The Global Race To Vaccinate

Facing new coronavirus variants and threats of backsliding, the world's effort to protect its most vulnerable populations must accelerate

PUBLISHED: MARCH 29, 2021

As of March 15, 2021, there have been over 120 million cases and 2.66 million deaths from COVID-19 around the globe, an increase of 43 percent in cases and 45 percent in deaths, since January 1. A second wave of the pandemic in the fall and winter resulted in a substantial increase in cases, severely straining even the strongest health care systems. Now, some countries are bracing for third and fourth waves. Several mutations of the virus—the three most prominent ones having emerged from the U.K. (B.1.1.7), South Africa (B.1.351), and Brazil (P.1)—have been complicating COVID-19 management just as vaccines are rolling out. According to The Johns Hopkins School of Medicine and the Centers for Disease Control and Prevention, the U.K. variant has been spreading quickly across the U.K., the U.S., and elsewhere, while laboratory studies indicate that the South African and Brazilian variants may be more resistant to vaccines. These mutations and stalled rollout of the vaccine across many parts of the world compound the urgency with which nations must act.

The authorization, approval, and initial distribution of 13 different COVID-19 vaccines, and the development of nearly 100 more that are currently in trials, offer hope for more effective management and an eventual end to the pandemic. As of this writing, there are seven vaccines approved for widespread use, six in early or limited use, and 23 in large-scale efficacy Phase 3 testing. A comparative summary of the leading vaccines currently being distributed globally is below:

Share of Leading Vaccines Procured Globally


Oxford-AstraZeneca Doses: 2

Efficacy rate: 76% efficacy rate against symptomatic COVID, 100% against critical disease or hospitalization, and 85% in symptomatic participants aged 65 and over.

Reported variant protection: Reported 74.6% efficacy against the B.1.1.7 variant; not effective against B.1.351 variant

Emergency use in: Algeria, Argentina, Australia, Bahamas, Bangladesh, Bahrain, Bhutan, Botswana, Canada, Chile, Colombia, Dominican Republic, Egypt, El Salvador, European Union, Iceland, India, Indonesia, Iran, Iraq, Kuwait, Liechtenstein, Malaysia, Maldives, Mexico, Moldova, Mongolia, Morocco, Nepal, Nigeria, Norway, Pakistan, Papua New Guinea, Philippines, Saudi Arabia, Seychelles, Sri Lanka, South Africa, South Korea, Thailand, Ukraine, United Kingdom, Vietnam.

Pfizer BioNTEch Doses: 2

Efficacy rate: 95.0%

Reported variant protection: U.K. (B.1.1.7), may be less effective for South Africa. (B.1.351)

Approved in: Bahrain, Brazil, New Zealand, Saudi Arabia, Switzerland

Emergency use in: Argentina, Australia, Botswana, Canada, Chile, Colombia, Costa Rica, Ecuador, European Union, Hong Kong, Iceland, Iraq, Israel, Japan, Jordan, Kuwait, Lebanon, Liechtenstein, Malaysia, Mexico, Moldova, Mongolia, Norway, Oman, Panama, Peru, Philippines, Qatar, Serbia, Singapore, South Korea, Tunisia, United Arab Emirates, United Kingdom, United States.

Johnson & Johnson Doses: 1

Efficacy rate: 72.0%

Reported variant protection: 64% against the B.1.1.7 variant, and 82% against severe disease in South Africa where B.1.351 was first detected

Emergency use in: Bahrain, Canada, European Union, Iceland, Liechtenstein, Norway, United States.

Moderna Doses: 2

Efficacy rate: 94.1% / 86.4% for adults age 65+

Reported variant protection: May provide protection against the B.1.17 and B.1.351 variants

Approved in: Switzerland

Emergency use in: Canada, European Union, Iceland, Israel, Mongolia, Norway, Qatar, Singapore, the United Kingdom, United States, Vietnam.

Sinovac Doses: 2

Efficacy rate: 50.4% - 91.3%

Reported variant protection: Unknown

Approved in: China

Emergency use in: Azerbaijan, Brazil, Cambodia, Chile, Colombia, Ecuador, Hong Kong, Indonesia, Laos, Malaysia, Mexico, Philippines, Thailand, Turkey, Ukraine, Uruguay, Zimbabwe.

Sputnik V Doses: 2

Efficacy rate: 91.6%

Reported variant protection: Unknown

Early use in: Russia

Emergency use in: Algeria, Angola, Argentina, Armenia, Azerbaijan, Bahrain, Belarus, Bolivia, Bosnian Serb Republic, Congo Republic, Djibouti, Egypt, Honduras, Gabon, Ghana, Guatemala, Guinea, Guyana, Hungary, Iran, Iraq, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Laos, Lebanon, Mexico, Moldova, Mongolia, Montenegro, Morocco, Myanmar, Namibia, Nicaragua, North Macedonia, Pakistan, Palestinian Authority, Paraguay, San Marino, Slovakia, Sri Lanka, St. Vincent and the Grenadines, Serbia, Syria, Tunisia, Turkmenistan, United Arab Emirates, Uzbekistan, Venezuela, Vietnam, Zimbabwe.

Sinopharm Doses: 2

Efficacy rate: 79.0% (self-reported)

Reported variant protection: Reduced effectiveness (by 1.6 times) against South African variant

Approved in: Bahrain, China, United Arab Emirates

Emergency use in: Argentina, Cambodia, Egypt, Guyana, Hungary, Iran, Iraq, Jordan, Nepal, Pakistan, Peru, Venezuela, Zimbabwe.

Sources: Yale Medicine, The Lancet, Bloomberg News, BBC News, New England Journal of Medicine, NY Times COVID-19 Vaccine Tracker.

All 36 countries in FP Analytics’ COVID-19 Global Response Index have access to doses of vaccines, through either their own governments’ procurement or allocation by supranational organizations such as the African Union or the European Union. However, access and distribution among the Index countries and around the world have been uneven and inequitable, hindered by procurement, supply chain, and geopolitical issues. Despite the initial rollout of vaccines, COVID-19 cases are still increasing rapidly.


Wide Disparity Between Rich and Poor Countries’ Access to Vaccines

The data on vaccine doses purchased clearly illustrates a gulf between rich and poor countries. Many wealthier countries moved early to secure a substantially higher number of doses relative to their population sizes as compared with poorer nations. As of March 15, on average, the wealthiest 25 percent of countries with the highest GDP per capita purchased nearly twice the number of doses needed to fully vaccinate their entire respective populations, while the poorest 25 percent (lowest GDP per capita) of countries have only secured enough doses to cover less than a quarter of their populations. In terms of actual doses, the richest countries have procured 4.1 billion doses (48.7 percent), while the poorest have procured just 1.1 billion doses (13 percent) of the 8.4 billion global total. Canada and the U.K., for example, have procured 4.3 times and 3.6 times, respectively, the number of doses needed to treat their entire populations. A summary of other countries’ procurement is below:

Overall Percentage of Population Treatable With Doses Purchased by Income Level

Average share treatable by income status
High income
189.5%
Middle-high income
101.9%
Low-middle income
36.6%
Low income
22.1%

Sort by income Sort by coverage

  • Low income
  • Low-middle income
  • Middle-high income
  • High income

Countries highlighted in red are included and link to Foreign Policy Analytics’ COVID-19 Global Response Index. Visit the index at globalresponseindex.com for more information.

  • Purchaser Entity
  • GDP/Per Capita
  • % OF POPULATION FULLY TREATABLE BY PURCHASED VACCINATIONS
Purchaser Entity GDP/Per Capita % OF POPULATION FULLY TREATABLE BY PURCHASED VACCINATIONS
Zimbabwe $2,583
2.7%
Ethiopia $2,772
29.0%
Senegal $3,463
0.6%
Nepal $3,586
43.7%
Kenya $4,993
29.0%
Bangladesh $5,139
10.1%
Pakistan $5,160
9.6%
Myanmar $5,179
31.0%
Palestine $5,320
19.4%
African Union $5,536
29.0%
Honduras $5,538
15.5%
Ghana $5,707
29.0%
India $6,284
4.3%
Venezuela $7,340
17.5%
Uzbekistan $7,378
1.5%
Morocco $7,609
90.5%
Bolivia $8,342
35.2%
El Salvador $8,401
7.5%
Philippines $8,574
42.5%
Iraq $9,952
1.9%
Jordan $10,007
4.9%
Tunisia $10,382
8.6%
Ecuador $10,617
31.7%
Vietnam $10,755
41.5%
Peru $11,516
110.7%
Lebanon $11,562
14.6%
South Africa $11,911
1.3%
Iran $11,963
1.2%
Indonesia $12,345
47.2%
Ukraine $12,710
20.5%
Egypt $12,719
47.3%
Sri Lanka $13,114
24.1%
Albania $13,651
8.8%
Colombia $14,137
50.2%
Azerbaijan $14,499
20.0%
Brazil $14,563
55.0%
Latin America w/o Brazil $14,914
11.9%
North Macedonia $16,609
19.2%
China $17,206
3.6%
Thailand $18,073
44.8%
Dominican Republic $18,783
83.3%
Mexico $18,804
59.5%
Serbia $18,840
25.2%
Costa Rica $19,309
39.6%
Argentina $20,370
52.3%
Uruguay $21,338
53.4%
Chile $23,455
244.0%
Kazakhstan $26,589
5.4%
Malaysia $27,287
92.0%
Turkey $28,294
62.6%
Oman $29,908
3.7%
Panama $30,034
35.3%
Slovakia $32,184
18.3%
Hungary $32,434
35.8%
Spain $38,143
227.4%
Israel $39,126
176.7%
Italy $40,066
227.4%
New Zealand $41,072
242.0%
Japan $41,637
124.3%
Kuwait $41,735
35.7%
UK $44,288
364.3%
South Korea $44,292
108.3%
France $45,454
227.4%
Saudi Arabia $46,273
4.4%
EU $46,622
227.4%
Canada $47,569
431.0%
Finland $49,334
227.4%
Belgium $50,114
227.4%
Australia $50,845
246.0%
Sweden $52,477
227.4%
Germany $53,571
227.4%
Taiwan $54,020
83.9%
Iceland $54,482
227.4%
San Marino $56,690
11.1%
Netherlands $57,101
227.4%
Denmark $57,781
227.4%
Hong Kong $58,165
99.9%
United Arab Emirates $58,466
15.4%
USA $63,051
199.5%
Norway $64,856
227.4%
Switzerland $68,340
122.5%

European Union Countries in the COVID-19 Index

  • Belgium
  • Denmark
  • Finland
  • France
  • Germany
  • Hungary
  • Italy
  • Netherlands
  • Spain
  • Sweden

Sources: Duke University Launch and Scale Speedometer, IMF World Economic Outlook.

For countries in the African Union, EU, and Latin America that did not report country-level data, the percentage reported for the respective bloc has been applied.

*Data represents confirmed and final vaccine procurement deals that specify the number of doses in the deal and that have been publicly reported as of March 15, 2021. Deals that have been announced but that do not report the number of doses are not included, nor are deals that are under negotiation or are options for future production.

**Countries where deals have been announced but doses are not reported and are unknown include: Pfizer (Kazakhstan, Qatar, Singapore, United Arab Emirates), Moderna (Qatar and Singapore), Sputnik V (Algeria, Belarus, Paraguay, Saudi Arabia), Sinovac (Singapore), CureVac (Saudi Arabia)

Number of countries with more than 100% of population treatable

23
  • Australia
  • Belgium
  • Canada
  • Chile
  • Denmark
  • EU
  • Finland
  • France
  • Germany
  • Iceland
  • Israel
  • Italy
  • Japan
  • Netherlands
  • New Zealand
  • Norway
  • Peru
  • South Korea
  • Spain
  • Sweden
  • Switzerland
  • UK
  • USA

Number of countries with less than 10% of population treatable

15
  • Albania
  • China
  • Honduras
  • India
  • Iran
  • Iraq
  • Jordan
  • Kazakhstan
  • Oman
  • Pakistan
  • Saudi Arabia
  • Senegal
  • Tunisia
  • Uzbekistan
  • Zimbabwe

The wealthier countries that have procured disproportionate supplies of vaccines, by and large, also represent those with the highest case rates. The U.S. and the U.K., which have been among the worst performers globally with respect to COVID-19 case and death rates, and lowest performers in the Global Response Index over the last year, are now among the leaders rolling out the vaccine. Still, they trail Israel and the United Arab Emirates, which have been the most effective at vaccine administration by far.

A handful of countries are leading vaccine administration

Source: Our World in Data vaccine administration data as of March 15, 2021.

*The data represents doses administered and may not represent the number of people fully vaccinated if the vaccine requires two doses.

**January 10th was the first date for which U.A.E. data was officially reported.

North American manufacturers are the world’s leading vaccine suppliers. Just under half (45.3 percent), or 29 countries out of 68 for which data is available, have a vaccine manufactured by an American or Canadian company as their primary supplier. The next closest, Europe, is the major supplier in almost half as many countries (25 percent, or 16 countries). Among vaccine makers, Pfizer/BioNTech and Oxford-AstraZeneca both lead the way, each being the primary vaccine in 25 percent of all countries, followed closely by China’s vaccines and Russia’s Sputnik V at 17.6 percent and 16.2 percent, respectively. Vaccines’ properties, dosage, pricing, and transportation requirements all influence uptake rates. While highly effective, the Pfizer-BioNTech vaccine’s need for ultra-cold freezers has challenged distribution. Though recent relaxation of that requirement by the Food and Drug Administration could facilitate broader distribution, both Pfizer and Moderna still require cold storage, making the other vaccines—Oxford AstraZeneca, Sinovac, Sputnik V and Johnson & Johnson—much more deployable, particularly in developing country contexts.

North America and Pfizer lead, but competition is intensifying among vaccine suppliers
Share of all Countries Procuring their Primary Vaccine from Regional Source. (Number of countries in parentheses below)

View by country View by manufacturer

  • North America
  • Europe
  • China
  • Russia
  • India
Breakdown of Global Vaccine Suppliers by Region
North America
45.3%
(29 Purchasers)
Europe
25%
(16 Purchasers)
China
17.2%
(12 Purchasers)
Russia
12.5%
(11 Purchasers)
African Union53.6% Rural Population
37.5%
62.5%
Albania38.8% Rural Population
100.0%
Argentina8% Rural Population
44.9%
53.1%
2.0%
Australia13.9% Rural Population
57.1%
42.9%
Azerbaijan44% Rural Population
100.0%
Bangladesh62.6% Rural Population
100.0%
Bolivia30.2% Rural Population
61.7%
32.1%
6.2%
Brazil13.2% Rural Population
31.1%
31.7%
31.1%
6.2%
COVAX% Rural Population
73.2%
26.8%
Canada18.5% Rural Population
72.3%
27.7%
Chile12.4% Rural Population
19.5%
15.6%
64.9%
China39.7% Rural Population
100.0%
Colombia18.9% Rural Population
68.3%
18.0%
13.7%
Costa Rica19.9% Rural Population
75.0%
25.0%
Dominican Republic18.2% Rural Population
44.4%
55.6%
EU27.4% Rural Population
59.8%
40.2%
Ecuador36% Rural Population
53.3%
33.3%
13.3%
Egypt57.3% Rural Population
31.3%
27.1%
41.7%
El Salvador27.3% Rural Population
100.0%
Honduras42.3% Rural Population
95.2%
4.8%
Hong Kong0% Rural Population
50.0%
50.0%
Hungary28.4% Rural Population
28.6%
71.4%
India65.5% Rural Population
9.4%
85.8%
4.8%
Indonesia44% Rural Population
19.5%
19.5%
60.9%
Iran24.6% Rural Population
100.0%
Iraq29.3% Rural Population
33.3%
44.4%
22.2%
Israel7.5% Rural Population
68.8%
31.3%
Japan8.3% Rural Population
61.8%
38.2%
Jordan8.8% Rural Population
100.0%
Kazakhstan42.5% Rural Population
100.0%
Kuwait0% Rural Population
25.0%
75.0%
Latin America w/o Brazil37.5% Rural Population
100.0%
Lebanon11.2% Rural Population
100.0%
Malaysia23.4% Rural Population
42.8%
10.5%
10.5%
36.2%
Mexico19.6% Rural Population
18.5%
42.4%
13.0%
26.1%
Morocco37% Rural Population
38.2%
61.8%
Myanmar69.1% Rural Population
100.0%
Nepal79.8% Rural Population
7.1%
92.9%
New Zealand13.4% Rural Population
68.3%
31.7%
North Macedonia41.8% Rural Population
100.0%
Oman14.6% Rural Population
100.0%
Pakistan63.1% Rural Population
100.0%
Palestine23.6% Rural Population
99.5%
0.5%
Panama31.9% Rural Population
100.0%
Peru21.9% Rural Population
27.8%
19.4%
52.8%
Philippines52.9% Rural Population
55.7%
17.5%
26.8%
San Marino2.6% Rural Population
100.0%
Saudi Arabia15.9% Rural Population
100.0%
Senegal52.3% Rural Population
100.0%
Serbia43.7% Rural Population
14.3%
57.1%
28.6%
Slovakia46.3% Rural Population
100.0%
South Africa33.1% Rural Population
93.6%
6.4%
South Korea18.6% Rural Population
84.8%
15.2%
Sri Lanka81.4% Rural Population
100.0%
Switzerland26.2% Rural Population
76.2%
23.8%
Taiwan% Rural Population
75.0%
25.0%
Thailand49.3% Rural Population
96.9%
3.1%
Tunisia30.7% Rural Population
100.0%
Turkey24.4% Rural Population
4.4%
95.6%
UK16.3% Rural Population
35.7%
64.3%
USA17.5% Rural Population
69.7%
30.3%
Ukraine30.5% Rural Population
64.7%
13.8%
21.6%
United Arab Emirates13.2% Rural Population
100.0%
Uruguay4.6% Rural Population
54.1%
45.9%
Uzbekistan49.6% Rural Population
100.0%
Venezuela11.8% Rural Population
100.0%
Vietnam63.4% Rural Population
37.5%
62.5%
Zimbabwe67.8% Rural Population
100.0%

Sources: Duke University Launch and Scale Speedometer, World Bank.

*Data represents confirmed and final vaccine procurement deals that specify the number of doses in the deal and that have been publicly reported as of March 15, 2021. Deals that have been announced but that do not report the number of doses are not included, nor are deals that are under negotiation or are options for future production.

**Countries where deals have been announced but doses are not reported and are unknown include: Pfizer (Kazakhstan, Qatar, Singapore, United Arab Emirates), Moderna (Qatar and Singapore), Sputnik V (Algeria, Belarus, Paraguay, Saudi Arabia), Sinovac (Singapore), CureVac (Saudi Arabia)

*Region/country color coding correction made April 1, 2021

For countries in the African Union, EU, and Latin America that did not report country-level data, the percentage reported for the respective bloc has been applied.

  • Pfizer
  • Moderna
  • J&J
  • Oxford/AZ
  • Sputnik V
  • China Vaccines
  • Covaxin
  • Other
% of purchasers with primary drug as:
Pfizer
25.0%
Moderna
2.9%
J&J
4.4%
Oxford/AZ
25.0%
Sputnik
16.2%
China Vaccines
17.6%
Covaxin
0%
Other
8.8%
African Union53.6 Rural Population
6.3%
30.4%
63.3%
Albania38.8 Rural Population
100.0%
Argentina8 Rural Population
44.9%
53.1%
2.0%
Australia13.9 Rural Population
15.9%
42.9%
41.3%
Azerbaijan44 Rural Population
100.0%
Bangladesh62.6 Rural Population
100.0%
Bolivia30.2 Rural Population
61.7%
32.1%
6.2%
Brazil13.2 Rural Population
31.1%
31.7%
31.1%
6.2%
COVAX Rural Population
2.8%
70.9%
12.1%
14.2%
Canada18.5 Rural Population
12.3%
13.6%
6.2%
6.2%
61.7%
Chile12.4 Rural Population
10.8%
8.7%
15.6%
64.9%
China39.7 Rural Population
100.0%
Colombia18.9 Rural Population
18.0%
18.0%
32.4%
18.0%
13.7%
Costa Rica19.9 Rural Population
75.0%
25.0%
Dominican Republic18.2 Rural Population
44.4%
55.6%
EU27.4 Rural Population
24.5%
15.7%
19.6%
14.7%
25.5%
Ecuador36 Rural Population
40.0%
33.3%
13.3%
13.3%
Egypt57.3 Rural Population
31.3%
27.1%
41.7%
El Salvador27.3 Rural Population
100.0%
Honduras42.3 Rural Population
95.2%
4.8%
Hong Kong0 Rural Population
50.0%
50.0%
Hungary28.4 Rural Population
28.6%
71.4%
India65.5 Rural Population
9.4%
85.8%
4.8%
Indonesia44 Rural Population
19.5%
60.9%
19.5%
Iran24.6 Rural Population
100.0%
Iraq29.3 Rural Population
33.3%
44.4%
22.2%
Israel7.5 Rural Population
25.0%
18.8%
31.3%
25.0%
Japan8.3 Rural Population
45.9%
15.9%
38.2%
Jordan8.8 Rural Population
100.0%
Kazakhstan42.5 Rural Population
100.0%
Kuwait0 Rural Population
25.0%
75.0%
Latin America w/o Brazil37.5 Rural Population
100.0%
Lebanon11.2 Rural Population
100.0%
Malaysia23.4 Rural Population
42.8%
10.5%
10.5%
36.2%
Mexico19.6 Rural Population
18.5%
42.4%
13.0%
26.1%
Morocco37 Rural Population
38.2%
61.8%
Myanmar69.1 Rural Population
100.0%
Nepal79.8 Rural Population
7.1%
92.9%
New Zealand13.4 Rural Population
6.3%
16.7%
31.8%
45.2%
North Macedonia41.8 Rural Population
100.0%
Oman14.6 Rural Population
100.0%
Pakistan63.1 Rural Population
100.0%
Palestine23.6 Rural Population
99.5%
0.5%
Panama31.9 Rural Population
100.0%
Peru21.9 Rural Population
27.8%
19.4%
52.8%
Philippines52.9 Rural Population
13.5%
10.4%
17.7%
27.1%
31.3%
San Marino2.6 Rural Population
100.0%
Saudi Arabia15.9 Rural Population
100.0%
Senegal52.3 Rural Population
100.0%
Serbia43.7 Rural Population
14.3%
57.1%
28.6%
Slovakia46.3 Rural Population
100.0%
South Africa33.1 Rural Population
93.6%
6.4%
South Korea18.6 Rural Population
15.2%
30.3%
9.1%
15.2%
30.3%
Sri Lanka81.4 Rural Population
100.0%
Switzerland26.2 Rural Population
14.3%
61.9%
23.8%
Taiwan Rural Population
75.0%
25.0%
Thailand49.3 Rural Population
96.9%
3.1%
Tunisia30.7 Rural Population
100.0%
Turkey24.4 Rural Population
4.4%
95.6%
UK16.3 Rural Population
8.0%
3.4%
12.1%
20.1%
56.3%
USA17.5 Rural Population
22.7%
22.7%
15.2%
22.7%
16.7%
Ukraine30.5 Rural Population
13.8%
21.6%
64.7%
United Arab Emirates13.2 Rural Population
100.0%
Uruguay4.6 Rural Population
54.1%
45.9%
Uzbekistan49.6 Rural Population
100.0%
Venezuela11.8 Rural Population
100.0%
Vietnam63.4 Rural Population
37.5%
62.5%
Zimbabwe67.8 Rural Population
100.0%

Sources: Duke University Launch and Scale Speedometer, World Bank.

*Data represents confirmed and final vaccine procurement deals that specify the number of doses in the deal and that have been publicly reported as of March 15, 2021. Deals that have been announced but that do not report the number of doses are not included, nor are deals that are under negotiation or are options for future production.

**Countries where deals have been announced but doses are not reported and are unknown include: Pfizer (Kazakhstan, Qatar, Singapore, United Arab Emirates), Moderna (Qatar and Singapore), Sputnik V (Algeria, Belarus, Paraguay, Saudi Arabia), Sinovac (Singapore), CureVac (Saudi Arabia)

*Region/country color coding correction made April 1, 2021

For countries in the African Union, EU, and Latin America that did not report country-level data, the percentage reported for the respective bloc has been applied.

Disproportionate Procurement and Manufacturing Bottlenecks Exacerbating Access Gap

While this handful of countries are showing leadership administering vaccines, many of the wealthier countries that locked up supply through advanced purchase commitments are struggling to administer them. European nations, in particular, continue to struggle in their efforts to ramp up vaccinations, as approval delays and incoherent distribution plans have been hampering vaccine rollout. Recent concerns over AstraZeneca and risks of blot clots have further complicated rollout as Germany, France, Spain, and Italy have joined other European countries to temporary halt distribution of that vaccine. Meanwhile, manufacturing shortfalls and rising COVID-19 case levels are increasing calls for, and tensions over, vaccine export restrictions, which the EU is in the process of imposing.

Early efforts by wealthier nations to lock in vaccine deals and the subsequent difficulty in distributing vaccines have created global distribution bottlenecks, exacerbating the vaccine access gap between wealthier and poor nations. Economic impacts from the pandemic have further strained developing countries’ governments’ ability to procure costly vaccines. Fewer than half of the African countries in the Global Response Index, for example, has secured vaccine supplies. Even suppliers that regularly provide vaccines and drugs to the developing world, notably the Serum Institute in India, will face serious challenges. As the largest vaccine manufacturer globally, Serum will be critical to the provision of COVID-19 vaccines to the developing world. It is planning to provide one billion doses to poorer nations, in partnership with AstraZeneca. However, the Institute has stated that half its production will be for India, where the coronavirus caseload trails only that of Brazil and the United States globally, significantly limiting availability for other developing countries. According to the People’s Vaccine Alliance, which includes Amnesty International, Frontline AIDS, Global Justice Now, and Oxfam, up to 90 percent of the population in 67 developing countries might not get any vaccines in 2021. In that time, COVID-19 is projected to continue mutating, producing new variants that might not be treatable by existing vaccines.

Countries where a larger share of the population is rural face exceptional challenges to secure and distribute vaccines. Already facing limited healthcare infrastructure, even in rich countries like the U.S., there is a disparity in vaccines procured; the most rural countries have purchased only enough vaccines to fully treat 25 percent of their populations, compared to almost 90 percent of the populations of the least rural countries.

Exceptionally High Access Barriers for Predominantly Rural Countries

Sort by population Sort by coverage

  • Extremely rural
  • Rural & Semi-rural
  • Semi-urban
  • Urban

Countries highlighted in red are included and link to Foreign Policy Analytics’ COVID-19 Global Response Index. Visit the index at globalresponseindex.com for more information.

  • Purchasing Entity
  • Rural Population
  • % OF POPULATION FULLY TREATABLE BY PURCHASED VACCINATIONS
Purchasing Entity Rural Population % OF POPULATION FULLY TREATABLE BY PURCHASED VACCINATIONS
Sri Lanka
81.4%
24.1%
Nepal
79.8%
47.2%
Myanmar
69.1%
31.0%
Zimbabwe
67.8%
2.7%
India
65.5%
4.3%
Vietnam
63.4%
41.5%
Pakistan
63.1%
9.6%
Bangladesh
62.6%
10.1%
Egypt
57.3%
47.3%
African Union
53.6%
29.0%
Philippines
52.9%
43.9%
Senegal
52.3%
0.6%
Uzbekistan
49.6%
1.5%
Thailand
49.3%
44.8%
Slovakia
46.3%
18.3%
Azerbaijan
44.0%
20.0%
Indonesia
44.0%
47.2%
Serbia
43.7%
25.2%
Kazakhstan
42.5%
5.4%
Honduras
42.3%
7.5%
North Macedonia
41.8%
19.2%
China
39.7%
3.6%
Albania
38.8%
8.8%
Latin America w/o Brazil
37.5%
0
Morocco
37.0%
90.5%
Ecuador
36.0%
43.2%
South Africa
33.1%
20.1%
Panama
31.9%
58.9%
Tunisia
30.7%
8.6%
Ukraine
30.5%
26.1%
Bolivia
30.2%
35.2%
Iraq
29.3%
5.7%
Hungary
28.4%
35.8%
EU
27.4%
227.4%
El Salvador
27.3%
15.5%
Switzerland
26.2%
122.5%
Iran
24.6%
1.2%
Turkey
24.4%
62.6%
Palestine
23.6%
19.4%
Malaysia
23.4%
92.0%
Peru
21.9%
110.7%
Costa Rica
19.9%
39.6%
Mexico
19.6%
72.0%
Colombia
18.9%
50.2%
South Korea
18.6%
108.3%
Canada
18.5%
431.0%
Dominican Republic
18.2%
83.3%
USA
17.5%
199.5%
UK
16.3%
364.3%
Saudi Arabia
15.9%
4.4%
Oman
14.6%
3.7%
Australia
13.9%
246.0%
New Zealand
13.4%
242.0%
United Arab Emirates
13.2%
15.4%
Brazil
13.2%
76.3%
Chile
12.4%
243.8%
Venezuela
11.8%
17.5%
Lebanon
11.2%
14.6%
Jordan
8.8%
4.9%
Japan
8.3%
124.3%
Argentina
8%
53.4%
Israel
7.5%
176.7%
Uruguay
4.6%
53.4%
San Marino
2.6%
11.1%
Kuwait
0%
47.5%
Taiwan
0%
83.9%
Hong Kong
0%
99.9%

European Union Countries in the COVID-19 Index

  • Belgium
  • Denmark
  • Finland
  • France
  • Germany
  • Hungary
  • Italy
  • Netherlands
  • Spain
  • Sweden

Sources: Duke University Launch and Scale Speedometer, World Bank, IMF World Economic Outlook.

*Data represents confirmed and final vaccine procurement deals that specify the number of doses in the deal and that have been publicly reported as of March 15, 2021. Deals that have been announced but that do not report the number of doses are not included, nor are deals that are under negotiation or are options for future production.

**Countries where deals have been announced but doses are not reported and are unknown include: Pfizer (Kazakhstan, Qatar, Singapore, United Arab Emirates), Moderna (Qatar and Singapore), Sputnik V (Algeria, Belarus, Paraguay, Saudi Arabia), Sinovac (Singapore), CureVac (Saudi Arabia)

To date, countries (notably Kenya, Ghana, Ethiopia, and Senegal) have relied on very aggressive policy, including stay-at-home orders, early school shutdowns, and restriction of public gatherings, to limit COVID-19’s impact, but it is unclear how long they can maintain it without increased international assistance, most notably for vaccines. Failure to address these inequities will be costly—for everyone. A RAND study puts the economic damage of unequal COVID-19 vaccine allocation at $1.2 trillion per year, with losses coming heavily from contact-intensive sectors, like tourism, travel, and transportation, compared to equitable global vaccine distribution. Conversely, according to the Eurasia Group, equitable distribution could generate an estimated $153 billion in economic benefits by the end of this year, which could triple to over $460 billion by 2025 when accounting for just 10 major economies. The transnational reality of the virus and stark costs of vaccine nationalism make greater multilateral collaboration on global vaccine deployment an imperative as gaps in distribution will allow for further spread and increase the risk of additional mutations.


International Vaccine and COVID-19-Related Aid Needed

Barring any significant change, these countries will have to rely on international financial institutions and other partners to fill gaps to keep the pandemic from worsening. Significant funding commitments will be required. A full treatment of the Pfizer or Moderna vaccine costs $40 or more, which becomes very expensive for poorer nations that need to purchase hundreds of millions of doses. In addition, indirect costs to store, transport, and administer the vaccine are substantial. As such, delivery will require refrigerated vehicles, temperature-monitoring devices, and adequate roads to transport vaccines to rural locations. Glass vials, syringes, and needles are other critical supplies for vaccines that can be costly for developing nations to acquire.

Pharmaceutical companies, among other entities, have stated that they would make low-cost doses available for poorer countries, but with high-income countries already having purchased 4.6 billion doses (out of approximately 8.5 billion purchased globally), and only a few direct deals between vaccine manufacturers and low-income countries for a limited supply of doses, the latter will have to rely entirely on the approximately 13 percent of supplies purchased through global vaccine initiatives such as the World Health Organization’s (WHO) COVAX—a collaboration among governments and manufacturers that seeks to provide equitable access to COVID-19 vaccines. Even if these are all provided at discount prices, they only amount to 1.1 billion doses, enough for just the combined populations of Indonesia, Pakistan, and Brazil, for example. While the COVAX initiative is seeking to provide equitable access to both rich and poor countries, it faces serious funding concerns: at the end of last year, COVAX estimated that it needed to raise another $6.8 billion for 2021, $6 billion of which could facilitate supply and delivery to developing countries. Additional support is being mobilized; in February, the G-7 countries committed $4.7 billion to the ACT (Access to COVID-19 Tools) Accelerator, the project that oversees COVAX. The ACT Accelerator funds development and equitable rollout of tests, treatments, and vaccines. The recent pledge brings total commitments to $10.3 billion, but the Accelerator still faces a $23 billion shortfall for 2021.

As the pandemic has reversed decades of progress in international development, targeted foreign aid represents another vital means of support. Foreign, and particularly bilateral, aid details are limited, but data gathered by Cooper-Smith indicates that COVID-19-specific foreign aid, particularly from the United States government, is flowing to countries with the highest case rates.

Major Contributors of COVID-Specific Foreign Aid

$129.5B

International Financial Institutions

$10.9B

US Government

$753.8B

Global Fund (immediate funding)

$291.5B

UN Agencies

$215.B

Global Fund (flexible grants)

Source: Cooper/Smith COVID-19 Foreign Assistance Dashboard

Geopolitical Competition and the Benefits of Vaccine Diplomacy

The excessive procurement and vaccine nationalism characterizing many wealthier countries has developing and developed countries alike clamoring for supply. Eager to respond and expand their influence abroad, China and Russia have been moving quickly to fill the gap. In addition to early uptake of Chinese vaccines in the Middle East, and Russia’s Sputnik V penetrating Eastern Europe, both countries’ vaccines are making inroads across the developing world. According to data from Duke University, as of March 12, 2021, China’s vaccines have been procured by 25 countries, enough to treat 360 million people. A tally by the Associated Press in early March indicated that China has struck deals with over 45 countries around the world, though it is unclear if these deals have been finalized; nonetheless, the country has been ramping up the diplomacy and committing over 300,000 doses to U.N. peacekeepers, with priority to those in Africa.

When examining the average GDP per capita of countries that had purchased a majority of Chinese, Russian, or North American vaccines, there was a stark difference; For the lowest quartile of GDP per capital, Russia and China actually sold vaccines to more countries than North America. Countries buying pluralities of Chinese or Russian vaccines have GPDs per capita of $17,700 and $18,200, respectively, as compared with those procuring North American vaccines whose GDPs per capita average $30,900. The sales demonstrate China and Russia’s efforts to strengthen ties among least developed countries – such as Pakistan, Zimbabwe, Uzbekistan and Kazakhstan - with whom they already tend to be politically aligned, while expanding soft power elsewhere.

Vaccine Supply to Countries by Income Level


  • Low income
  • Low-middle income
  • Middle-high income
  • High income

Sources: Duke University Launch and Scale Speedometer, IMF World Economic Outlook.

The data is organized based on the national/regional origin of the vaccine manufacturer, not the production location

Leading vaccines being exported include: Europe (Oxford/AstraZeneca), North America (Pfizer/BioNTech, Moderna, J&J), China (Sinopharm and Sinovac), Russia (Sputnik V), India (Covaxin)

Data represents confirmed and final vaccine procurement deals that have been publicly reported as of March 15, 2021. This includes deals that do and do not specify the number of doses included in the deals. This graphic, updated April 2, 2021, examines whether any vaccines were procured, not how many doses.

However, while China and Russia are expanding commitments, they are facing production hurdles and must ramp up production capacity in order to inoculate their own populations and actually fulfill the deals brokered around the world.

Geopolitical competition is spurring production. With rivals facing production barriers, India—a major hub for vaccine manufacturing—has been leveraging its production capacity and reinforcing itself as a key supplier of vaccines for Asia and the developing world. While allocating the majority of production to its domestic population, India has already been supplying millions of doses across the region, pre-empting distribution of Chinese vaccines and strengthening its own diplomatic ties across Asia and around the world. India’s critical role in regional (and global) vaccine distribution and diplomacy was amplified in early March at the Quadrilateral Security Dialogue, when the Quad announced their joint commitment to provide one billion doses of vaccine to Southeast Asia, leveraging India production capacity, U.S. biotechnology, Japanese funding and Australia’s logistics. Such efforts will be key to countering China’s influence in the region, but competition among the rivals will also help accelerate access for the billions of people around the world still need of vaccines.


Looking Ahead

The proliferation of COVID-19 variants and threats of backsliding make collaborative action and more equitable distribution of vaccine imperative. Failure to accelerate vaccination globally risks lives as well as the global recovery from the pandemic, for which all countries will bear the costs. Wealthier countries, many of which have secured doses in excess of domestic need, could donate or loan doses—actions recently taken by the U.S.—and/or democratize production, as a range of leading public health experts have called for. Given pharmaceutical companies’ vaccine-production shortfalls and that the vaccines were largely produced using public money, the U.S. and EU could support technology transfer as well as the development and retrofitting of manufacturing capacity across Africa, Asia, and Latin America—as has been done by Russia, they argue. Cooperative international agreements, such as that of the Quad, which leverage countries’ relative expertise and competitive advantages, will be crucial to accelerating the response and ultimately to arresting COVID-19, and they will lay a foundation for stronger and more effective global health networks moving forward.

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