High-income countries are hedging their bets while low-income countries are left out

Milestones :: Perspectives :: Research


Duke Global Health Innovation Center
Launch and Scale Speedometer
January 19, 2021

High-income countries are hedging their bets while low-income countries are left out
These direct deals made by high-income (and some middle-income) countries result in a smaller piece of the pie available for equitable global allocation. This pattern results in a majority of vaccines going to high-income countries and fewer doses available for low- and middle-income countries and for equity-focused partnerships like COVAX.


Updated: January 19, 2021

High-income countries currently hold a confirmed 4.2 billion doses, upper middle-income countries hold 1.1 billion doses, and lower middle-income countries hold 411 million doses, and low-middle income countries hold 270 million.
Many high-income countries have hedged their bets by advance purchasing enough doses to vaccinate their population several times over. Since none of these candidates are approved, some of the purchased vaccine candidates may prove to be unsuccessful.


Updated: January 19, 2021

While this makes sense from the perspective of an individual country, it leads to deep inequities in terms of global allocation. While some middle- and lower-middle income countries are represented here with direct deals, none of them have enough to vaccinate their entire populations. At the same time, Canada has purchased enough to vaccinate its population five times over. (Again, it is important to remember that not all of these vaccines will necessarily receive approval and move to market.)

CEPI, one of the COVAX founding partners, is negotiating with self-financing countries to ensure that, once a certain percentage of their population has been vaccinated, a percentage of the doses secured through bilateral deals would be shared through the COVAX Facility. These negotiations are ongoing; however, high-income countries have little incentive to share from their advance purchase stock.