Covid boosters in rich countries outnumber all jabs among poor nations

Wealthy countries have rolled out more Covid-19 boosters than the total number of all doses administered so far in poorer nations, according to analysis by the Financial Times.

High prices have been identified as one of the main factors behind the widening vaccine inequality a year into the world’s biggest inoculation campaign.

The uneven provision of vaccines worldwide means that while rich nations such as the UK and Ireland move to give every adult a booster to combat the Omicron variant, more troublesome variants could spring up in areas where there has been insufficient inoculation. Global health authorities have warned of that threat since the beginning of the global rollout.

Nearly 16 booster doses per 100 people were administered across the world's 59 high-income countries – as defined by the World Bank – up to December 15th, compared with just under 11 shots per 100 people of any doses in low-income nations.

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The number of boosters dispensed in the world's richest countries is growing by 5.5 million each day. Spain and South Korea have, on average over the past week, jabbed more than 1 per cent of their population – around half a million people – each day. Germany is dispensing more than 800,000 boosters a day, also enough for 1 per cent of its population. The US, which has a much larger population, is rolling out boosters more slowly but is administering more than a million a day.

By contrast, across the world’s 29 low-income countries, which have a combined population 687 million people, just 669,504 doses of any Covid vaccine were dispensed each day in the past week – around one jab for a tenth of one per cent of the population.

Tiered pricing

One of the main barriers is cost, say health experts. Although most pharmaceutical companies have kept their pledge to offer tiered pricing, with poorer countries paying less for shots, the price of Covid-19 vaccines remains higher than for any other comparable jab widely used in poorer countries, according to the World Health Organisation (WHO).

The median price of Covid-19 vaccines for low income countries is $6.88 (€6.12) per dose, compared with a median of $10.45 a dose for high-income countries, according to figures compiled in November by the WHO.

In comparison, another expensive vaccine sold in low-income countries, the human papillomavirus jab, is priced at $4.50 a dose. "That gives you a sense of the difference in price," said Tania Cernuschi, the WHO's technical lead for global vaccine strategy.

“Covid is the highest [priced] vaccine for lower-income settings that was ever commercialised,” she said. “Price tiering for Covid-19 vaccines is extremely limited relative to other vaccine markets.”

Some countries pay for the shots themselves, while in others costs are absorbed by multilateral access schemes.

Richard Kozul-Wright, director of globalisation and development strategies division at the United Nations Conference on Trade and Development, expressed concern that poorer countries were being squeezed by high costs.

“Given health budgets were stretched before the crisis, this just adds massively to that burden [in parts of the developing world],” he said.

The 59 highest-income countries have received deliveries of enough vaccine doses to cover their population twice over and have fully vaccinated nearly 70 per cent of their combined populations, according to FT analysis of data compiled by Unicef and Our World in Data.

While observers have signalled that supply has improved significantly in the past year and will continue to ease into 2022, the world is set still to face a shortage of 3 billion shots early next year if aggressive booster campaigns in richer nations continue alongside child immunisation, the Financial Times reported on Wednesday.

If, on the other hand, countries were to boost only those over the age of 50, supply would meet demand from the start of 2022.

The success of Covax – the vaccine access scheme set up by Gavi, a vaccine alliance with the goal of increasing access to immunisation, the Coalition for Epidemic Preparedness Innovations and the WHO – has been mixed. Deliveries to low-income countries have picked up significantly, reaching 29 million doses in November and 99.6 million since the rollout began, according to data compiled by Unicef.

Order process

Poorer nations, the WHO, Covax and others have lamented opacity in the order process and late deliveries of vaccine batches with little shelf life left – in some cases as short as three weeks, according to Kate O’Brien, the WHO’s head of vaccines.

The industry has pushed back against criticism of tight supplies, saying the problem was instead largely caused by vaccine hesitancy in poorer nations. But activists and global health authorities disagree.

"It provides convenient cover to pharmaceutical companies whose control of markets [has] fuelled artificial scarcity," wrote health experts including Fatima Hassan, founder of South Africa's Health Justice Initiative group that campaigns for equitable access to vaccines, in a recent British Medical Journal article.

Campaigners and health officials have said manufacturers have favoured deliveries and contracts with the global north, a claim that pharmaceutical companies have denied.

“Data show [companies] did not deliver on time, at all, so we were subject in Africa to drip-feed supplies enabled by the disproportionate power of intellectual property monopolies and control,” Hassan said. “Shameful.”

The available data do suggest that only about half the doses delivered to low income countries have been administered, suggesting some countries are facing difficulties in absorbing the supplies that they have received.

But the WHO’s O’Brien said countries could not “suddenly turn on absorption capacity” at scale when doses suddenly arrived.

“It’s not enough to just point at the number of doses being sent,” she told the FT, noting there was also shortage of syringes and that different vaccines with different cold-chain requirements made rollouts very difficult.

“If you really wanted to capacitate and facilitate countries to deploy a mass vaccination programme as quickly as possible you wouldn’t design [it like] that.” – Copyright The Financial Times Limited 2021