As a result, relatively wealthy nations will likely be able to vaccinate their entire populations, with billions of others relegated to the back of the line. People in low-income countries could be waiting until 2024.
These deals between countries and drug manufacturers, known as advance purchase agreements, are undermining a World Health Organization-linked initiative to equitably distribute vaccines, the study suggests.
“Where we are headed is a situation where high-income countries have enough, and low-income countries just don’t,” said Andrea Taylor, the lead researcher.
Since the vaccine race got underway, experts have warned of the dangers of “vaccine nationalism” and calling for a cooperative approach to vaccine development and distribution.
More than 150 countries, representing a large share of the world’s population, have signed on to participate in the Covid-19 Vaccines Global Access Facility, or Covax, which aims to develop and equitably distribute $2 billion in doses of a vaccine by the end of next year.
Under the plan, both rich and poor countries pool money to offer manufacturers volume guarantees for potential vaccines. The idea is to discourage hoarding and focus on vaccinating high-risk people in every participating country first.
Many wealthy players, including the European Union, Canada and Japan, joined the initiative. But most are backing Covax while also cutting deals directly with manufacturers.
The researchers found that Canada and the United Kingdom have already reserved more than enough potential vaccines to cover their entire populations. The E.U. has also secured hundreds of millions of doses.
These deals make sense from a country perspective, but they undermine cooperative efforts to secure enough doses, particularly for low-income countries, experts said.
“The more that countries hedge their bets and work outside of Covax, the harder it is for Covax to actually deliver on its promises,” said Suerie Moon, co-director of the Global Health Center at the Graduate Institute of International and Development Studies in Geneva.
Rich countries, she said, “are eating up all the supply before Covax can take a nibble.”
The United States did not join Covax, in part because the Trump administration did not want to work with the WHO. The Duke analysis found that the U.S. already has agreements to buy enough doses to cover 139 percent of its population — and could eventually control 1.8 billion doses, or roughly a quarter of the world’s “near-term” supply.
Middle-income countries are also reserving doses. Brazil and India already have secured the rights to enough vaccines to cover about half of their populations, the study noted.
Most low-income countries, by contrast, have little choice but to rely on Covax, which must compete with big players to secure access to vaccines.
Taylor, the lead researcher, stressed that the study offers a “snapshot” of where things stand, not a definitive prediction. Access to vaccines depends in large part on which vaccines prove safe and effective — and that is still very much up in the air.
Another critical question is capacity: How many coronavirus vaccines can the world make in a year?
The Duke study does not offer an estimate, but calls for investment in manufacturing capacity, particularly in the developing world, to increase supply.
“This study shows a lot of doses have been bought, what I don’t know is what is left for low-income countries to reserve,” said Thomas J. Bollyky, a senior fellow at the Council on Foreign Relations and director of its Global Health Program.
What is clear, Bollyky said, is that the world is headed for “a two-tiered system.”