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Monitoring the global equity of COVID-19 vaccines

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As of July 7, 2021, of the estimated 3.3 billion doses of COVID-19 vaccine administered globally, most have only been delivered to a small number of countries. For much of the world, especially those living in low- and middle-income countries, COVID-19 vaccines remain out of reach. While international efforts, such as COVAX and supplementary vaccine donations, aim to increase global access to vaccines, several estimates suggest that many countries may not achieve substantial immunization levels until at least 2023.

Building on and complementing existing efforts that track global vaccine access, such as Our World in Data, the Launch and Scale Speedometer, and Bloomberg’s Vaccine Tracker, we are examining several measures of global vaccine equity in order to ” assess where the biggest gaps are and whether they are narrowing or getting worse. More precisely, we group the countries by Income and by Region and look :

  • Share of total population that received at least one dose of vaccine
  • Rate of first doses of vaccine administered (using 7-day moving average per 1,000,000 population)

Based on the current rate of vaccine doses administered, we also estimate by how much the rate should increase to meet the global immunization coverage targets set by the World Health Organization, the World Trade Organization, the International Monetary Fund. and the World Bank: 40% coverage by the end of 2021 and 60% by mid-2022. We do this at the country level, and for countries by income group and regional classification.

As we see here, there are large disparities in access by income and region (especially when these overlap), with low income countries (LICs) in particular falling far behind, followed closely by Lower Middle Income Countries (LMICs) and Africa lags behind all other regions. If current rates continue, most low-income countries and most countries in Africa are not on track to meet global immunization targets.

COVID-19 vaccinations by country of income

There are large differences in the proportion of the population that received at least one dose of vaccine by country income, with LMICs lagging behind. As of July 7, while more than half of individuals (51%) had received at least one dose in high income countries (LICs), only 1% of the population in LICs, 14% in LMICs and 31% in upper middle-income countries (UMIC) received at least one dose (see Figure 1 and Figure 2).

Three countries (China, India and United States) account for the majority (57%) of all first doses administered worldwide. When removed, the difference between high-income and middle-income countries becomes even more marked, with high-income countries still well ahead of other income groups in terms of the proportion of the population receiving at least one dose (see Figure 3). See Table 1 for the full list of countries in each income group per share of population that received at least one dose.

Likewise, there is also a large gap in the rate of vaccine administration according to the country’s income. While the daily rate of first doses administered varies from country to country (see Figure 4), HICs administered the first doses at a rate nearly twice the rate in LMICs and LMICs, and nearly 30 times the rate in LICs. See Table 2 for a breakdown of the top countries in each income group by coverage and daily administration rates.

If current trends continue, these disparities are likely to widen and LICs are unlikely to meet immunization targets. Based on current immunization rates (using rates of first doses administered), HICs and UMICs are on track to have 40% or more of their populations having received at least one dose by the end of the year. year, while the LMICs would have to increase their rate by 1.03 times and the LICs would have to increase their daily rate by almost 19 times in order to achieve the same goal. HICs, UMICs and LMICs are on track to have 60% or more of their populations having received at least one dose by mid-2022, while LICs are expected to increase their daily rate by 14 times (see Figure 5). Some countries, mainly HICs, have already achieved some of these immunization targets.

COVID-19 vaccinations by region

As with country income, there are large differences in the share of the population that received at least one dose of vaccine between regions, with the highest coverage in Europe and the lowest in Africa. As of July 7, the region with the highest coverage is Europe (40%), followed by the Americas (39%) and the Western Pacific (37%); Africa has the lowest coverage (2%) (see Figure 6 and Figure 7).

Similar to income level, China, India and the United States are leading the trends in immunization coverage in their respective regions. For example, China accounts for 87% of the first doses administered in the Western Pacific, the United States 46% in the Americas and India 84% in Southeast Asia. By removing these countries, the differences between Europe and the Americas, the Western Pacific and Southeast Asia are greater (see Figure 8). See Table 3 for a breakdown of the top countries in each region by coverage and daily administration rates.

The rate of vaccine administration is highest in Europe and the Americas and lowest in Africa. While the rates of first doses administered vary by country (see Figure 9), Europe and the Americas currently have the highest rate of daily doses administered. These regions are vaccinating at a rate about 1.5 times that of Southeast Asia, almost 3 times that of the Eastern Mediterranean, 4 times that of the Western Pacific and more than 13 times that of the Africa. See Table 4 for a breakdown of the top countries in each region by coverage and daily administration rates.

These disparities are likely to increase depending on current trends in immunization. The Western Pacific, Europe, the Americas and Southeast Asia are all ahead of schedule to reach 40% by the end of 2021, while the Eastern Mediterranean is expected to increase its rate of first daily doses administered at nearly 1.6 times the current rate, and Africa at about 11 times the current rate. They are also ahead of schedule to reach 60% by mid-2022, while the Eastern Mediterranean is expected to increase its rate of first daily doses administered to about 1.4 times the current rate, and Africa to ‘about 8 times the current rate (see Figure 10). Some countries, mainly those in Europe, have already achieved some of these vaccination targets.

Implications

These findings highlight a persistent equity gap in access to COVID-19 vaccinations around the world, especially for those living in the poorest countries and countries in Africa. In addition, they suggest that if current rates continue, some of these disparities could widen and many low-income countries will not meet the global goals of immunizing 40% of each country’s population by the end. 2021 and 60% by mid-2022. Increasing vaccine supplies and accelerating the pace of immunizations in the backward countries can narrow the equity gap and help all countries meet COVID-19 vaccine coverage goals.

Vaccination data: We used country-level immunization data on doses delivered, provided by Our World in Data (OWID), to assess global immunization trends at the income and regional levels. Totals for some entities have been combined (Taiwan, Hong Kong and Macao included as part of China, and Jersey and Guernsey have been combined and reported as the Channel Islands). When missing data in the daily doses provided existed between two dates for a country, we estimated the number of doses administered each day between the two reported dates assuming a linear distribution. For those countries that stopped reporting, we assumed there was no change in the new doses administered. For countries that report total doses administered but not the proportion of the population that received at least one dose, we use the methodology suggested by OWID and calculated a lower bound estimate. Therefore, our estimates are conservative and the actual share of the population receiving a dose is likely higher. For data on the daily administration of the first doses, we calculated the 7-day moving average of the daily change in the number of people who received at least one dose. To project the increase in the rate necessary for the groups to reach certain benchmarks (40% by the end of 2021 and 60% by July 1, 2022), we calculated the rate necessary to reach these benchmarks for each group, in based on the number of first doses already administered and population and calculated the percentage change between the current daily rate of first doses administered and the increased rate necessary to achieve these goals. Finally, for all data, in order to take into account any delay in reporting countries, we use data up to one week before (July 7, 2021).

Demographic data : Demographic data was obtained from the United Nations World Population Prospects using 2020 estimates for the total population (and the CIA World Factbook for Serbia and Kosovo). The totals of some entities have been combined (Taiwan, Hong Kong and Macao included as part of China), while others have been separated (separating Kosovo from Serbia).

Income data: Income classifications were obtained using data from the World Bank. Entities without an income classification were excluded from the income level analysis.

Regional data: The classifications of the regions were obtained using data from the World Health Organization. Features without regional classification were excluded from the analysis at the regional level.


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