Addressing Disparities in Access to Vaccines in Low- and Middle-Income Countries

Introduction

Vaccination aims to protect individuals against diseases through the introduction of a live or modified agent (such as the oral polio vaccine), a suspension of deactivated organisms (as seen in pertussis), or an inactivated toxin (as found in tetanus) (Lahariya, 2016). Vaccination is considered as one of the most cost-effective public health interventions in human history (WHO, 2009). In fact, and throughout the 20^th century, vaccination was able to tackle several health problems for infants, children, and adults. However, access to vaccines remained a major challenge, especially in low- and middle-income countries (LMICs). In fact, as of November 29, 2023, only 32.82% of people living in low-income countries have been vaccinated with at least one dose of vaccine vs 79.86 in high-income countries (UNDP, 2021).

Low-income countries (LICs) are those with the least robust economies, as assessed by the World Bank. For the 2022-23 period, LICs were identified as those with a gross national income (GNI) per capita of up to $1,085 in 2021. The majority of these nations are located in sub-Saharan Africa (World Population Review, 2023). They include countries such as Burundi, the Democratic Republic of the Congo, and Chad, where the fully vaccinated portion of the population is less than one percent. Beyond the African continent, Haiti, and Yemen have yet to achieve a two percent vaccination coverage (UN, 2022).

The emergence of SARS-CoV-2 virus in December 2019 (COVID-19) and its related pandemic showed the gap between the high and low & middle-income countries. By January 21, 2021, a mere 25 vaccine doses had been administered in Africa, whereas higher-income countries had already administered around 40 million doses (Soy, 2021). Then, by July 2021, nearly 85% of vaccine doses had been dispensed in high- and upper-middle-income countries, with more than 75% concentrated within just 10 countries (WHO, 2023).

Equitable vaccine access and distribution means allocating vaccines to all countries based on their needs, independently of their economic standing. Access to and distribution of vaccines should adhere to principles rooted in the universal right of every individual to attain the highest possible standard of health, irrespective of factors such as race, religion, political beliefs, economic status, or any other social conditions (UNDP, 2021).

The COVID-19 pandemic has exposed divisions across social, political, economic, and health spheres, revealing inequities in the access and acceptance of vaccines both within countries and globally. In fact, as of August 30, 2022, the percentage of individuals vaccinated ranged from over 95% in Qatar to below 20% in Nigeria and Congo. Likewise, the cumulative number of doses administered per 100 people spanned from 365 in Cuba to under 50 doses in several African countries. As for pediatric vaccination, many children, especially in LMICs, still lack immunization. For example, the worldwide coverage of diphtheria-tetanus-pertussis (DTP3) vaccination varies from 75% in Africa to 96% in Europe (Harris, 2014). These statistics underscore the necessity of identifying and understanding the diverse factors influencing these disparities in vaccination coverage (Peano, 2023).

Budget constraints remain a major challenge for LMICs as healthcare spending should increase by 56.6% in LMICs to vaccinate 70% of the population vs 0.8% only in high-income countries (HICs) (WHO, 2023). Data from studies exploring costs of COVID-19 vaccination showed that the cost of providing one dose is USD 1.4 per person and is USD 3.15 per person vaccinated with two doses (WHO, 2021). This poses a substantial financial challenge for LICs, where the average annual per capita health spending is USD 41 (GHED, 2023). As such, as vaccination programs elevate healthcare expenses universally, the impact is more notably pronounced in low-income nations.