Studies warn of COVID vaccine access issues for low-income nations

Vaccine quality testing
Vaccine quality testing

Neznam / iStock

Two studies in BMJ yesterday highlight operational challenges of the global COVID-19 vaccination program, including difficulties meeting demand and ensuring fair and equitable access in low- and middle-income countries (LMICs).

The first study warned that nearly a quarter of the world's population may not have access to a COVID-19 vaccine until at least 2022, and the second study estimated that only two thirds of adults worldwide are willing to accept a COVID-19 vaccine.

One-fourth may be left out in 2021

For the first study, researchers from Johns Hopkins Bloomberg School of Public Health analyzed pre-orders for COVID-19 vaccine, finding that a total of 7.48 billion doses (3.76 billion courses for a two-dose vaccine) from 13 manufacturers were reserved by Nov 15—51% of them earmarked for high-income countries representing just 14% of the world's population.

The authors estimated that if all 48 COVID-19 vaccine candidates currently in clinical trials are successfully brought to market, the total capacity will be 11.92 billion doses, or 5.96 billion courses, by the end of 2021, with up to 40% of these available for LMICs—but less if high-income countries order more vaccine. The authors note that these figures leave at least a fifth and likely a fourth of the world's population without access to vaccines until 2022.

"This study provides an overview of how high income countries have secured future supplies of covid-19 vaccines, but that access for the rest of the world is uncertain," the study authors wrote.

Wide variations in target populations

Chinese and US researchers in the second study estimated country-specific target populations for COVID-19 vaccination, finding wide variation by geographical region and national vaccine objectives such as maintaining essential services, reducing severe disease, and stopping virus transmission.

They note that only around 68% of the global population is willing to receive a vaccine.

"Variations in the size of the target populations within and between regions emphasise the tenuous balance between vaccine demand and supply, especially in low and middle income countries without sufficient capacity to meet domestic demand for covid-19 vaccine," they conclude.

In an editorial in the same journal, Jason L. Schwartz, PhD, of the Yale School of Public Health advocates for global coordination of vaccination efforts, including participation by the United States and other high-income countries in the COVAX initiative that subsidizes vaccine costs for poorer countries.

"The successful, equitable implementation of COVID-19 vaccination programmes requires unprecedented global coordination and a sustained commitment of resources—financial, logistical, and technical—from high-income countries," Schwartz wrote.

"US participation in vaccination efforts will be invaluable in challenges ahead, and in ensuring that all populations globally have access to the COVID-19 vaccines that will ultimately help bring an end to this devastating global health crisis."

This week's top reads