As doses of the first COVID-19 vaccine begin to roll out in the U.S. now, the estimate is that younger, healthy people may have to wait until spring or summer before they get their shot. But around the world, many people will be waiting far longer. Researchers who looked at the deals that wealthy countries have struck with vaccine manufacturers found that nearly a quarter of the global population is likely to be waiting until 2022—and possibly longer—to have access to the vaccine.
By mid-November, before any COVID-19 vaccines had regulatory approval, countries had reserved a total of 7.48 billion doses of the vaccines, enough to cover 3.76 billion people. But of the 13 different vaccines with preorders, it still isn’t clear how many will actually succeed. And just over half of the doses have been reserved by wealthier countries, even though low- and middle-income countries make up 85% of the global population. Even if all of the leading vaccines move forward and can reach maximum production, the study says that 22.5% of the world’s population may have to wait until at least 2022 for vaccination.
That’s a problem for everyone, not only the countries that may be waiting longest. “If we do not curb the pandemic globally, then there is always the possibility that it will return to our shores, and trade and travel in the world will not return to the pre-COVID days, unless we do effectively treat and prevent the resurgence of this pandemic in all countries of the world, not just in high-income countries,” says Anthony So, a professor at Johns Hopkins School of Public Health and one of the authors of the study, published today in The BMJ.
Some help will come from the Covax Facility, an international effort to buy vaccines for lower-income countries, but the effort still needs more funding. So far, it has raised around $2 billion, enough to buy doses for around half a billion people, with doses going first to healthcare workers and populations that are most at risk. It aims to raise another $5 billion next year.
The challenge will also depend on which vaccines are successful and how quickly each can be scaled up. (Some organizations, such as Oxfam and Doctors Without Borders, argue that pharmaceutical companies should also freely share their intellectual property in vaccines now to help manufacturing scale up more quickly.) The Pfizer-BioNTech vaccine can’t easily be distributed in remote areas because it requires extremely low-temperature storage, for example.
“We’re starting to see some signs that there may be bumps in the road,” So says. “GSK-Sanofi plans to go back to the drawing board so that they can establish a formulation that could be more effective for those populations that are more elderly. That’s a pretty significant player in this space. The University of Queensland announced that they would withdraw their vaccine from further development.” These announcements, which have come after the new study went to press, mean that the numbers that it projected are potentially more optimistic than what may actually happen.
Other vaccines, still at an earlier stage of development, may be better suited for distribution in developing countries, but production will take time. “It also takes time to scale,” he says. “It takes time to get the financing required to build the facilities, and secure the supply chains. You need everything from glass vials to the transportation logistics be worked out.”
Even in the U.S., which has reserved 800 million doses so far, it will be challenging to roll out vaccines to everyone, and it’s not yet clear how quickly the last in line—the youngest and healthiest citizens—will have access. Some vaccines may also be preferred over others, since the Pfizer and Moderna vaccines, for example, appear to be more effective than AstraZeneca’s vaccine, even though the AstraZeneca vaccine is also likely to get approval. “There may be vaccine hesitancy by parts of the population to really wait for the most effective vaccine,” he says. “These challenges are going to be significant, and really speak to the need for global coordination, because as much as we’re seeing this challenge unfold in the United States, you can only imagine the challenge that faces global allocation of these vaccines.”
The U.S. should play a role in ensuring equitable access, he says. The Trump administration refused to participate in the Covax Facility, but the Biden administration could change that policy, along with bringing American support back to the World Health Organization. The Canadian government, which has reserved more doses than any other country, is also now pushing for a new way to donate or exchange doses through the Covax Facility, and the U.S. could support that effort. “We would hope that the Biden-Harris administration would really reaffirm what was once U.S. leadership in global health,” So says.