Global Equity Challenges in COVID-19 Vaccine Purchasing

A rush to preemptively secure COVID-19 vaccines resulted in high income countries hoarding an excess supply while low- and middle-income countries are prevented from equitable access. Previous work on equity in vaccine purchasing has compared cases per million of COVID-19 to vaccination coverage but does not reflect urgent pressures placed on healthcare systems. This analysis investigates vaccination coverage against three measures of COVID-19 burden: deaths per 100,000 population, general hospital capacity reached, and ICU capacity reached, in order to identify the countries overburdened and underrepresented in vaccine purchasing. Publicly available data from the Duke Launch & Scale Speedometer, IHME COVID-19 projections, and Johns Hopkins COVID-19 mortality reports are used for this analysis. While non-high-income countries comprised 64% of this dataset, they represented 93% of countries in ICU crisis, 87% in general hospital capacity crisis, and 85% in a mortality crisis. This data provides evidence for the creation of a priority list for equitable global allocation of vaccines to low- and middle-income countries. High income countries can be incentivized to redistribute their excess vaccine supplies by reframing measures of pandemic progress away from nationalistic targets.