Report: Rich Countries Are Buying Up COVID-19 Vaccines, Leaving Shortages

Wealthier countries are staking claim to COVID-19 vaccines, possibly buying more doses than they need and leaving low- and middle-income countries short, according to research from Duke University.

Shortages, coupled with other distribution hurdles, could mean that the global population may not be vaccinated until as late as 2024, prolonging the pandemic and leaving some areas struggling, researchers say.

“It’s very likely that some people will never get a vaccine, or at least it’ll take a really long time for everyone to get vaccinated,” Nicole Hassoun, PhD, a professor of philosophy at Binghamton University, State University of New York, and a bioethicist studying global access to essential medicines, tells Verywell. “We need a lot more global collaboration in order to succeed.” 

Advance Deals for Vaccines 

The Duke Global Health Innovation Center has been tracking COVID-19 vaccine pre-orders around the world. Even though many vaccine candidates are still in trials, 12.1 billion doses across various vaccine candidates have already been spoken for. That number includes 8.6 billion confirmed purchases and 3.5 billion under negotiation or earmarked for expansion under existing contracts.

“A country can sign with any pharmaceutical company that’s developing a vaccine,” Farley Cleghorn, MD, MPH, an epidemiologist and global head of health practice at Palladium, tells Verywell.

Deals come in the form of direct purchasing power, investment in research and development, large-scale manufacturing and development agreements, and the hosting of clinical trials, according to the Duke analysis.

Through these deals, wealthier countries have put their eggs in multiple baskets by reserving shots across various vaccine candidates. Canada, for example, has enough doses to vaccinate residents five times over, reports the Duke study. However, the vaccine candidates in the country’s portfolio may not all receive approval.

Canada, the United States, the United Kingdom, Australia, Japan, and 27 member states of the European Union have claimed about half of the initial production capacity of the current leading vaccine candidates AstraZeneca, Pfizer, and Moderna, according to an article in Nature. “That’s only 13% of the population that has 50% of available vaccine doses,” Hassoun says.

High-income countries have purchased a confirmed 4.1 billion doses. Upper middle-income nations have secured 1.1 billion doses. And lower middle-income countries hold more than 1.9 billion doses. But the Duke researchers say they haven’t found evidence of direct deals for vaccine purchases from low-income countries. And even middle- to lower middle-income countries that do have some direct deals have not secured enough doses to vaccinate their whole populations.

Vaccine Access Inequities 

In the absence of direct-purchase deals, countries are relying on a program called COVAX for vaccines. COVAX was launched to help get COVID-19 vaccines to all parts of the world by providing member countries equal access. It is an arm of the World Health Organization’s Access to COVID-19 Tools (ACT).

COVAX works like this: High-income nations that are part of the COVAX Facility commit to purchasing a set amount of vaccine doses that will be distributed fairly and equitably across countries. Middle- and low-income countries in the alliance then gain access to doses that will be primarily funded through donations. In this way, self-funded countries can purchase different levels of vaccine coverage for residents, and lower-income countries will receive enough doses to vaccinate 20% of their populations.

Most of the world’s population lives in countries that are part of the COVAX Facility, according to the Duke report. WHO lists 98 high-income countries that are part of COVAX, with the U.S. notably absent from the list. And 92 low- and middle-income countries in the alliance are eligible for COVAX support. 

But with higher-income countries buying up doses through direct deals with pharmaceutical companies, COVAX could face vaccine shortages for lower-income nations, the Duke report says.

“You can understand why countries would enter into bilateral deals or not participate in the initiative,” Hassoun says. “But at the same time, I think that’s highly inequitable. It would have been much better if everyone would have collaborated for equitable distribution through COVAX.”

What Happens to a Country’s Dose Surplus?

According to the Duke study, Canada leads the world in terms of confirmed vaccine dose purchases based on population. Though the country has purchased more than 400 million doses of seven vaccine candidates, it's possible not all of those vaccines will be approved. But if a nation does wind up with a surplus, where will those doses go?

“The hope is they would donate those and make those available at a really low cost through the COVAX initiative,” Hassoun says.

The Coalition for Epidemic Preparedness (CEPI), a fellow founder of COVAX, is negotiating with the self-financing countries in the alliance that secured doses through outside deals to see if surplus vaccines could be shared with COVAX, according to the Duke report.

The U.S., not part of COVAX, has secured more than 1 billion doses across six vaccine candidates, enough to vaccinate 200% of the population based on COVID-19 burden, according to the Duke data. Again, it's possible that not all of those candidates will be approved, however.

Additional Barriers to Global Vaccine Distribution

A dose deficit won’t be the only hurdle in vaccinating populations in lower-income countries. And the challenges may depend on the specific vaccine available. “Some can be refrigerated, basically,” Hassoun says. “Others require ultra-cold storage, dry ice, special storage boxes.” 

Whether a vaccine will require more than one dose will also be a concern if people have to travel long distances over rough terrain or in difficult conditions to receive multiple shots. And because of these challenges, different vaccines will likely be targeted to different places, she added.

Funding will also be needed to address obstacles to procurement and distribution, the Duke report says. The World Bank has recently committed $12 billion to COVID-19 vaccine efforts in low-income countries.

The Importance of Global Vaccination

Even though the U.S. and other countries have had large-scale vaccine production since the middle of the last century, we’re in uncharted territory with vaccine efforts for the COVID-19 pandemic.

“We’ve never vaccinated the world before,” Cleghorn says, explaining that a global pandemic is a unique circumstance. “Childhood vaccinations are targeted to children. Catch-up vaccinations are targeted to people who didn’t get their vaccinations. Travel vaccinations are for travel…” He says the need versus the supply will evolve in phases.

But Hassoun says whatever hurdles we face for vaccinating the entire world as quickly as possible need to be looked at immediately and as an exercise for our future—and for global public health in general. We could face pandemics with even higher death tolls down the road, and vaccination efforts shouldn’t take years. “This isn’t going to be the only pandemic,” she says. “There have always been other pandemics. There always will be. In fact, there’s lots of ongoing pandemics.” 

She says when countries aren’t onboard with programs to vaccinate everyone around the globe, or are thwarting those strategies, it becomes a moral issue. “Everyone’s life is as valuable to them as your life is to you,” she explains. “I think that we need to ensure that everyone has access to essential medicines as a matter of human rights globally.” 

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