Vaccination against COVID-19 will define countries’ socioeconomic recovery

But so far, vaccine inequity is widening the gap between rich and poor

Two years into the COVID-19 pandemic – and the world’s response has widened the poverty gap between rich and poor countries. While high-income countries are likely to bounce back quickly from the recent Omicron variant, low-income countries are not likely to see pre-pandemic growth rates until 2023 or 2024.

But this is only half of the picture. Inequalities within countries are now greater than those observed between. The pandemic is hitting vulnerable and marginalized groups hardest: progress in education completion is expected to be reversed, especially among children from the poorest households. Gender disparities are increasing, with spikes in gender-based violence and less than 20 percent of countries’ pandemic support geared towards women. And informal workers have been disproportionally hit by extended lockdowns.

Speed in the vaccination effort will determine how countries and populations recover from the pandemic. Every day, week and month matter to reach WHO’s target to vaccinate 70 percent of the population by mid-2022. Because unless everyone is safe, no one is.

As of March 2022, only 1 percent of the 10.9 billion administered doses worldwide have been given in low-income countries. This means that 2.8 billion people around the world are still waiting to get their first shot.

Most of the vulnerable countries are found in Sub-Saharan Africa, including Burundi, the Democratic Republic of the Congo and Chad, where less than one percent of the populations are fully vaccinated. In total, 50 out of 54 countries in Africa were off-track to achieving the 70 percent target as of February 2022. And outside of Africa, Haiti and Yemen are still to reach two percent coverage.

This is why the 2030 Agenda focuses on Leaving No One Behind

Using data from the Global Dashboard of Vaccine Equity, developed by UNDP, WHO and the University of Oxford, we have shown how vaccine inequity will not only affect poorer countries disproportionally in terms of health, but also have a profound and lasting impact on their socio-economic recovery.

So far, this is a story of lost opportunities. UNDP’s analysis shows that if low-income countries had the same vaccination rate as high-income countries in September last year (54 percent), they would have increased their GDP by US$16.27 billion in 2021, which could have been used to address other pressing development challenges – education, health care, energy for all, for example.

The speed with which the world gets vaccinated in 2022 is critical to avoid more lost ground in contexts where progress is needed the most.

And roll-out of vaccination in low and lower-middle income countries is picking up: Cambodia, Viet Nam and Bhutan have exceeded the 70 percent target and countries including Nepal, Rwanda, Morocco and El Salvador reached over 60 percent. But there is no shortage of herculean tasks ahead.

As many as 19 million people need to be inoculated each week in low-income countries to reach the 70 percent target by mid-2022, which represents an increase by over 800 percent compared to current rates. However, 24 of the 27 low-income countries have lower vaccination rates than what would be required to reach that target, due to vaccine supply bottlenecks or insufficient absorptive capacity.

Vaccination is critical for the world’s informal workers

A speedy roll-out is critical not least to the world’s 1.6 billion informal workers, who saw their earnings decline by 60 percent in 2020. And some countries with a large informal sector, like Uganda, Bangladesh and Colombia, experienced a significant increase in the number of days of complete lockdown in 2021, before reaching higher vaccination coverage. As of early 2022, global informal employment was still eight percent lower compared to the beginning of the pandemic

Over the past two years, governments in richer countries have been able to provide more comprehensive and longer-lasting economic support to both formal and informal workers, than poorer countries. Only in low-income countries did the average duration of economic support decline between 2020 and 2021.

With low vaccination coverage and limited social protection schemes exposing informal workers to multiple risks, urgent action is required to support vaccination campaigns and integrated solutions that cover broader health aspects, welfare measures, education and job opportunities, to name a few, if we are to move closer to an equitable global recovery.

What will it cost?

Reaching the 70 percent target means that countries that can least afford it will have to boost health spending by a disproportionate amount compared to richer countries. More than US$4.7 billion, or about 1 percent of low-income countries’ projected GDP growth for 2022, will be required to reach the 70 percent goal post. This can be compared to US$654 million for high-income countries – which is  only 0.02 percent of their projected growth.

In a time of regress across several Sustainable Development Goals (SDGs), these numbers matter more than ever. For low-income countries, the spending required on vaccines equals 59 percent of the annual average investment needs to end extreme poverty by 2030 (SDG 1.1) or 89 percent of the average expenditure needs per year to ensure that all girls and boys can complete free, equitable and quality primary and secondary education (SDG 4.1).

The risk for poorer countries to be further pushed down the debt spiral is looming. In Sudan, remaining vaccine costs would add almost US$333 million to the existing public debt by the end of 2022. This amount could be used to cover out-of-pocket health expenditure for 10.6 million people, which represents a quarter of the population. Similarly, in Burundi, the country with the highest relative increase in public debt/GDP ratio due to vaccine costs, the projected increase of US$96 million in public debt could provide healthcare for 4.7 million people, or 39 percent of the population.

Additional financing in the form of grants and concessional financing recently proposed by the IMF is crucial to prevent countries from accumulating additional debt.

Countries can still accelerate out of the crisis

...but it will take solidarity, tailored support and integrated responses. The poorest countries need urgent access to both vaccines and financing, however it is not only that low-income countries need access to adequate doses: those doses must also be converted into administered vaccinations. To get there, the support must be tailored to local realities and take historical trends from previous vaccination campaigns into account. The work of trusted, national partners and organizations like Gavi, the Vaccine Alliance is crucial in this regard. Streamlined country support, including through the Global Action Plan for Healthy Lives and Well-being for All,  is another key component.

The logistics and planning needed to effectively distribute vaccines on the ground, especially in low resource settings, also require more attention. UNDP’s forthcoming Hyperlocal Vaccine Analytics tool seeks to help policy makers identify vulnerable groups using a combination of data, including geospatial data, and identify options to support national level vaccine rollout and vaccine microplanning. And under the leadership of WHO and UNICEF, UNDP is working with government, civil society, academia, private sector partners and other UN agencies to support COVID-19 vaccine equity efforts in 62 countries, focusing on digital solutions, systems strengthening, data for vaccine equity and greening COVID vaccination.

What’s more, we need to ensure that recovery efforts make the world more equal – not less. UNDP recently showed how a set of ambitious but feasible investments in governance, social protection, green recovery and digitalization – an ‘SDG Push’ – could help the poorest countries in the world to exceed pre-pandemic development trajectories and lift 100 million people out of poverty by 2030, even when taking COVID impact into account.

It comes down to the choices we make today as recovery programmes and ‘build back better’ measures are designed. While some countries have doubled down on fossil fuel investments during the pandemic, others have chosen to deepen emergency social protection measures, and even expand regular programmes. This shows that it can be done – it is up to leaders, countries and partners to choose a sustainable way of out this crisis.

Craft your country-tailored advocacy messages with insights from the Global Dashboard for Vaccine Equity.