COVID-19 VACCINE ACCESS
*Last updated on October 07, 2021
Access to Covid-19 vaccines is an issue of high global public concern. We have been tracking publicly available data on agreements to manufacture, purchase, supply and/or donate Covid-19 vaccines in order to shed light on who is likely to have access to which vaccines, from whom, and when.
A selection of graphics representing the data are presented below; the full dataset is available for download here, along with its associated README file.
KEY RESEARCH FINDINGS
LACK OF TRANSPARENCY
Not all primary arrangements are being publicly reported in a timely fashion. Those that are reported, often lack basic information such as the total number of vaccines being provided and their prices. The related terms and conditions (such as timelines for delivery, liability arrangements, flexibility to re-sell) are also often unavailable. This lack of transparency makes it challenging to draw firm conclusions about global access to COVID-19 vaccines.
Pricing information is not available for the vast majority of confirmed vaccine purchases. Based on our dataset, price estimates are unavailable for approximately 66 percent of the confirmed purchase arrangements. This availability also varies significantly among vaccine candidates.
Where pricing information is available, there are substantial variations in pricing both within and among vaccine candidates. There have been questions raised about the fairness of such variations. For example, the AstraZeneca vaccine is priced higher in Uganda (7 USD) and South Africa (5.25 USD), in comparison to the European Union (3.50 USD). Similarly, there have been conflicting reports that Brazil is paying either an estimated 1.95 USD/dose or closer to 10 USD/dose for Sinovac, whereas Ukraine is paying an estimated 18 USD/dose.
There is rarely information on how the total price and/or price per dose were arrived at, or on what is included in the reported values, making it impossible to determine at this time to what extent these variations are due to true differences in price versus differences in how the total price and/or price per dose has been calculated and reported. For example, it is possible that some countries have included shipping and handling costs or investments in manufacturing in their reported total prices and others have not. Many of the available price estimates were reported secondhand by government officials, and the underlying contracts have not been made available to the public.
AGREEMENTS COVER AT LEAST 27 VACCINE CANDIDATES
As of September 29, 2021, seventy-seven vaccines are in late-stage (Phase 2 or 3) development and another twenty-nine are in post registration phase. We have found publicly reported purchase agreements for twenty-seven of these. A total of over 16 billion doses of these vaccines have been reserved through finalised agreements.
Among these 27, Pfizer/BioNTech has publicly committed to supply the greatest number of doses – at over 4.7 billion doses, (followed by AstraZeneca at approximately 3.4 billion doses). The majority of doses from Pfizer/BioNTech (80%) and Moderna (64%) have been reserved by high income countries, but no bilateral agreements have been reported with low-income countries. In comparison, AstraZeneca/Oxford, Johnson & Johnson and Novavax have a greater distribution among LMICs. Vaccines developed in middle income countries (China, India and Russia) are predominantly reserved by the developer country or other middle income countries. Low-income countries have bilaterally reserved very small amounts of any of these vaccine candidates.
Based on current estimates, it is unlikely that enough vaccines will be manufactured in 2021 to meet global demand or achieve global population immunity. Several new agreements of Pfizer/BioNTech and Moderna now include delivery commitments for 2022 and beyond. There is ongoing debate as to whether there will be adequate volumes of supply in 2022, but inadequate transparency from producers makes it difficult to independently estimate global supply, which countries will control that supply, and when vaccines will be delivered to whom. In addition, there are significant unknowns regarding national approaches to booster shots and vaccinating younger populations, the risk of export bans by producers of inputs and finished products, and the course of the pandemic in various countries. We are collating further data on manufacturing volumes, locations and technology transfer agreements, which can be found on our COVID-19 Vaccine Manufacturing page.
MOST OF THESE AGREEMENTS ARE BETWEEN VACCINE DEVELOPERS AND GOVERNMENTS
The majority of purchase agreements in the dataset are between vaccine developers and governments or intergovernmental organizations (i.e., African Union, European Union, and COVAX). However, there are numerous more complicated arrangements. For example, a purchase agreement between a vaccine developer and government may also include an agreement to manufacture and/or distribute the vaccine via a local company, or a private entity may purchase vaccine doses from a vaccine developer to sell on the private market in a given country.
SIGNIFICANT DISPARITIES IN VACCINE ACCESS PERSIST
Countries with the means to do so began making advance purchase agreements for vaccines in the second and third quarter of 2020, before there was data available on which, if any, of the vaccines would prove to be safe and effective. High income countries have finalised agreements that would allow them to fully vaccinate their population three times over . In contrast, through bilateral arrangements, upper middle income countries have secured enough for 42.05% population coverage, and lower-middle income countries have secured for 45.47% population coverage, with the Philippines being the only LMIC that has secured enough for 100% of its population. This may be a significant underestimate, however, as middle-income countries such as Russia and China are able to produce significant volumes of vaccines, but public information on total volumes to be produced and/or exported is limited.
Finally, low-income countries have secured enough vaccines to cover 3.76% of the population through bilateral agreements. However, these numbers exclude the 570 million doses available for African Union members to purchase through arrangements between the African Union and vaccine producers; this arrangement would equate to roughly 30.3% population coverage.
 Doses secured by the United States include 1 billion doses of Pfizer/BioNTech that the government has announced it will donate to low and lower-middle income countries.
 This includes vaccines that are yet to receive regulatory approval. Many countries have also included provisions in their contracts to buy additional doses at a later date; those optional doses are not included in the totals presented here. In addition, it is important to note that these calculations do not include donations of doses of vaccines between countries nor do they include doses anticipated through COVAX.
Purchasing agreements have been publicly announced with 117 countries or territories, the African Union, the European Union, and COVAX.
The international pooled purchasing mechanism for COVID-19 vaccines, COVAX, led by the World Health Organization, CEPI, and Gavi, the Vaccines Alliance, is intended to ensure equitable access to vaccines for each participating country. More than 180 countries – including 90 self-financing upper middle- and high-income countries, and 92 low- and lower middle-income countries – are reported to be participating in COVAX. As of September 8, 2021, COVAX reduced its supply estimates by 25% compared to its previous forecast, and it is now projecting coverage for approximately 20% of the population of the 92 low-and lower-middle income countries by the end of the year. COVAX cited disruptions in supply and manufacturing, competing orders made by countries through bilateral agreements and delays in regulatory approval as the reasons for the reduced forecast.
BILATERAL DONATIONS ARE INCREASING, BUT STILL LIMITED AND SLOW
At least 75 countries or entities have donated or made commitments to donate vaccine doses to nearly 150 different recipients, accounting for just about 11% of the total doses reserved through primary arrangements. These vaccines come from various sources such as the donor’s purchased stocks, locally produced doses or their COVAX allocations. Most of the donations in the first quarter of 2021 were mainly undertaken by only a few countries such as China, India, Russia and the United Arab Emirates (UAE). Since July 2021, the number of donors has been increasing. Several high income countries started pledging donations from June 2021, especially following two summits - the Gavi COVAX AMC summit “One World Protected” and the Group of Seven or G7 summit. The most recent commitments were announced at the Global COVID-19 Summit in September 2021.
Among the donors, the United States is poised to become the largest donor, following an announcement to purchase and donate 500 million doses of Pfizer/BioNTech, in addition to previous announcements to share about 510 million doses. The European Union and its member countries together, have also committed to sharing about 500 million doses. Individually, the next largest donor is China, which has committed to donating about 100 million doses in 2021. Other large donors include Australia, Japan, and Canada, each of which have committed to donating at least over 40 million doses.
However, only some of these commitments have been rolled out so far. For example, according to Politico, the EU had delivered just 28 million doses by September 2021. Moreover, close to one-fifth of the secondary arrangements are missing public information regarding at least one of the key details, i.e. recipients, doses allocated or which vaccines are to be donated. Among those who have started sharing doses, some have done so directly with the recipients, while others have shared through intermediaries such as COVAX or the European Union.
DOSES DONATED ONLY COVER A SMALL PROPORTION OF POPULATION
The recipients of vaccines from any given donor vary greatly by income level and region. Most donations are for fewer than 1 million doses and the doses cover only a small proportion of the recipient’s population. So far, the majority of doses committed or delivered are to lower middle-income countries (193.3 million, which includes two donations of a total 17 million doses to the African Union), followed by 99.9 million to upper middle-income countries and 32.3 million to low-income countries. Another 15 million doses are for high-income countries. Overall, low-income countries have received relatively few donations - in terms of both total doses donated and the proportion of the total population covered by these donations. From the current donations, most low-income country recipients have a population coverage of 2% or less.
Total donations by recipient region show particular trends in how recipients are prioritised. For example, while the United States and China have allocated doses globally, the total doses shared with each region varies considerably. So far, the United States is the single largest donor in all regions (except the Middle East and North Africa), with the largest allocations for the Latin America and Caribbean region. China has also made significant donations in nearly all regions, while sending the most doses to East Asia and the Pacific, and South Asia. Japan has also allocated most of its doses for these same regions. Australia has shared doses only with countries in the East Asia and Pacific region. Portugal has allocated doses to Portuguese-speaking African countries and Timor Leste, while Spain has announced donations for Latin America and Caribbean countries.
The poor coverage in low-income countries and regional variations in donations, suggests that so far recipients are being selected not just on the basis of financial and/or epidemiologic need, but based on diplomatic and strategic relationships. This data is evolving as more allocations are made public.
Following announcements from several countries pledging to donate their vaccines either directly to COVAX or to other countries through COVAX, the total dose donations committed to COVAX are now at over 1 billion. Finalised commitments have been announced by several countries. Among these, the United States, United Kingdom, Canada, France, Spain, Germany, Japan, and the Netherlands, have each pledged at least 10 million doses.
However, delivery of these doses is only just beginning and most allocations are yet to be announced. So far, among the recipients of doses donated through COVAX, only a small amount has been earmarked for low-income countries. With a few exceptions, COVAX’s role in the allocation of doses donated through them remains unclear.
Apart from governments, some vaccines have also been donated by private companies (such as the Alrosa diamond mining company) or other charitable organisations (such as the Qatar charity). In addition to donations, countries have also been engaging in other types of secondary arrangements. In at least one case, a country has provided a grant to another country to purchase vaccines directly, as seen with Australia giving Cambodia a grant of USD 28 million. Several countries have also resold or loaned vaccine doses to others, especially among high income countries. For example, Poland has sold its excess vaccines to at least five different countries (Australia, Denmark, Norway, Portugal, Spain and Serbia). Similarly, Australia has entered into four different swap or purchase deals with other countries to secure doses including the European Union, Poland, Singapore and the United Kingdom. The Democratic Republic of Congo (DRC) has also begun to “redeploy” the majority of its vaccines received through COVAX, to other African nations, expecting to regain these doses from COVAX at a later stage. In other cases, countries that have received vaccine donations have then donated some of those doses to third countries, such as Barbados and Dominica sharing doses, donated to them by India, with other Caribbean countries.
For more resources on COVID-19 research and development, intellectual property and access, and pricing, procurement, distribution and manufacturing, see our COVID-19 Data Sources page.
For other useful sources of data and analysis on this topic, see the Duke Global Health Innovation Center and UNICEF, which are also both tracking information on COVID-19 vaccine agreements and access issues.
Given that this dataset is reliant on information reported in the public domain, it may contain inaccuracies, be incomplete, or quickly become out of date.
Please contact us with comments and suggestions at:
Surabhi Agarwal is leading data collection and analysis. Adriàn Alonso Ruiz is overseeing the project management and contributing to data collection and analysis. The project research and analysis is supervised by Suerie Moon.
Other Contributors: Seraina Laura Kull, Marcela Vieira
Past Contributors: Anna Bezruki, Zhubin ChenXiaoyi Wang
Global Health Centre. (2021). COVID-19 Vaccine Purchases and Manufacturing Agreements. Graduate Institute of International and Development Studies. Retrieved from: www.knowledgeportalia.org/covid19-vaccine-arrangements
Please contact Nora Sada, Communications Officer for the Global Health Centre.
This work is available open access and distributed in accordance with the Creative Commons Attribution Non Commercial International (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. Third party material are not included.