In Which Country Is Vaccination How Effective?
In Which Country Is Vaccination How Effective?

In Which Country Is Vaccination How Effective?

We show the follow-up of the COVID-19 vaccine application and its stage worldwide.

Eight weeks after the first coronavirus vaccination campaigns began, many people – especially those living in low- and middle-income countries – are still wondering when it is their turn to get vaccinated and which vaccine they will get. Based on government websites and vaccine manufacturers’ statements, publications or contracts and major local or international news media, Think Global Health has gathered this information. Below is a table with detailed information and links to these resources as of 18 February 2021 and will be updated regularly.

The vaccine that governments can provide and administer – is a factor of influence for the states financing the development of that vaccine. Starting with smallpox in the early nineteenth century, governments in other countries used vaccine donation and vaccination campaigns to build goodwill, increase the productivity of their colonies, ensure the safety of citizens overseas, and increase human benefits.

Scientific collaboration on vaccines during the Cold War unified even the most hostile states, ushering in the “golden age” of vaccine science diplomacy.

Since then, vaccines have been branded as a way to achieve global equality, and global health diplomacy has focused on providing universal or equal access to these tools for low- and middle-income countries, such as the universal polio eradication campaign. However, in the COVID-19 outbreak, the richest countries did not raise the poor, and vaccine diplomacy has become a way to strengthen their sphere of influence rather than advance global health equity.

It is well reported that many wealthy nations are taking a “first-first” approach to obtaining and distributing safe and effective vaccines proven in the COVID-19 pandemic, and the data show the resulting unfair access. About four out of five high-income countries started vaccinations, but only two of 29 low-income countries – Guinea and Rwanda – received vaccinations. Guinea used 55 doses of Sputnik V vaccine from the Gamaleya Research Institute, and Rwanda began making “limited quantities” of Moderna vaccine available through an undisclosed international partnership.

Eighty-two percent of countries that administer the vaccine are classified as high-income or upper-middle-income countries, according to the World Bank. Experts worry that this approach, known as vaccine nationalism, will deprive many middle- and low-income countries from widespread access to vaccines by 2022 and even 2023, prolonging the pandemic and potentially causing global economic losses of up to $ 9.2 trillion.

‘Starting with smallpox, governments have used vaccine donation and vaccination campaigns to generate goodwill in other nations’

Income groups are based on World Bank classifications. Chart: Priyanka Sethy

Middle-income countries that do not have access to proven vaccines and do not want to expect wealthy nations to donate them, III. It is moving from phase trials to “unproven” vaccines that have not completed or published data. Argentina, for example, introduced the Gamaleya vaccine on December 29, 2020 – exactly one month before Sputnik V’s safety and efficacy data were published in The Lancet this week. Additionally, China has yet to publish trial data for any vaccine (CanSino, Sinopharm, and Sinovac) currently being applied globally. When these data were collected, 25 percent of all middle-income countries currently administering the vaccine were using Sputnik V, while 34 percent were using at least one of the Chinese vaccines. No low-income or low-middle-income countries were using the Pfizer / BioNTech vaccine, but 88 percent of high-income countries that used the vaccine did.

Vaccines Currently Administered in Countries by Income Level

Income groups are based on World Bank classifications. Countries can administer more than one vaccine, so the percentages above reflect vaccines relative to each other by income group and do not represent the total percent of countries in that income group administering a given vaccine.

Looking at a global map of which vaccines are currently applied where and how, it is clear that the impact of the vaccine has declined diplomatically as well as economically.

This map only reflects campaigns of approved vaccines within a country. It does not include vaccine trials, individual vaccinations within a country (such as a political leader or high-profile person), or vaccinations of foreign military or government personnel. Map: CFR/Samantha Kiernan Sources: Regional and international news outlets and national governments

In Europe, the EU’s promises of assistance to the Balkan countries and access to EU vaccines forced Eastern European countries to wait or turn to Russian or Chinese options; many chose the latter. In Latin America, the region is split between Western (i.e. Pfizer / BioNTech), Russia and Chinese vaccines. In particular, all but one of the seven Caribbean island countries that have launched vaccination campaigns are now dependent on Indian donations.

In Asia and the Pacific, donations trigger vaccination efforts. Producing their own vaccines, China and India donated vaccines to Brunei, Cambodia, Laos, Myanmar and Pakistan respectively, and to Afghanistan, Bangladesh, Bhutan, Nepal, Samoa and Seychelles. A handful of Pacific Island countries have also started vaccination, such as the Moderna vaccine, which has access to vaccine doses through the United States. Relative COVID-19 success stories such as Australia, Japan, New Zealand, South Korea only received vaccines and some still haven’t started vaccination campaigns. While many Pacific Island countries depend entirely on COVAX or neighboring states for access, Taiwan is still waiting for vaccination.

“Equal access to vaccines globally depends on the success of COVAX”

Tragically, only ten African countries have started to introduce vaccines in Africa. Three of these are island countries in North Africa and two in the Indian Ocean. More than half of the African countries that launched vaccination campaigns received their doses through donations from China and / or India.

Perhaps the clearest message from this global vaccine access map, now and projected at the end of 2021, is that global equitable access to vaccines depends on COVAX’s success. COVAX announced distribution estimates on February 3 [PDF] and provided vaccine access to 75 countries that have not yet supplied vaccines through bilateral or regional programs such as the African Union.

Another important takeaway, the vaccine from Oxford and AstraZeneca, which bears its own brand as “a vaccine for the world”, seems to fulfill its promise. More than half of low-middle-income countries that are starting the vaccine are using the AstraZeneca vaccine. Between COVAX, regional purchasing regulations and bilateral agreements, a total of 178 countries are expected to reach AstraZeneca by the end of 2021.

Several factors contribute to the global popularity of the AstraZeneca vaccine, from its lower price point to its easier storage, but the Serum Institute of India’s license agreement to manufacture and distribute the vaccine is arguably one of the most important. Most low- and middle-income countries with access to AstraZeneca are set to receive doses produced by the Serum Institute of India, not by European manufacturers. This voluntary license agreement is particularly important as the EU is trying to prevent AstraZeneca’s exports from Europe. However, the global launch of AstraZeneca, especially in Sub-Saharan Africa, may slow with recent evidence that SARS-CoV-2 is less effective against the South African variant; South Africa has already canceled the AstraZeneca campaign and Eswatini has said it will not use the vaccine.

“More than half of low-middle-income countries that are starting to use the vaccine are using AstraZeneca vaccine”

Much of Africa and most of southern Asia are currently unable to access the Pfizer / BioNTech vaccine, the other vaccine COVAX plans to distribute in the first half of 2021. Sanofi, a French manufacturer, has agreed to help manufacture Pfizer / BioNTech’s vaccine, but it is unclear whether this will expand access to low- and middle-income countries.

Vaccine sponsors, such as Pfizer / BioNTech and AstraZeneca, who published phase III clinical trial data on safety and efficacy at the end of last year, currently have more global reach in phase III trials such as CanSino or trial data than vaccines set out below. Like Johnson & Johnson or Gamaleya it was only recently disclosed. The exception to this rule is Moderna, where access is limited by its high prices.

Relatively few countries have made deals to purchase Russian and Chinese vaccines, with few exceptions in Latin America, the greater Middle East, and Asia. As more clinical trial data on Russian or Chinese vaccines are published and independently verified, more countries may turn to these non-Western options. However, concerns about Sinopharm’s and Sinovac’s effectiveness could push countries to Sputnik V of the Gamaleya Institute, especially if EU vaccine export restrictions remain in place.

This tracker will be updated regularly. See the table below for detailed information on country specific vaccination agreements and vaccination campaigns.