Alex J Choi, Crean Lutheran High School, Irvine, California, USA
ABSTRACT
Throughout the pandemic, experts and the World Health Organization have criticized the imbalanced distribution and administration of the SARS-CoV-2 (COVID-19) vaccine due to wealth disparities among countries. This paper reports the results of the analyses that examine the relationship between a country’s vaccination status and wealth. Data for the number of vaccinated individuals per hundred was collected from a global public dataset, which tracked the scale and rate of vaccine rollout in each country. A statistical analysis was performed to determine if there was a correlation between the number of people vaccinated per hundred and GDP per capita. The analysis showed no correlation or weak correlation in early 2021. Most countries, including low-income and low-resource countries, commenced COVID-19 vaccination within a half year after the first global COVID-19 vaccine administration in December 2020. However, the correlation between the vaccination rate and the GDP per capita steadily increased until July 2021 and remained high until November 2021. The analysis was also done for the COVID-19 booster data based on the country’s income level, and results indicated a statistically significant difference between the country’s income levels. Thus, the analyses demonstrate that the disparities between low-income and high-income countries continually increased as more vaccines became available in the first half of 2021, and vaccine nationalism was continuously prevalent in the second half of 2021.
INTRODUCTION
Many public organizations and private companies collaborated to develop vaccines for SARS-CoV-2 (COVID-19) to ensure that COVID-19 vaccines were made available to the public as quickly as possible. The first COVID-19 vaccine was administered in the United Kingdom on December 8, 2020 (Triggle, 2021), and many other countries followed suit with their own vaccination programs. However, there have been strong criticisms regarding the disproportionate distributions between these programs. Namely, the World Health Organization (WHO) commented on the “shocking imbalance” in the distribution of COVID-19 vaccines in April 2021 (“Director-General’s,” 2021). An article published in Infectious Disease News in May 2021 highlights that there was greater accessibility to vaccines in high-income countries compared to low-income and low-resource countries (Stulpin, 2021). This paper examines how the vaccine imbalance has changed over time using the correlation between the number of vaccinated people per hundred and the GDP per capita for various countries. This paper also analyzes the COVID-19 booster shot data to compare the number of countries that started booster shots based on different income levels.
METHODS
Data obtained from the Our World in Data website was used to examine the relationship between vaccine availability and the country’s wealth. The website provides a global public dataset that tracks the scale and the rate of the vaccine rollout in each country. This dataset is updated regularly and includes accumulated data on the total COVID-19 positive cases, population-adjusted number of people who received at least one dose of vaccines, population-adjusted number of people who received booster shots, etc., for all countries for which data are available. The dataset covers the entire period from December 2020 and has been updated regularly ever since (Mathieu et al., 2021). As of November 30, 2021, the dataset contains a total of 194 countries’ COVID-19 vaccination data.
The number of people who received at least one dose of vaccine per hundred and the GDP per capita from the Our World in Data was used to examine the correlation between vaccine availability and the country’s wealth. The correlation is a statistical measure that describes the degree of relationship between two variables (Trochim, 2021). The values range from -1 to 1, where -1.0 indicates a perfect negative correlation, 1.0 indicates a perfect positive correlation, and 0.0 shows no relationship between the two variables (“How to interpret,” 2020). The correlation between the vaccination rate and the GDP per capita will be positive if high-income countries have a higher vaccination rate than low-income countries. Also, the higher the correlation value, the greater imbalance of COVID-19 vaccine distribution. The correlation was computed between the population-adjusted number of people who received at least one dose of vaccine and the GDP per capita. This computation was repeated each month from December 2020 to November 2021.
The analysis also compared COVID-19 booster shot data against countries’ income levels. Countries that have begun the booster shots are grouped into high-income, upper-middle-income, lower-middle-income, or low-income groups based on the World Bank’s income classification criteria. Then, the differences in the number of countries in the four income-level groups were tested using the Chi-square test. This test was repeated for each month from July 2021, the month the first booster shot was administered, to November 2021. A p-value less than 0.05 shows a statistically significant difference between the four income-level groups.
RESULTS
Table 1 reports the number of countries that commenced COVID-19 vaccination and the correlation between the population-adjusted number of people with at least one vaccine dose and the GDP per capita for each month starting from December 2020. The correlation for December 2020 was -0.003, which indicates no relationship between the two variables. By December 31, 2020, 29 countries had initiated vaccine administration but were not in the top 29 wealthiest countries. The 29 countries that launched vaccination programs included Mexico and Bulgaria, ranked 71 and 72 in GDP per capita among the 194 countries in the dataset. Meanwhile, Qatar and Macao, the first and second wealthiest countries based on GDP per capita, were not among the 29 countries. Although no low-income county was able commence COVID-19 vaccine administration in 2020, it is hard to argue that countries’ wealth was the only factor contributing to early COVID-19 vaccine initiation.
Table 1. Correlation Between Vaccination Rate and GDP per Capita
The number of countries that started vaccinating their people has increased rapidly over time, as shown in Table 1. Close to 100 countries rolled out the vaccination program by the end of February 2021, and a total of 181 countries initiated COVID-19 vaccine administration by the end of May 2021. The 181 countries include the Central African Republic, Liberia, and Congo, which are low-income countries with a GDP per capita of less than $1,000. This data indicates that most countries, including low-income countries, could initiate vaccination within a half year after the first distributed vaccination.
Although there was no apparent relationship between the country’s wealth and the time of vaccine initiation, a clear trend was observed with the population-adjusted number of vaccinated people. The last column in Table 1 shows the correlation between the population-adjusted number of people who received at least one dose and the GDP per capita. The correlation was weak at the beginning of 2021: 0.14 and 0.24 in January and February, respectively. By the end of July 2021, however, the correlation was 0.7, demonstrating a strong positive correlation between the vaccination rate and the GDP per capita. Since then, the correlation has slightly weakened and was 0.65 by the end of November. The strong positive correlation values demonstrate that the vaccination rate increased as the country’s GDP per capita increased. Furthermore, this trend has become more explicit as more vaccines became available.
Various countries have been administering COVID-19 booster shots since July 2021. Table 2 below highlights that as many as 12 high-income nations distributed COVID-19 booster shots to their fully vaccinated citizens in July 2021. By November 2021, the number of countries administering Covid-19 booster shots increased to 62. High-income countries account for the highest percentage (82.2%) of nations that administered booster shots. The data in Table 2 shows that almost all lower-middle-income and low-income nations have yet to administer COVID-19 booster shots, and only a small portion of upper-middle-income nations have begun offering their citizens booster shots. Since the p-value obtained from the Chi-square test are all <0.0001, as shown in Table 2, it is clear that a statistically significant difference exists between income level groups.
Table 2. Number of Countries Commenced COVID-19 Booster Shot by Income Level
Note: The classification is based on the World Bank country classification by income level in 2021.
*Cambodia in the lower-middle-income class started vaccination in Feb 2021 and booster shots in Aug 2021.
DISCUSSION
A primary reason why inequity in vaccine rollout emerged is due to the fact that many wealthy countries pledged vast amounts of money to pharmaceutical companies to be the first to receive the vaccines when they were made available (Weintraub et al., 2020). Rich countries used their wealth to prioritize their interests, creating vaccine nationalism, which is responsible for the strong positive correlation between the number of people with at least one dose of vaccine and GDP per capita and the statistically significant difference in the booster shot data between income level groups. The correlation analysis suggests that the growing disparity shown in the first half of 2021 is slowly reducing, given the slightly weaker correlation in November 2021 than in July 2021. However, the correlation values of the second half of 2021 can be misleading since vaccination rates in wealthier nations would not increase as rapidly during this period simply because fewer citizens remain unvaccinated. Therefore, the evidence of weaker correlation values in the second half of 2021 should not be interpreted as a signal of disparity reduction. The COVID-19 booster shot data are a more accurate measure of vaccine nationalism for the second half of 2021. The booster shot data summarized in Table 2 clearly shows the continuing prevalence of vaccine nationalism in the second half of 2021.
The concern for the high vaccine disparity led to the establishment of COVAX, an initiative tasked with ensuring equitable access to COVID-19 vaccines, directed by Gavi, the Vaccine Alliance, and the WHO. The establishment of COVAX was welcomed and acted as a beacon of hope for countries facing the disparity in vaccine distribution (Binagwaho et al., 2021). The development of COVAX could be one of the leading reasons why low-income nations were able to initiate vaccination within a few months since the first global vaccine administration. However, the impact was limited, as the analysis of initial vaccine administration data and booster shot data indicated. Vaccine nationalism has made it difficult for vulnerable groups to obtain vaccines, causing a prolongation of the pandemic. In addition, studies show that vaccine nationalism is costly. A study performed by the International Chamber of Commerce found that fully vaccinating the populations of wealthy countries while neglecting developing countries could cost wealthy countries as much as $4.5 trillion in lost economic activity.
The vaccine disparity has led to various leaders of developing countries to call for temporary vaccine patent waivers. Allowing developing countries to obtain access to vaccine patents and increase vaccine production will help increase vaccine availability for their citizens. However, the issue of distributing temporary waivers for vaccine patents has been controversial. Top COVID-19 vaccine producers such as Pfizer, BioNTech, and Moderna have all condemned such an idea, noting that it would do more harm than good (Binagwaho et al., 2021). In addition, supporters of capitalism have criticized the idea, noting that it would negatively impact competition in the future and kill investments in research and development (Binagwaho et al., 2021).
Achieving vaccine equity is not merely ethical, but it also prevents the emergence of new variants and strengthens the global effort to end the pandemic. The danger of allowing a significant global population to go unvaccinated is that it will perpetuate needless illnesses and deaths, cause the pain of ongoing lockdowns, and spawn new mutations that may be hard to control (The United Nations, 2021). Furthermore, according to the International Commerce Chamber (ICC) Research Foundation, vaccine nationalism could lead the global economy into a $9.2 trillion loss, with advanced economies being the ones likely to bear the greatest loss (International Chamber of Commerce, 2021). Thus, it is vital to have solidarity among governments and public/private organizations to develop a global effort towards ending the pandemic and mitigate the issues that may develop if such actions are not taken.
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