Vaccine inequity is the ignominy of our times

Vaccine inequity is the ignominy of our times. Over the last year over 9 billion jabs have been administered. But the distribution of these doses has been blatantly regressive: the poorest countries have benefited the least.

This glaring inequity is visualized here by connecting four different variables:

• Extreme poverty rate (X-axis):  the share of the population living on less than $1.90 a day at 2011 international prices
• Average income (bubble color): the country’s per capita income level (high, upper-middle, lower-middle or low income) as per the World Bank income classification, which approximates the level of development of nations
• Population size (bubble area): the total  population (i.e. including children) in millions.

• Full vaccination rate against COVID-19 (Y-axis): the share of people who have completed a vaccination cycle as per the underlying protocol (1 shot as in CanSino and J&J, 3 shots as in Abdala and ZF2001, and 2 shots for most other vaccines). Boosters are not considered here.

The following results are striking:

• Despite the considerable progress in reducing extreme poverty, extreme poverty remains a pressing problem in so many countries in this world. This includes many large countries. As of 2017 – the last reference year for which we have globally comprehensive information –  the world counted just under 700 million extremely poor people.
• Among countries that have all but eliminated extreme poverty, there is a huge variation in full vaccination rates (check the wide range along the Y-axis among the vertically stacked countries at the 0% value for the X-axis).  Among them, the top observations for full vaccination are almost all data points for the high-income countries. China, which is an upper-middle-income  country, is a notable exception.

• Conversely, and this is the point of this visualization, among the countries that have nonzero extreme poverty rates, virtually all of them have very low vaccination rates. This includes most lower-middle-income and all low-income countries. Notice how again some of these countries are very large – the largest one of course being India.

Global vaccination has been highly regressive. The extremely poor are also extremely poorly vaccinated. The huge inequality we currently observe is an inequity that may eventually backfire epidemiologically, socially and economically. The regressive pattern of vaccination enhances the risk of the development of more dangerous variants and by doing that it risks exacerbating the direct and indirect effects of the health emergency on social and economic outcomes either through domestic or cross-border channels.