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Although COVID-19 cases are declining rapidly in the US, they have reached record highs in low- and middle-income countries (LMICs). The nucleus of the pandemic has shifted decidedly to the global south. The South-East Asia region and Latin America now represent 75% of global weekly deaths. On June 22, the Latin America region reported more than 1 million weekly new cases and 30 000 new deaths. Latin America has the highest deaths per capita, where deaths in countries such as Brazil, Argentina, Mexico, and Peru have reached 177 to 564 per hundred thousand. The Africa region has had increasing numbers of cases, with Uganda and Zambia experiencing 10 000 and 17 000 new weekly cases, respectively. Increasingly, the pandemic is where the vaccines are not.

Approximately 1.2% of the global vaccine supply has been received by low-income countries and just 14% by lower-middle-income countries, which account for nearly 40% of the world’s population. In contrast, more than half the US adult population is fully vaccinated, including most health workers and individuals from vulnerable populations. Yet sub-Saharan Africa has doses to cover only an estimated 18% of health workers and older individuals. South Asia has not vaccinated all priority groups, and vaccine supplies would fully vaccinate just 9% of the total population.

Vaccine inequity is driven by insufficient supply and unfair allocation. Powerful high-income countries prepurchased sufficient doses for their entire populations, sometimes twice the number needed. In contrast, COVAX, a global initiative to procure and equitably allocate vaccines, failed to secure enough doses even for its modest goal of covering 20% of lower-income country populations this year. Pfizer, for example, agreed to sell COVAX only 40 million doses, and had delivered just over 1 million by mid-May.

On June 13, the G7 countries pledged to share 1 billion vaccine doses, half of which would come from the US. But this represents only a fraction of the approximately 11 billion doses needed to vaccinate the world. Support for LMICs to enable them to produce vaccines for their populations and significantly more donations are necessary to vastly increase supplies and ensure equity. The US and allied governments could take several steps to overcome barriers to vaccinating the world.

Publication Citation

Journal of the American Medical Association, Online First, at E1-E2.