This Is What Vaccine Inequity Looks Like

More than 5.5 billion COVID-19 vaccine doses have been administered worldwide, a number equal to 72 doses per 100 people. But that number does not reflect the widespread inequities that impact billions of people. Nine months after the first vaccines became available in the United States and United Kingdom, large swaths of sub-Saharan Africa, Central Asia, the Middle East, and the Caribbean still do not have them.

More than 80% of vaccine doses to date have gone to people in high-income or upper-middle-income countries. Researchers are now warning that it might take until 2023 until the world’s poorer countries have enough supply to vaccinate their populations.

The devastating spread of the delta variant is a stark reminder of the importance of vaccine equity. Until everyone has access to the vaccine, COVID-19 will continue to threaten health workers and health systems worldwide.

Here’s what vaccine equity looks like on the ground in four countries where Project HOPE works.

Cora Nally, Bahamas

What would you want people to know about the vaccine situation in your country?

The Bahamas has been slow to gain access to vaccines. A few weeks ago, the U.S. donated the Johnson & Johnson and Pfizer vaccines to the Bahamas, which joined the previous option of AstraZeneca. There has been a dramatic uptake in the number of people seeking vaccinations now that there are options available.

So far, a majority of the vaccines have been kept on New Providence, the capital island. Three times now the government has sent a small team from the Ministry of Health to the smaller “family” islands to administer vaccinations there over a three- or four-day period. A majority of the work Project HOPE is doing in the Bahamas is on the island of Abaco, one of those primarily impacted by Hurricane Dorian in 2019. Approximately 1,000 people in Abaco have been fully vaccinated, and another 2,000 have received at least one dose. At the most recent round of vaccination sites, there were people turned away as the supply ran out for that site. So there are more people willing to be vaccinated than there are vaccines available on the Family islands.

What percent of your country would you estimate has been vaccinated?

Approximately 17% of the population has been vaccinated to date, and about 7% of the population in Abaco.

What are the greatest hurdles to getting people vaccinated?

The greatest hurdle is the lack of supply to the family islands and the Bahamas in general.

What must be done to make vaccine distributions more equitable worldwide?

More countries need access to purchase vaccines. This includes having access to a variety of vaccines so that populations are presented with a choice and so that people younger than 18 have the opportunity to be vaccinated as well.

Chilobe Kambikambi, Zambia

What would you want people to know about the vaccine situation in your country?

The Zambia government has committed to procure 4.4 million vaccine doses through the African Vaccine Acquisition Trust, an initiative under the African Union and its partners. To date, 599,340 doses have been administered.

The current available vaccines are way too little to meet the target on time. There isn’t enough vaccine for everyone who is eligible. The vaccine rollout started with big cities and is now slowly being rolled out to the rural areas. We need a regular flow of adequate vaccines to equitably vaccinate all the target population, as COVID-19 will continue to be deadly.

What percent of your country would you estimate has been vaccinated?

As of September 1, 2.2% of the country (291,947 people) had received a second dose and an additional 2.3% (311,049 people) had received a first dose. With a total population of 13.4 million, that comes out to 4.48 doses per 100 people.

How common is vaccine skepticism in your community?

Vaccine skepticism is very common. Many people still don’t believe COVID exists. In the communities there are a lot of misconceptions around the vaccine. Some still believe that vaccines are not safe and have a lot of side effects, or that they cause infertility. Some religious communities ascribe supernatural meanings to it. Others say vaccines don’t work because they have seen people who have been vaccinated get the virus and die.

What are the greatest hurdles to getting people vaccinated?

The greatest hurdles are the myths and misconceptions that result in low uptake of the vaccine, the lack of information on the availability of the vaccine, and the lack of the vaccine itself.

What must be done to make vaccine distributions more equitable worldwide?

Getting enough vaccines for everyone in Zambia — or Africa in general — is challenging because we do not make any vaccines and solely depend on the vaccines coming from richer countries. Because of that, the world needs to know that if one person is not vaccinated, the next person is not safe. COVID affects us all. We live in a globally networked world, and all inhabitants of our world need to be vaccinated if we are to get back to “normal.”

We need the richer countries that have the means to share with those that don’t, and to support sustainability among the poorer countries. We need a commitment from world leaders, the United Nations, and other stakeholders to ensure that there is access to the vaccine for all. We also need policy makers and development partners to take urgent action to reduce vaccine inequity, and we need to continue the work of reaching communities to dispel the myths that discourage them from accessing the vaccines.

Simon Mathias, Namibia

What would you want people to know about the vaccine situation in your country?

More and more people in Namibia are getting vaccinated, albeit at a slow pace. The slow pace can be attributed to two factors: limited accessibility, especially in rural areas, and vaccine hesitancy in urban areas where the vaccines are sometimes available but not many people show up for vaccinations.

Initially, the country only had two vaccines available, Sinopharm and AstraZeneca, and these two vaccines were introduced in the country for the first time in forms of donations. However more vaccines such as the Russian Sputnik and Johnson & Johnson have now become available.

What percent of your country would you estimate has been vaccinated?

The latest national figures indicate that by the end of August, just 8.2% of the population had received the first dose of the vaccine, and less than 4% had received a second dose. However, the Health Ministry remains optimistic that they will be able to vaccinate at least 60% of the population by the end of 2022.

How common is vaccine skepticism in your community?

Vaccine skepticism is very common in Namibia. Some people do not trust the vaccine apparently because it was developed in a record amount of time, some do not trust the countries where the vaccines are manufactured, while some say they are waiting for the “perfect” vaccine.

What are the greatest hurdles to getting people vaccinated?

The greatest hurdles are the limited supply of vaccines, the limited options to choose from, and the misinformation and lack of accurate information on vaccine safety, efficacy, and its side effects.

Ramiro Proaño, Ecuador

What would you want people to know about the vaccine situation in your country?

Ecuador’s population is 17 million. The goal of the vaccination plan was to vaccinate 9 million people within 100 days, which has been achieved. In addition, the country has negotiated 18 million vaccines from four pharmaceutical brands to date. The vaccination plan gave priority to health care professionals, the elderly, teachers, and private companies who have donated syringes and other supplies so that their employees can be vaccinated. In July, universities joined the process and they are vaccinating university students and high school students.

What percent of your country would you estimate has been vaccinated?

As of the end of August, 49.3% of the population had been vaccinated with both doses.

How common is vaccine skepticism in your community?

The lack of information is the main problem in Ecuador. A lot of people believe that there are good and bad vaccines, which is why many prefer a specific brand of vaccine. There are people who do not trust the vaccine because they believe that COVID is not fatal and take magnesium chloride or natural medicines to prevent or cure the symptoms.

What are the greatest hurdles to getting people vaccinated?

The biggest obstacles are reaching remote rural populations where you can only get there by plane or canoe, especially in the Amazon rainforest. Another problem is that there are not enough health brigades to bring the vaccine to the homes of people who cannot go to the vaccination sites, such as elderly or disabled people.

What must be done to make vaccine distributions more equitable worldwide?

In order to achieve the goal of vaccinating the entire global population, vaccine doses must be made available to those living in areas that are difficult to access. For this, help must come in the form of vaccine donations and storage facilities so that countries can purchase single-dose vaccines for hard-to-reach communities.