The impact of delayed access to COVID-19 vaccines in low- and lower-middle-income countries

Abstract

IntroductionA majority of low-income (LIC) and lower-middle-income countries (LMIC) were unable to achieve at least 10% population coverage during initial vaccine rollouts, despite the rapid development of the coronavirus disease 2019 (COVID-19) vaccines. Nearly three years into this pandemic, evaluating the impact of inequities in vaccine access, uptake, and availability is long overdue. We hypothesized that a delay in receiving COVID-19 vaccines was associated with an increased toll on cumulative cases and mortality. Furthermore, this relationship was modified by the size of a country's economy.MethodsWe performed an ecological study assessing these relationships, in which a country's economic standing was assessed by world bank income classification, gross domestic product based on the purchasing power parity (GDP PPP) per capita category, and crude GDP PPP.ResultsCountries with the smallest economies reported first vaccination much later than larger economies on all three rankings, as much as 100 days longer. Among low-income countries, a one-day increase until the first vaccination was associated with a 1.92% (95% CI: 0.100, 3.87) increase in cumulative cases when compared to high-income countries (p = 0.0395) when adjusting for population size, median age, and testing data availability. Similarly, among the lowest GDP PPP countries a one-day increase until the first vaccination was associated with a 2.73% (95% CI: 0.100, 5.44) increase in cumulative cases when compared to the highest GDP PPP countries (p = 0.0415). When modeling cumulative mortality, effects in the same direction and magnitude were observed, albeit statistically non-significant.ConclusionEconomic standing modified the effects of delayed access to COVID-19 vaccination on cumulative cases and mortality, in which LMICs tended to fare worse in outcomes than high-income countries despite the eventual rollout of vaccines. These findings highlight the importance of prioritizing equitable and timely access to COVID-19 vaccines across all countries, irrespective of economic size. Future studies should examine the impacts that vaccine inequities had on local transmission dynamics.

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“…27 Low vaccination rates in low-and-middle-income (LMICs) African countries are partly due to the inequitable distribution of vaccines caused by constrained financial resources to support competing priorities in underdeveloped health systems and bottlenecks in the supply chain which may lead to delayed vaccine rollout. 28,29 Studies have also reported that pregnant women did not receive COVID-19 vaccines due to their limited availability in Africa, perhaps an indication of the inability of pharmaceutical companies to manufacture vaccines in Africa, and the compromised quality of the vaccines manufactured by international pharmaceutical companies for the African market. 27,30 COVID-19 vaccination uptake is also hampered by the low-risk perception of the pandemic, concern about adverse vaccine effects, low vaccination awareness, and low acceptance, intention and willingness to get vaccinated.…”

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“…The Africa region represents one-fifth of the global population, but in 2021 it received just 3% of all COVID-19 doses 16. While the number and types of vaccines delivered to the Global South have increased over time, countries in the Global South have been the most disadvantaged in obtaining access to the most effective vaccines 17. Prices for some vaccines were sometimes higher in the Global South than in the Global North (see table 1).…”

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“…A systematic study to assess the impact of delayed supply of COVID-19 vaccines indicated that only 25% of the population in low-and lower-middle-income countries received at least one dose of vaccine as of October 2022. 1 Ensuring an adequate supply of COVID-19 vaccines for low-and lower-middle-income countries (LMICS), which constitute 85% of the global population, is essential. The rapid rollout of COVID-19 vaccines saved millions of lives globally.…”