Find out how rich countries came to the forefront of the vaccine line

More than three-quarters of the more than half a billion doses of vaccine that have been administered so far have been used by the richest countries in the world. The reason, experts say, lies in how – and when – the dose agreements were reached.

At the start of the pandemic, when drug makers were just starting to develop vaccines, placing orders for any was a risk. Wealthier countries could mitigate that risk by placing orders for multiple vaccines and in doing so blocking doses that smaller countries would otherwise have purchased, experts say.

As a result, most high-income countries were able to pre-order enough vaccines to cover their populations multiple times, while others struggled to obtain doses. Throughout 2020, even middle-income countries struggled to win contracts.

“We’ve seen it with countries like Peru and Mexico,” said Andrea Taylor, a researcher at Duke University who studies vaccine purchase agreements. “Money was not the problem for them. They have the funding to do the shopping, but they couldn’t get to the front row. ”

Low-income countries made their first major vaccine purchase agreements in January 2021 – eight months after the United States and the United Kingdom reached their first agreements, according to data compiled by Unicef.

The result was that as of March 30, 86% of gunshots worldwide had been administered in high-income and upper-middle-income countries. Only 0.1 percent of the doses were given in low-income countries.

“Inequality is growing, unfortunately,” Ms. Taylor said, “and we expect that to be the case for at least the next six months, as rich countries continue to roll the majority of doses off the chains. production.”

Covax, a global effort to distribute vaccines equally, run by the World Health Organization and others, has tried to alleviate some of the imbalances. Its main goal is to provide vaccines to 92 low-income countries, through its program called Advanced Market Commitment, or AMC. These vaccines are paid for with cash donations from governments and organizations; the United States gave $ 2.5 billion, for example, and Germany, $ 1.1 billion.

For countries that can afford to buy their own vaccines, Covax has also offered a way to buy doses without jumping in the queue, acting as an intermediary between these countries and pharmaceutical companies. As an incentive, Covax pre-negotiated deals that any of its member countries could use, leveraging its ability to place larger orders earlier in the pandemic. In turn, countries that purchased vaccines under these agreements would wait their turn and receive their doses as early as possible in low-income countries.

As of March 30, Covax had shipped 32.9 million doses of the vaccine to 70 countries and regions. Most of these shipments were donations to low income countries. To put this number in context, this is only 6% of the 564 million doses administered worldwide.

The World Health Organization expects the supply to increase, however. According to a budget released this month, the organization said Covax was “on track to meet its goal of delivering at least two billion doses of vaccine by 2021.” And 1.3 billion of those doses, according to the budget, would be donations to low-income countries.

But even with this influx, poor countries can end up waiting years before their populations can be fully immunized. Kenya, for example, expects that by 2023, only 30% of its population will be vaccinated, and it is with Covax that covers the first 20 percent. This long wait would give the virus more time to spread and potentially give rise to new mutations.

The global dose race has also affected which countries receive which vaccines. With much of the Pfizer and Moderna vaccine supply already in demand by richer countries, China, India and Russia have emerged as major suppliers of vaccines to low-income countries. And some experts believe these governments can use such relationships to gain traction.

“Giving other nations access to vaccines is a powerful tool that can wield tremendous influence,” said Dania Thafer, executive director of the Gulf International Forum, a Washington-based think tank.

The Oxford-AstraZeneca vaccine has become ubiquitous: at least 94 countries with varying incomes have administered doses. Its lower price and relatively easy storage have positioned it as a crucial part of the global immunization effort, but it has recently suffered a series of setbacks.

A study found that the Oxford-AstraZeneca vaccine showed relatively low efficacy in preventing mild and moderate cases of the most contagious variant dominant in South Africa, leading the South African government to suspend its deployment.

Some European countries suspended use of the Oxford-AstraZeneca vaccine in mid-March over fears that it could increase the risk of blood clots. A review by the European Medicines Agency later found the vaccine to be “safe and effective” with no overall increased risk of clots, but confusion caused public confidence in the vaccine to plummet.

India has cracked down on exports of the vaccine made at the Serum Institute of India, one of the world’s largest vaccine producers, as the country battles its own worsening epidemic. Many low-income countries depend on exports from the Serum Institute, including Nepal, which has already halted its vaccination campaign due to shortages.

In a joint statement released Tuesday, more than two dozen heads of government and international agencies called for “a new international treaty for pandemic preparedness and response.” They stressed the importance of a coordinated approach to future pandemics, including vaccination efforts.

“Immunization is a global public good, and we will need to be able to develop, manufacture and deploy vaccines as quickly as possible,” the statement said.