Redressing Vaccine Inequity Will Accelerate Pandemic Recovery

Obstacles in Progressing Vaccination Coverage Are Deepening Inequalities for Vulnerable Populations

By Babatunde Abidoye - Global Policy Adviser, Ludo Bok - Manager SDGs and UNAIDS, Mandeep Dhaliwal- Director: HIV, Health and Development, Andrey Krachkov - Data Futures Platform Analyst, Teresa Martens - Data Futures Platform Analyst, Edvard Orlic - Data Futures Platform Analyst, Laurel Patterson - Head, SDG Integration,  Roy Small - Policy Analyst, Douglas Webb - Manager, Health and Innovative Financing, UNDP

The world has hit numerous devastating milestones in the course of the two and a half years since the start of the pandemic. The global cumulative death toll surpassed 6.5 million in early September 2022; numerous novel variants emerged and were identified, re-accelerating the spread of COVID-19 and prolonging its impacts around the world. During the same period, there have been notable achievements, including the high-speed development of the COVID-19 vaccines that have saved an estimated 20 million lives in the first year alone. [1]

In October of 2021, the World Health Organization (WHO) set out a proposal for all countries to achieve vaccination coverage of 70 percent by mid-2022; a challenge to achieve one of the most ambitious public health goals in history and to do so in record time. With vaccines to be distributed equitably with the most vulnerable being the highest priority, this coverage level was seen as critical to averting the majority of projected COVID-19 deaths, reducing the risk of new variants, and setting countries on a path of resumed socio-economic activity. [2] 

The Global Dashboard for Vaccine Equity, a collaboration between UNDP, WHO and the University of Oxford, shows that this widely promoted milestone has not been met by any of the 27 low-income countries, even though the global vaccine supply would have been sufficient to cover over 95 percent of the world’s population. Just 15 percent of lower-middle income countries have been able to meet the target, leaving more than 1.2 billion people who live in these countries unvaccinated.  

Coverage for the highly vulnerable healthcare workers and older adults in low-income countries remains significantly below the WHO-recommended 100 percent, [3] while the overall unavailability of data for other vulnerable groups - the urban poor, displaced persons, those living in fragile settings, and others who often remain invisible - means there are few opportunities for monitoring and improving progress in their coverage.  

While the officially reported cases and deaths in low- and lower-middle-income countries have remained low over the course of 2022, previous pandemics should serve as a reminder that dormant outbreaks can re-flare with tragic consequences.  For instance, while the complete toll of the 1918-1919 influenza pandemic may never be certain, estimates suggest that its second and most deadly wave was particularly devastating in poorer Asian and African countries. The coping capacity of these populations was substantially lower compared to their higher-income counterparts. [4]    

The COVID-19 pandemic is not over either, with the Economist estimating that between June and September of 2022, it caused 1.5 million excess deaths- a measure which quantifies COVID-19’s total mortality burden, including from unreported deaths and the pandemic’s downstream effects. Low- and lower-middle-income countries accounted for 53 percent of this additional mortality.5 Missing the 70 percent target is an important reminder to take stock of the vulnerable populations that continue to be left behind. 

Let’s rewind. By December 2020, when COVID-19 vaccines first became available, the majority of high-income countries had already hedged their bets on multiple vaccine candidates, securing enough supply to immunize their entire populations many times over as well as priority access to the first deliveries. Through their access to political, economic and diplomatic leverage, the world’s richest countries had created the conditions that led to a substantial availability gap between them and lower-income countries and a two-track pandemic. By June 2021, high-income countries had received one in every three of the globally delivered doses, while low-income countries had only received one in every 253. Learn more about the obstacles countries have faced on the road to 70 percent coverage.

While supply improved significantly in 2022, coverage in low-income countries has remained low. They have faced continuous financial barriers to recruiting sufficient healthcare personnel, and have needed to launch a pervasive communication campaign addressing hesitancy in order to turn vaccines into vaccinations. The combination of these challenges, coupled with the unpredictability of supply and the risk of dose expiration given the short shelf life, has meant that low-income countries had to rapidly distribute the little that was available to them, likely forcing their hand to expand vaccination access beyond the most vulnerable groups and further contributing to their low levels of protection.

Despite these setbacks and amidst the current collision of an environmental crisis, restricted fiscal space, political polarization, cost of living and debt crises, the world is in a better position than ever to end the pandemic and ensure against a resurgent global outbreak that could cause more preventable deaths and further fuel disruption and insecurity. By taking advantage of the unprecedented availability of effective public health tools, including vaccines, countries can invest in loosening the grip of this devastating pandemic.  To date, it has led to estimated total mortality of 21.8 million and is projected to cause a cumulative global output loss of US$13.8 trillion by 2024.

Vaccine inequity is not seen only in COVID-19 vaccination rates, but also through the increase in excess mortality in low and lower - middle-income countries that points to the strain the pandemic is placing on the healthcare systems. The benefit of strengthening healthcare systems to deliver COVID-19 vaccines in high-income countries has also been leveraged to reduce the indirect effects of the pandemic. For instance, while reported cases and deaths in lower-income countries have remained low over the course of 2022, the estimates for excess deaths from the pandemic’s downstream effects have continued to increase in those low- and lower-middle-income countries.

The benefits of vaccination reach beyond health and tell the story of missed opportunities to speed up COVID-19 recovery. UNDP estimates suggest that if by March 2022 low-income countries had the same vaccine coverage as high-income ones, their GDP projections would have increased by $2.61 billion, which could have been used toward other pressing development priorities. And in the longer term, vaccine equity is a critical ‘SDG investment’. Upcominganalyses conducted by UNDP and the Pardee Center for International Futures at the University of Denver show that an additional 6.1 million people would be lifted from poverty by 2030 if all countries reach the 70 percent target and make a set of targeted investments in accelerated development, compared to the same scenario but without vaccine equity.

Where does this leave us now? While some high-income countries have declared the end of the pandemic in their countries, taking COVID-19 off the agenda eclipses the potential pace of recovery for low-income countries, increasing their vulnerability to the impacts of the multiple compounding global crises we are facing. With inequalities exacerbated by the pandemic, this is the time to make a bigger global commitment to ensure no one is left behind. Investments are needed now to not only continue to protect the most vulnerable globally against COVID-19 but also build systems for health that are resilient and sustainable. We can’t speak about a post-COVID world without leveraging new innovations, technological advances and governance to be prepared for future outbreaks, pandemics and crises.