shot was the last shot under a 3-dose protocol, such as Abdala. But usually it is a third shot following a 2-dose protocol such as Pfizer/BioNTech.

The chart below shows how HICs have rapidly ramped up boosting since August. UMICs are following, LMICs to a lesser extent and LICs to no extent.  The chart further below takes a snapshot that shows the country shares of those who have started boosting within each income group. 

Vaccine equity needs a boost

The suggestion here is not that the richer countries should stop boosting. Rather it is that vaccine equity itself needs a boost. The fact that vaccine supplies remain inadequate to cover critical priority groups in low-income countries is ignominious. And so is the overall extremely low vaccine coverage ratio in these countries. We need to do better as a global community and achieve a more equitable distribution of vaccines. This global challenge does require a truly global solution.