COVID-19 Vaccine Access

*Last updated on June 17, 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.

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We particularly welcome suggestions on additional data sources

Key Research Findings

Lack of transparency

Not all agreements are being publicly reported in a timely fashion, and of those that are reported, they often lack basic information, such as the total number of vaccines being provided and their prices. This lack of transparency makes it challenging to draw firm conclusions about global access to COVID-19 vaccines.

Pricing information and related terms and conditions of the agreement (e.g., timelines for delivery, liability arrangements, flexibility to re-sell) are not available for the vast majority of confirmed vaccine purchases. For example, price estimates are unavailable for approximately 67 percent of confirmed purchase arrangements in our dataset. 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, questions have been raised about the fairness of prices per dose agreed for the AstraZeneca vaccine 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 24 vaccine candidates
 

Thirty-nine vaccines are in late-stage (Phase 2 or 3) development or post-registration; we have found publicly reported purchase agreements for 24 of these.

 

Among these 24, Pfizer/BioNTech has publicly committed to supply the greatest number of doses – at over 3.5 billion doses, (followed closely by AstraZeneca at approximately 2.8 billion doses). Based on current estimates, it is unlikely that enough vaccines will be manufactured in 2021 or even 2022 to meet global demand or achieve global population immunity. We are collating further data on manufacturing volumes, locations and technology transfer agreements, and welcome contributions of data at globalhealthresearch@graduateinstitute.ch.

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 the COVAX facility). 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.

There are significant disparities in vaccine access

Countries with the means to do so began making advance purchase agreements for vaccines in the second and third quarter of 2020, well before there was data available on which, if any, of the vaccines would prove to be safe and effective. Thirty-five countries – Canada, Australia, the United Kingdom, New Zealand, United States [1], Israel, Switzerland, Chile, and the 27 EU Member States, have publicly announced agreements that, if all vaccine candidates were to be approved by regulatory bodies, would provide enough doses to cover their entire populations at least twice over. However, most of the countries that have announced agreements publicly have secured enough doses to cover less than 50 percent of their populations.

[1] It should be noted that doses secured by the United States include 500 million doses of Pfizer that the US intends to donate to low income countries.

Purchasing agreements have been confirmed with 104 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 April 7, 2021, it is projecting coverage for approximately 26% of the population of the 92 low- and lower-middle income countries by the end of 2021. This poses a particular challenge for the many countries, primarily low- and lower-middle income, that appear to be relying entirely or largely on their participation in COVAX to secure access to vaccines, having made no other publicly available vaccine purchase arrangements to date.

In the next year, as manufacturing capacity remains limited, most of the available doses will go to high-income countries, who have reserved the greatest number of vaccine doses – amounting to 278% population coverage (the European Union arrangements are included in this figure, as are the number of doses for each vaccine). [2] In contrast, through bilateral arrangements, upper middle income countries have secured enough for 36.6% population coverage, and lower-middle income countries have secured for 22.5% population coverage. This may be a significant underestimate, however, as middle-income countries Russia, China and India are able to produce significant volumes of vaccines, but we have found little public information on total volumes to be produced and/or exported.

 

Low-income countries have bilaterally secured enough vaccines to cover 1.48% of the population. 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.

 

[2] Many countries have included provisions in their contracts to buy additional doses at a later date, those optional doses are not included in the totals presented here. These optional doses are, however, included separately in the full dataset. 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.

Bilateral donations are increasing
 

At least 49 countries have donated or made commitments to donate vaccine doses to other countries, either from their purchased stocks or from domestically produced vaccines.  Most of the initial donations in 2021 were undertaken by a few countries such as China, India and Russia. However, a number of new commitments for vaccine donations have been announced by high income countries. The most recent commitments were made at two summits in June 2021 - the Gavi COVAX AMC summit “One World Protected” and the Group of Seven or G7 summit. At the Gavi summit, five countries (Japan, Belgium, Denmark, Spain and Sweden) announced new commitments for vaccine donations, including through COVAX, totalling to 54 million doses. The G7 summit committed to donating 1 billion doses to poor countries. However, Reuters reported that this includes several commitments that were already made public before the summit.

 

The United States’ announcement on the 10th of June to purchase and donate 500 million doses of Pfizer/BioNTech, in addition to the already committed 80 million doses, has poised the US to become the largest donor by far. The next largest donors are the UK and the EU, which have both committed to donating approximately 100 million doses. Other large donors include France, Germany and Japan, each of which have committed to donating approximately 30 million doses. Canada is also in talks to donate nearly 100 million doses, but it is yet to be formalised.


Most donors to date have donated fewer than 1 million doses to other countries. In at least one case, a country has provided a grant to another country to be able to purchase vaccines directly, as has been seen with Australia giving Cambodia a grant of 28 million USD. In other cases, countries that have received vaccine donations then donate some of those doses to third countries, as has been seen with Barbados, Bermuda, Dominica, Grenada and St. Vincent and the Grenadines. 

Following several announcements from countries who are planning to donate their vaccines either directly to COVAX or to other countries through COVAX, the total doses committed to COVAX are at nearly 700 million. Finalised commitments have been announced by at least 10 countries, including Belgium, Denmark, France, Japan, New Zealand, Norway, Spain, Sweden, United Kingdom and United States. 

 

Among recipients of bilateral vaccine donations, so far the majority have gone to lower middle-income countries (32.9 million), which includes a 7 million donation to the African Union; followed by 8.4 million to upper middle-income countries, 4.7 million to low-income countries, and 3.4 million to high-income countries. Low-income countries have received relatively few donations - whether considered in terms of total numbers of vaccine doses donated or in terms of proportion of the total population covered by the donations (under 2% of the population in each recipient country). The recipients of vaccines from any given donor vary widely on income level and Covid-19 disease burden. This 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. However, this data is likely to change as more allocations from recent announcements are made public.

 

In the absence of adequate supply for COVAX, such donations may become an important way for countries without bilateral agreements with vaccine developers to obtain vaccines for their populations.

 

In addition to vaccine donations, some countries have begun reselling or loaning vaccine doses to other countries. For example, the United States offered to "loan" vaccine doses to Canada and Mexico now, with the expectation that Canada and Mexico will reciprocate in the coming months. 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.

Other resources

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 similar information on COVID-19 vaccine agreements and access issues.

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.

Notes About the Data

Sources and methodology

Data are updated every one to two weeks. Information on agreements is aggregated from publicly available sources, including news reports (links available in dataset). 

 

Income and population calculations are primarily based on World Bank data, and regional groups are based on World Bank definitions. Income levels for the European Union and African Union are calculated as if all the countries involved formed a single entity (countries or territories for which the World Bank do not provide such data are excluded from these calculations). Taiwanese income and population calculations are based on Taiwanese government data.  

Clinical trial stage information primarily based on the New York Times’ vaccine tracker; vaccines that have achieved regulatory approval in at least one country, as captured by UNICEF's COVID-19 Vaccine Market Dashboard, are counted here as approved. 

Estimates for doses committed and the price of the agreements are used when precise figures not available. Depending on data available, total price may be calculated based on price per dose or vice versa; calculation method noted. When currency is not reported in USD, currency is converted using currency conversion rate on the announcement date.

Data limitations

This dataset relies on companies, governments, and multilateral organizations making their agreements publicly available. There are substantial gaps in the data, including that not all agreements are being reported in a timely fashion, and reported agreements may lack one or more relevant data points, such as price, doses committed, or manufacturer.

 

Russia, China, and India, which are each developing and/or manufacturing several vaccine candidates, have not released clear information on how many doses they will retain for domestic use versus how many they plan to export.

While efforts are made to ensure data accuracy and completeness, given the lack of detailed information available publicly and the fast-moving nature these agreements, the data may contain inaccuracies, be incomplete, or be out of date. 

Download Dataset

 

The dataset and graphics are updated every one to two weeks. 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 globalhealthresearch@graduateinstitute.ch.

 

Suggested citation: 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

Anna Bezruki is lead researcher for this initiative, responsible for data collection, curation, visualizations and analysis. Surabhi Agarwal and Zhubin Chen are contributing to data collection. Adriàn Alonso Ruiz is contributing to data collection and analysis. Marcela Vieira is contributing to data collection. Suerie Moon is supervising the research and analysis.

 

For media inquiries please contact Nora Sada, Communications Officer for the Global Health Centre at nora.sada@graduateinstitute.ch.

 

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. 

 
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This work is licensed under a Creative Commons Attribution 4.0 International License.