COVID-19 Vaccines Tested in Low-Income Countries, But Distributed in Wealthy Nations

Low- and middle-income countries have experienced COVID-19 vaccine delays and shortages. Even though vaccines and other pharmaceuticals are frequently tested in low-income countries, they often do not reap the benefits of this technology.

A study published last week in JAMA Network Open sought to examine the authorization and dispersal of COVID-19 vaccines recommended by the World Health Organization (WHO) in the countries where they were tested.

The cross-sectional study analyzed the COVID-19 vaccines authorized for emergency use by the WHO through September 7, 2021. Using the WHO COVID-19 Vaccine Tracker and Landscape and the McGill University COVID-19 Vaccine Tracker, the investigators identified all completed clinical trials for the authorized vaccines. They noted trial primary completion dates, phases, and country locations. Countries were assigned a national income group based on the 2021 World Bank historical classifications.

Using regional and national regulatory agency websites, the investigators determined whether countries hosting vaccine clinical trials also authorized them for use. They also extracted data on doses obtained from the UNICEF COVID-19 Vaccine Market Dashboard and Airfinity COVID-19 platform.

The investigators calculated the proportion of countries hosting clinical trials who had authorized any vaccine tested in their population and vaccine delivery. They determined the number of people 15 years and older who received a full vaccination series of the tested vaccine. All descriptive statistical analyses were performed using Microsoft Excel spreadsheet software.

There are 6 COVID-19 vaccines authorized for emergency use by WHO, tested in a total of 25 countries. Among 11 high-income countries who completed clinical vaccine trials, 90.9% (n=10) authorized the tested vaccine and received sufficient doses to vaccinate an average of 51.7% of their populations 15 years and older. Lower middle- and upper middle-income countries had respective authorization rates of 100% and 90.9%, with median vaccination rates of 31.0%.

Moderna completed clinical trials in 2 countries, Janssen completed trial in 10 countries, and AstraZeneca completed trials in 14. Janssen received authorization in 80% of these countries, while AstraZeneca did in 85.7%. Across all vaccine manufacturers, high-income countries received more doses to vaccinate larger proportions of their countries’ populations 15 and older. COVAX delivered an average of 15.4%, 48.8% and 78.8% of their vaccines in low-, lower middle-, and upper middle-income countries, respectively.

Countries of all income levels have largely authorized the vaccines their populations tested, but high-income countries continue to receive more doses to vaccinate a larger proportion of their populations.

The study authors noted “These wealth-based access inequities among countries hosting trials parallel general disparities in COVID-19 vaccine access, as high-income countries have successfully procured and administered doses ahead of low- and middle-income countries.”