Here’s just how unequal the global coronavirus vaccine rollout has been

Patent waivers could -- eventually -- help address the dramatic gap between “haves” and “have-nots.”

Updated May 6 at 6:13 p.m.Originally published April 22, 2021

The Biden administration on Wednesday threw its support behind a proposal to waive intellectual property protections for coronavirus vaccines, paving the way for potentially tense talks at the World Trade Organization.

Those who support the move frame it as a step toward vaccinating the world, while vaccine makers argue that it would undermine innovation without helping near-term supply issues

Although the fate of the proposal remains uncertain, the need for some type of action on vaccines seems clear to most.

In 2021, the globe has been split into coronavirus vaccine “haves” and “have-nots,” creating a gap that may define the next phase of the pandemic.

Using publicly available figures from Our World in Data, The Washington Post found that 45 percent of all vaccine doses administered so far have gone to just 16 percent of the world’s population in what the World Bank considers high-income countries.

Through the summer and fall of last year, wealthy nations cut deals directly with vaccine-makers, buying up a disproportionate share of early doses — and undermining a World Health Organization-backed effort, called Covax, to equitably distribute shots.

[Mapping the worldwide spread of the coronavirus]

So now, in a small number of relatively wealthy nations, including the United States, doses are relatively plentiful and mass immunization campaigns are progressing apace. But much of the world is still struggling to secure enough supply. For many, herd immunity is many months — if not years — away, which could extend the crisis.

A team at Duke University’s Global Health Innovation Center recently found that high-income countries locked up 53 percent of near-term vaccine supply. They estimate that the world’s poorest 92 countries will not be able to reach a vaccination rate of 60 percent of their populations until 2023 or later.

The front of the pack

Israel has so far immunized the largest number of people per capita. As of May 6, nearly 60 percent of Israelis had received at least one dose and 56 percent were fully vaccinated, according to Our World in Data. Though Israel was later than some countries to sign vaccine deals, it offered to pay premium prices and give drug companies access to its health-care data. The country reportedly spent $788 million on coronavirus vaccines by March, most notably on a large shipment of Pfizer-BioNTech’s RNA vaccine. While Israel has been criticized for neglecting the Palestinian population in its midst, its vaccination campaign has otherwise been deemed a success and has allowed the return of a more normal way of life, including the lifting of outdoor mask requirements.

People sit at a cafe in Tel Aviv on April 19. Israel has vaccinated enough people to be able to lift mask mandates outdoors. (Corinna Kern for The Washington Post)
People sit at a cafe in Tel Aviv on April 19. Israel has vaccinated enough people to be able to lift mask mandates outdoors. (Corinna Kern for The Washington Post)

[Israel’s ahead-of-the-world vaccine rollout offers hope for countries lagging behind]

Britain is another country leading the way. Between developing, buying and administering vaccines, the country will spend about $16 billion, according to a National Audit Office estimate. To stretch supply as far as possible, Britain opted to space doses by several months, meaning that while 52 percent of the country has had at least one shot, just over 23 percent is fully vaccinated. The campaign was set back when concerns about rare blood clots in people receiving the AstraZeneca vaccine led the government to restrict use in adults under 30. Still, early studies in Britain show significant reductions in infections and hospitalizations after a first dose of the AstraZeneca or Pfizer vaccines. And the country has been able to slowly begin lifting its lockdown.

The United States, after experiencing one of the world’s most deadly outbreaks, is now the envy of the world with its abundant vaccine supply and rapidly progressing inoculation campaign. The country spent billions on vaccine development, deals and distribution. About 45 percent of U.S. residents have received at least one dose and more than 23 percent are fully vaccinated.

Since coming into office, the Biden administration has faced calls to address vaccine inequalities, either by donating doses to other countries or boosting global supply by making it easier to transfer technology around the world.

Late last month, as the coronavirus crisis in India intensified, the administration announced plans to share up to 60 million AstraZeneca doses with countries in need once a federal safety review is conducted. Wednesday’s announcement on patents could be a step toward upping supply, though many stress that a waiver alone is not enough.

[U.S. could have 300 million extra vaccine doses, raising concerns about hoarding]

Chile is another vaccination standout, though it has not yet escaped the grips of the pandemic. Chile moved quickly to secure a high number of potential doses. It now leads the Western Hemisphere in inoculations per capita, with about 43 percent of the population having received a dose and more than 36 percent fully vaccinated. At the same time, new cases of covid-19 recently surged because of new variants, lockdown fatigue and reliance on a Chinese vaccine that’s proved less effective than Western offerings.

A covid-19 patient on a ventilator is treated at the intensive care unit of Felso-Szabolcsi Hospital in Kisvarda, Hungary, on April 13.
A covid-19 patient on a ventilator is treated at the intensive care unit of Felso-Szabolcsi Hospital in Kisvarda, Hungary, on April 13. (Attila Balazs/EPA-EFE/Shutterstock)

Hungary, too, bet on as many as vaccines as it could, breaking with the European Union’s collective purchasing effort to cut bilateral deals for Chinese and Russian-made vaccines. About 43 percent of people there have had a dose, but the country still saw a spring surge in deaths.

Both Canada and the European Union have much more vaccine than much of the world, but their immunization campaigns are the source of significant anger and political blowback. Despite numerous advance purchase agreements, Canada has struggled to secure and smoothly administer actual doses, leaving residents seething as cases climb. European officials, meanwhile, have faced criticism for taking too long to negotiate deals, leading to a delayed rollout and a variant-fueled spring surge. The E.U. is now accelerating its vaccination campaign and hopes to match the United States by July.

Stuck in the middle

Among countries that the World Bank classifies as either lower- or upper-middle income, vaccination campaigns are for the most part going slowly.

Brazilians wait to receive a dose of the AstraZeneca vaccine during a vaccination day for those 57 and older in Duque de Caxias, near Rio de Janeiro, on April 21.
Brazilians wait to receive a dose of the AstraZeneca vaccine during a vaccination day for those 57 and older in Duque de Caxias, near Rio de Janeiro, on April 21. (Ricardo Moraes/Reuters)

Though Serbia — an upper-middle-income country that cut deals for both Chinese and Russian vaccines — has fully vaccinated about 29 percent of its population, few others come close.

Brazil, a populous, upper-middle-income country, for instance, is losing thousands of people a day to the coronavirus. Less than 15 percent of the people there have had a dose, and the nation’s variant-fueled outbreak is turning into a regional superspreader event.

Another worrying case is India, a leading maker of coronavirus vaccines that is struggling with its domestic rollout amid a monumental surge in cases. Less than 10 percent of the population has had at least a dose and just about 2 percent is fully vaccinated, per Our World in Data estimates.

[India’s devastating outbreak is driving the global coronavirus surge]

With supply tight, China and Russia have engaged in vaccine diplomacy, donating or selling doses to countries in need in an apparent bid for influence. Pakistan, for instance, has received doses from Chinese vaccine-makers and Russia’s Sputnik V vaccine is selling on the private market. So far, less than 1 percent of the population has been vaccinated.

Left behind

For many countries, vaccination campaigns are just getting started.

Covax, the WHO-backed push to distribute doses, aims to deliver enough for 20 percent of participating countries by the end of the year but may struggle to meet that target. Though shipments have arrived in some countries, the number of doses is limited and upcoming shipments may be delayed.

[Nearly 20 percent of the U.S. population is fully vaccinated. Many countries may not hit that target this year.]

A worker prepares to store boxes of vaccine in a cold room as the country receives its first batch of coronavirus vaccines under Covax in Accra, Ghana, on Feb. 24.
A worker prepares to store boxes of vaccine in a cold room as the country receives its first batch of coronavirus vaccines under Covax in Accra, Ghana, on Feb. 24. (Francis Kokoroko/Reuters)

Ghana received the program’s first doses in February, for instance, but like most lower-middle-income economies, has significantly less than it needs. Less than 3 percent of people have received a dose, according to an Our World in Data estimate from May 6.

In Nigeria, where officials are battling both a shortage of supplies and vaccine hesitancy, less than 1 percent of people had a dose.

A small number of countries, including Tanzania, have indicated they have no need for vaccine — though that may change as the pandemic grinds on.

About this story

Vaccination data from Our World in Data, Duke University and the Centers for Disease Control and Prevention. Population data from the World Bank and United Nations, rounded to the nearest million. Country income classifications from the World Bank. Silhouettes from Wee People.

Atthar Mirza is a graphics reporter and animator working on interactive storytelling.
Emily Rauhala writes about foreign affairs for The Washington Post. She spent a decade as an editor and correspondent in Asia, first for Time magazine and later, from 2015 to 2018, as China correspondent in Beijing for The Post. In 2017, she shared an Overseas Press Club award for a series about the Internet in China.