While early arrangements to secure supplies of Covid-19 vaccines are paying off for the likes of Israel, Britain and the U.S., much of the world is still waiting for anything beyond a trickle of the life-saving doses. Tempers have flared in the European Union over the bloc’s relatively slow vaccine rollout, though Covid inoculations have been much rarer in most other countries. Public health specialists warn that uneven access to the vaccines is likely to prolong the pandemic, bringing more suffering and economic pain in a way that exacerbates global inequality.

1. What’s at stake?

Health experts say the pandemic would be controlled fastest if safe and effective vaccines were deployed in the most efficient way possible, with the first doses going to groups at the highest risk -- such as medical workers, nursing-home staffers and the elderly -- everywhere in the world before supplies were used to start vaccinating whole populations, as the most privileged countries are doing. Research in December by the Eurasia Group found that leaving lower-income countries without access to vaccines during the pandemic would cause significant economic damage both for those regions and advanced economies. A study by Northeastern University in Boston concluded that monopolization of vaccines by wealthy nations -- what’s known as “vaccine nationalism” -- could cause almost twice as many deaths as distributing them equally. One risk in allowing the SARS-CoV-2 virus to remain rampant in some parts of the world is that it will have more scope to develop dangerous variants, which will inevitably make their way elsewhere and may not be neutralized by existing vaccines.

2. How are some countries first in line?

• Israel has vaccinated a greater percentage of its population than any country -- 53% were fully vaccinated by the end of March -- through a supply deal struck with Pfizer Inc. Facing re-election, Prime Minister Benjamin Netanyahu offered to pay roughly $30 per dose for Pfizer’s shot, about 50% more than the U.S. government. He also agreed to share countrywide data on the vaccine in what amounts to a large-scale effectiveness study.

• The U.S., with 4% of the world’s population, had injected about a quarter of the world’s Covid vaccine doses as of the end of March, according to Bloomberg’s Vaccine Tracker. As part of its multibillion-dollar Operation Warp Speed program hastening the development of Covid vaccines, the U.S. used wartime powers to require manufacturers to fill massive U.S. government orders first, amounting to a de facto ban on vaccine exports. In exchange, companies have received crucial aid procuring supplies, including through the Defense Production Act, which grants the U.S. president extraordinary powers over manufacturing in times of crisis.

• The U.K. got a jump on other countries in part by being the first to authorize a Covid inoculation for emergency use apart from China and Russia, which deployed domestically developed vaccines before they’d undergone full testing. In the months prior to that Dec. 2 move, the U.K., like the U.S., had signed contracts securing doses from a variety of vaccine-makers, increasing the chances it would have access to the early winners. Health Secretary Matt Hancock has said that the government’s deal with U.K.-based AstraZeneca Plc gives the country priority access to the vaccine that has formed the backbone of the British campaign.

3. Why has the EU’s rollout lagged behind?

For a number of reasons. For one thing, the EU moved relatively slowly locking down supplies, and it couldn’t compete with copious spending by the U.S. vaccine program. Secondly, regulators in some European countries have been particularly cautious. They have at various times suspended administration of the AstraZeneca vaccine and put age restrictions on its use in light of concerns about a possible connection to blood clots and an initial lack of data about efficacy in the elderly. Finally, the EU, unlike the U.S. and U.K., has exported large quantities of Covid vaccines. As of late March, companies had shipped 77 million doses out of the bloc, compared with the 62 million that had been administered to EU citizens. EU officials have repeatedly threatened to bar such exports.

4. Where does this leave other nations?

A handful of countries with modest populations have procured enough doses to inoculate significant portions of their people. They include Chile, the United Arab Emirates, Bahrain, the Maldives, the Seychelles and Monaco. But the majority had vaccinated at most 1% or 2% by the end of March, and many had yet to administer a single shot. Because many middle and low-income countries have no ability to sign contracts for Covid vaccines on their own, they are largely dependent for supplies on Covax, an initiative backed by groups including the World Health Organization designed to level global access to the inoculations.

5. How does Covax work?

Funded by contributions from governments and private organizations, Covax has secured contracts with vaccine manufacturers and plans to distribute at least 2 billion doses, two-thirds of them to lower-income economies, by the end of 2021. Its goals have been challenged by India’s decision in March to pare back shipments so that more supply can be kept for domestic use as a new wave of infections emerges there; India’s Serum Institute, the world’s biggest vaccine manufacturer, is a key Covax supplier. At the end of March, Covax had shipped about 32 million vaccines to 70 participants, a figure equal to 6% of the roughly 574 million doses given worldwide.

6. Will countries with ample supplies share them?

Rich countries have been more willing to donate money to Covax than to share their actual or contracted supplies, but some have pledged to do so. Covax plans to create an exchange for that purpose. Countries including Norway, the U.S. and the U.K. have promised to contribute, but details have been scarce. Separately, the U.S. announced plans to send neighboring Mexico and Canada about 4 million doses of the AstraZeneca vaccine, which isn’t authorized for use in the U.S.; the shipments were described as a loan, to be paid back in the future with the same or a different vaccine. New Zealand has secured contracts for enough vaccines for its population plus that of six neighboring Pacific island states and has offered them free doses.

7. What about vaccines from China and Russia?

While most countries with access to vaccines have taken a nationalistic approach, Russia and China are doling out doses, albeit modestly, to other countries, using them as a tool of diplomacy. China has sent vaccines to dozens of countries including Turkey, Indonesia and the U.A.E.; Russia has exported its Sputnik V vaccine to, among other places, Argentina, Mexico and Kenya. According to detailed trial results published in February, Sputnik V proved safe and highly effective. China has been less transparent with results for the two vaccines it’s exporting, from Sinovac Biotech Ltd. and state-owned Sinopharm, leading to some concerns about their quality. A 2018 scandal that uncovered instances of Chinese vaccine-makers cutting corners hurt the industry’s global reputation.

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