The Global Vaccination Effort Is Still Undercut by Deep Inequalities

A drive-in vaccination site in New Delhi, India. Photo: Hindustan Times via Getty Images

The pandemic is receding in the United States, where, on Sunday, fewer than 10,000 Americans tested positive for the coronavirus — the first time the four-figure mark has been breached since March 22 of 2020. With half of the U.S. population having received at least one vaccine dose, most states are planning a full reopening within the next month. “Every day, the light at the end of that tunnel is growing brighter,” President Joe Biden said earlier this month about the success of the American vaccination effort.

Unfortunately, that success has not been universal. When doses first began to be delivered en masse, at the beginning of the year, to countries like the United States, the United Kingdom, and the United Arab Emirates, vaccine disparities between the developing world and wealthier nations are still the dominant story of the global effort to halt the virus’s spread. While a handful of well-off nations have reached the 50 percent vaccination mark, at least 41 countries have yet to provide at least one dose to 2 percent of their population, according to New York Times data from May 29. The worst-off of the nations reporting vaccine numbers is the Central African Republic: With a population of close to 5 million, just 667 doses have been administered. According to the Guardian, as of May 30, only one percent of the 1.3 billion shots administered around the world have been in Africa, though the continent represents close to 17 percent of the world’s population.

The reason for such a profound inequality largely breaks down to two factors: rich nations stockpiling vaccines and the difficulties developing nations have faced in distributing them, challenges that are rooted in public-health inequities dating back to the colonial era. Since the beginning of the pandemic, wealthy nations have purchased vaccines and vaccine materials to provide shots within their own borders, leaving poorer governments last in line to sign contracts with vaccine-producing firms. As of March, the United States had bought 1.3 billion doses, enough to fully vaccinate more than three times its adult population. In the U.S., there were several reasons for the purchasing spree, which some public-health experts have described as hoarding. Before vaccines had been produced or approved, the Trump administration purchased hundreds of millions of doses as part of an effort to encourage a speedy development. President Biden added to that number by several hundred million in order to ensure that there would be no kinks in the supply chain and to insure against COVID-19 variants that have caused new waves of infection in the United Kingdom, India, and Brazil.

Since facing intense criticism over acts of vaccine nationalism, countries with large vaccine stocks have made several efforts to donate shots where they are needed. On May 17, President Biden announced that by the end of June, the United States will donate a total of 80 million doses throughout the world; 60 million of those are Astra-Zeneca shots that have not yet been approved for emergency use by the FDA, while the reminder will be a mix of the Pfizer, Moderna, and Johnson & Johnson shots. (Last month, the U.S. also sent PPE and materials to make vaccines to India amid the record-setting surge in cases on the subcontinent.) Though the Kaiser Family Foundation estimates that 80 million shots is three times larger than the number of doses pledged by France, the second-largest donor, the scale of the global vaccination effort renders it inadequate. More concerning still are the failures of COVAX — the effort involving 165 member countries to distribute vaccines throughout the developing world. The program, dependent on supplies from the pharmaceutical giant of India, aimed to distribute 2 billion doses by the end of the year. But due to the surge that infected hundreds of thousands of Indians on a daily basis last month, the program was only able to hit a quarter of its April goal of 235 million doses. It has adjusted its 2021 target to around a third of the original.

COVAX’s challenges are a microcosm of the threat to nations with high vaccination levels, revealing how regional outbreaks can threaten supply and increase the likelihood of more dangerous variants developing — leading to a feedback loop undercutting the effort to control the virus. As President Biden put it earlier this month: “We know America will never be fully safe until the pandemic that’s raging globally is under control. No ocean’s wide enough, no wall is high enough to keep us safe.” No economic recovery is safe either. Earlier this month, the U.N. released its annual “World Economic Situation and Prospects” report, warning that low rates of vaccination threaten the bounce back from the last year of stagnation and unemployment. “Timely and universal access to COVID-19 vaccinations will mean the difference between ending the pandemic promptly and placing the world economy on the trajectory of a resilient recovery, or losing many more years of growth, development and opportunities,” the report read.

And as vaccine inequality emerges in India — where class divides and language barriers restrict who is able to sign up for a shot — new data from the United States reveals that the pandemic is still raging among unvaccinated Americans. According to an analysis by the Washington Post, hospitalizations among the unvaccinated population are as high as they were in February, while the rate of COVID-19 deaths is as high as it was in March.

Global Vaccination Effort Still Marred by Deep Inequalities