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COVID-19 wrap: success, challenges and inequities in the global vaccine rollout

Introduction by Croakey: National Cabinet is expected to decide tomorrow on a series of options to address significant glitches in Australia’s vaccine rollout to date, including mass vaccination sites (as vaccine supplies increase) and bringing forward vaccinations for Australians over 50.

Australian Medical Association President Dr Omar Khorshid addressed the National Cabinet on Monday, and today was calling for “clear changes to ‘reset’ the vaccination program”, including mass vaccinations and better managing vaccine hesitancy.

The Public Health Association of Australia (PHAA) and Médecins Sans Frontières (MSF) have their sights beyond just Australia.

They are calling on healthcare and public health professionals and academics to back this petition urging the Australia to push for greater global equity in the vaccine rollout, including the waiver of Trade and Intellectual Property Rules (TRIPS) for COVID-19 vaccines.

The PHAA is hosting a webinar tomorrow (Thursday 22 April) to discuss what the Federal Government can contribute to a fairer distribution and adequate supply of vaccines globally, and the role health workers and academics can play in holding it to account.

It comes amid ongoing concern about the COVID-19 toll and risk in Papua New Guinea and its implications for the region, outlined here by Professor Brendan Crabb AC and Professor Mike Toole from the Burnet Institute.

Meanwhile, according to the World Health Organization, new cases of COVID-19 increased for the eighth week in a row, with more than 5.2 million cases reported — the most in a single week so far, and with infections and hospitalizations among people aged 25 to 59 “increasing at an alarming rate”.

That all makes for a very timely COVIDWrap from public health researcher Alison Barrett, who looks at how vaccines have been rolled out in other countries, and what have been strengths and weaknesses for their own populations and for global health.


Alison Barrett writes:

Another grim milestone in the COVID-19 pandemic was met last week, as three million global deaths were reached on Saturday 18 April 2021.

Worryingly, in recent weeks, COVID-19 cases and deaths have risen in some countries including, but not limited to, India, Papua New Guinea, and Brazil, resulting in devastating human loss and impact to healthcare systems.

Dr Maria van Kerkhove, head of the World Health Organisation’s COVID-19 technical response, said at a press conference on 12 April 2021:

We are in a critical point of the pandemic right now. The trajectory of this pandemic is growing. For the seventh week in a row we’ve had more than 4.4 million new cases reported in the last week…. This is not the situation we want to be in 16 months into a pandemic, where we have proven control measures. It is time right now when everyone has to take stock and have a reality check about what we need to be doing.”


In addition to maintaining standard COVID-19 prevention control measures (handwashing, physical distancing, contact tracing and testing), vaccinating the global population will be required for the pandemic to end.

As of 20 April 2021, 203 million people have been fully vaccinated for COVID-19, which is 2.62 percent of the globe’s populations. This is a long way off the 60-70 percent that the World Health Organisation (WHO) have estimated will provide global herd immunity.

Snapshots across the globe

While some countries are forging ahead with their vaccine roll-out, some, including Tanzania, Cuba and Bosnia-Herzegovina, have only recently started or yet to begin.

Reasons for the slow or non-existent start to vaccine roll-outs vary between countries.

Throughout the pandemic, Tanzania’s leaders denied the pandemic was an issue, and have made the decision to not secure vaccines for their people.

Cuba, on the other hand, managed the pandemic very well with a strong public health system, a strong community of volunteers and following evidence-based recommendations.

It began production of COVID-19 vaccines in 2020 and currently has four COVID-19 vaccine candidates in development, one of which is due to begin a phase 3 trial in April, which it will use to immunise its population.

Due to an increase in COVID-19 cases and the economic impact of the pandemic in Cuba, there is some urgency for a vaccine.

However, assuming the phase 3 trial is successful, it is confident it will be able to manufacture enough doses to vaccinate the country by the end of the Northern Hemisphere’s summer.

Again, with the caveat of an effective vaccine, Cuba also plans to export at low cost to other countries.

Bosnia-Herzegovina’s leaders did not secure sufficient vaccines, largely a result of the fractured health and political system since the Bosnian war in the 1990s.

It has received some vaccines from Turkey, China, Serbia and via COVAX, a joint initiative between WHO, Gavi Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations, developed to enable an equitable distribution of vaccines.

Successful strategies

Leading the way in full vaccinations are Gibraltar (a country of 33,691 people near Spain) which has fully vaccinated 90 percent of its population, followed by Israel, at  57.5 percent, Chile 28.4 percent, and the United States, 25.2 percent.

Gibraltar is a British Territory and benefited from a sufficient supply of the Pfizer-BioNTech vaccine from the United Kingdom. Its small population and geographical size also helped.

Reasons for Israel’s successful vaccination rollout are largely due to a centralised government that had primary responsibility for the planning and implementation of the rollout; a nation-wide electronic medical record system; and an agreement with Pfizer, where Pfizer will ensure Israel has a sufficient supply of the vaccine and Israel will provide Pfizer epidemiological data from its vaccine program.

The Israeli Government recently implemented a “green pass” that allows vaccinated people access to gyms, hotels, restaurants and other social events; this was discussed in more detail in a recent COVID-19 wrap.

Chile’s President Pinera negotiated for contracts with multiple pharmaceutical companies, enabling them to have access to a diverse range of vaccines.

As Chile hosted phase 3 clinical trials for AstraZeneca, Johnson & Johnson, Sinovac and CanSino vaccine candidates, these negotiations were made easier.

Chile’s prompt rollout was also helped by the implementation of mass vaccination clinics and previous experience in mass immunisation programs.

Despite vaccinating nearly a third of its population, Chile is experiencing a rise in COVID-19 cases and recently introduced new lockdowns, highlighting the importance of maintaining standard COVID-19 prevention measures, until the pandemic is properly under control.

After its devastating response to the pandemic, it is pleasing to see the United States’ vaccine rollout progressing well.

While it has not been without issues, including with the ultra-cold storage of Pfizer’s vaccine and vaccine booking websites, the US rollout has progressed with the implementation of mass vaccination clinics and ramping up of vaccine manufacture. More can be read about its mass vaccination program in a recent Croakey piece here.

Similar to Chile, the US purchased many vaccines, and from multiple pharmaceutical companies through its Operation Warp Speed program.

Unequal spread

While the US have fully vaccinated nearly one-quarter of its population, the distribution of vaccines has been unequal.

Demographic data published by the US Centers for Disease Control and Prevention show that of the Americans who have received at least one vaccine dose, 8.6 percent are Black Americans and 11.6 percent are Hispanic/Latino populations, compared to 64.5 percent White, non-Hispanic Americans.

Disproportionate access to, and distribution of, vaccines is not an issue unique to the US.

This map clearly shows the unequal proportion of vaccines administered between countries worldwide, with higher-income countries administering a greater proportion of vaccines than many lower income countries in Africa, South East Asia and Central and South America.

Image sourced from Our Word in Data, licensed under Creative Commons for sharing.

Members of the Lancet Commission on COVID-19 Vaccine and Therapeutic Task Force recently questioned whether  the United States’ Operation Warp Speed would benefit the global distribution of vaccines.

An analysis by global health data experts at the Kaiser Family Foundation, in the US, highlighted that high-income countries, that account for only 19 percent of the global adult population, have purchased 54 percent of vaccines.

Conversely, lower-middle-income countries, that account for 81 percent of the global adult population have purchased 33 percent of vaccines.

COVAX has purchased the remaining 13 percent of vaccines.

Urgent call for global action

Associate Professor Deborah Gleeson, from La Trobe University, explained some of the challenges that COVAX are facing in accessing more vaccines here in this earlier article at Croakey.

Vaccine inequities will reduce if higher-income countries redistribute some of their doses to lower-middle-income countries.

WHO’s Director-General Tedros recently requested help:

First, we call on countries who have enough vaccines to cover their entire populations many times over to make immediate donations to COVAX – not in several months’ time, but now. Please donate now.”

The Medecins Sans Frontieres and Public Health Association of Australia are calling on healthcare and public health academics and professionals to support and sign an open letter to the Australian Prime Minister Scott Morrison asking for Australia’s commitment to a fairer worldwide allocation of vaccines.

Different social, cultural, economic and political factors make it difficult to compare between countries’ vaccine rollouts.

In summary, it does appear that some factors that have helped with more efficient rollouts are having a sufficient supply of vaccines and implementation of mass vaccination clinics.

In contrast, some, but definitely not limited to, factors that have hindered vaccine rollouts are unstable political and healthcare systems, disbelief in the pandemic and inequitable distribution of vaccines.

Vaccines alone won’t end the pandemic, but inequitable distribution of vaccines within and between countries is bad for everyone as transmission of the virus and new variants emerge.

Dr Tedros said last Friday, The more transmission, the more variants. And the more variants that emerge, the more likely it is that they could evade vaccines. And as long as the virus is circulating anywhere, the longer the global recovery will take.”


Resources and other readings:

Weighing up the potential benefits against risk of harm from COVID-19 vaccine AstraZeneca, Australian Government, 13 April 2021

Fact sheet developed by the Australian Government Department of Health to help inform patients about the potential benefits against risk of harm from the AstraZeneca vaccine.

Launch and Scale Speedometer: tracking vaccine procurement, Duke Global Health Innovation Centre, 2021

If interested in tracking the purchasing of COVID-19 vaccines, visit this website.

Opinion: 5 ways to make the vaccine rollout more equitable, by Fletcher, F and Maybank, A, NPR, 25 March 2021

Faith E. Fletcher, a senior advisor to the Hastings Center (a leading bioethics research institute in the US) and assistant professor at Baylor College of Medicine, and Dr Aletha Maybank, Chief Health Equity Officer and group vice president at American Medical Association discuss 5 ways to make the vaccine rollout more equitable.

  1. Recognise the barriers to equitable, quality health care, including structural and systemic racism, transport barriers and lack of access to internet (for booking vaccine appointments).
  2. Acknowledge, respect and address concerns, such as those surrounding the safety of the vaccines.
  3. Empower choices with truth and transparency, by clearly communicating benefits and risks of vaccines.
  4. Engage trusted community leaders to communicate consistent and trustworthy messages.
  5. Enlist trusted messengers to create and deliver the message.

The full piece can be read here.

Australia’s leadership in helping end the COVID-19 pandemic: an open letter to Prime Minister Scott Morrison, Medecins Sans Frontieres and Public Health Association of Australia, April 2021

We write as Australian health workers and academics in public health and other health disciplines who urge you to forge a strong leadership role for Australia in regards to the global provision of vaccines and other medical tools to fight COVID-19…”

The full letter can be read and signed here.


Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.

See previous editions of the COVID wrap.


COVID-19 Twitter lists

Follow this Twitter list for informed news sources, global and Australian.

Follow this Twitter list for news from Aboriginal and Torres Strait Islander health organisations and experts.

Follow this Twitter list for news from South Australia on COVID.

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