Abstract
Inequity in the access to and deployment of the coronavirus disease 2019 (COVID-19) vaccines has brought about great challenges in terms of resolving the pandemic. Aiming to analyze the association between country income level and COVID-19 vaccination coverage and explore the mediating role of vaccination policy, we conducted a cross-sectional ecological study. The dependent variable was COVID-19 vaccination coverage in 138 countries as of May 31, 2021. A single-mediator model based on structural equation modeling was developed to analyze mediation effects in different country income groups. Compared with high-income countries, upper-middle- (β = −1.44, 95% CI: −1.86–−1.02, p < 0.001), lower-middle- (β = −2.24, 95% CI: −2.67–−1.82, p < 0.001), and low- (β = −4.05, 95% CI: −4.59–−3.51, p < 0.001) income countries had lower vaccination coverage. Vaccination policies mediated 14.6% and 15.6% of the effect in upper-middle- (β = −0.21, 95% CI: −0.39–−0.03, p = 0.020) and lower-middle- (β = −0.35, 95% CI: −0.56–−0.13, p = 0.002) income countries, respectively, whereas the mediation effect was not significant in low-income countries (β = −0.21, 95% CI: −0.43–0.01, p = 0.062). The results were similar after adjusting for demographic structure and underlying health conditions. Income disparity remains an important cause of vaccine inequity, and the tendency toward “vaccine nationalism” restricts the functioning of the global vaccine allocation framework. Stronger mechanisms are needed to foster countries’ political will to promote vaccine equity.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has infected more than 170 million people, caused more than 3.7 million deaths [1], and had a severe negative impact on the global economy
We developed a single-mediator model to determine the effect of country income level (X) on COVID-19 vaccination coverage (Y), as well as the mediating role of vaccination policy strength (M) in the impact pathway
Six months after the development, allocation, and deployment of COVID-19 vaccines, globally, vaccination coverage remains lower in countries with lower income levels, demonstrating that additional efforts are needed to narrow the gap in vaccination coverage across countries
Summary
The coronavirus disease 2019 (COVID-19) pandemic has infected more than 170 million people, caused more than 3.7 million deaths [1], and had a severe negative impact on the global economy. Allocation, and deployment of safe and effective vaccines is the key instrument to save lives and contain the pandemic. To this end, there has been an unprecedented level of global funding and collaboration for COVID-19 vaccine development. As of early June 2021, there were 322 vaccine candidates worldwide, of which 97 were in clinical testing and 17 were in use [2]. Barriers to the equitable allocation and deployment of the vaccines present a significant challenge to accelerating the end of the pandemic. Approximately 20% of the global population has received at least one dose of a COVID-19 vaccine, but this number is less than 1% in low-income countries [3]
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