Global COVID-19 Vaccine Distribution

Global COVID-19 Vaccine Distribution

Updated August 5, 2021
Global COVID-19 Vaccine Distribution
Background
vaccine doses have been distributed in high-income
countries (Figure 1).
The Coronavirus Disease 2019 (COVID-19) pandemic has
led to severe health and economic consequences across the
Figure 1. Global Distribution of COVID-19 Vaccines
globe, as governments work to contain the spread of the
(millions of doses, as of July 28, 2021)
virus and its variants. In late 2020, researchers started
identifying several COVID-19 variants, now driving surges
in related cases and deaths across Africa and south Asia.
The United States, India, and Brazil have the highest
number of confirmed COVID-19 cases, many caused by the
Delta variant. Vaccines and other countermeasures play a
growing role in COVID-19 control. However, insufficient
access to vaccines in many low- and middle-income
countries (LMICs) raises questions about how inequities
may hinder pandemic control worldwide.
Congress appropriated approximately $15 billion for a
range of COVID-19-related responses through
supplemental appropriations (P.L. 116-123, P.L. 116-136,
P.L. 116-260, and P.L. 117-2), including $4 billion for
multilateral COVID-19 vaccine efforts. The Biden
Administration has announced that the United States will
provide over 500 million vaccine doses worldwide through
direct donations and contributions via COVAX—a

multilateral effort comprising nearly 200 countries, co-led
Source: Adapted by CRS from United Nations Development
by the World Health Organization (WHO), the Coalition for
Program (UNDP), Global Dashboard for Vaccine Equity, accessed on
Epidemic Preparedness and Innovation (CEPI), and Gavi,
August 2, 2021.
the Vaccine Alliance. On May 31, 2021, the International
Advances. By the end of July, donors had pledged $15
Monetary Fund (IMF), the World Bank Group, WHO, and
billion for COVAX, which had shipped more than 153
the World Trade Organization (WTO) established the Task
million COVID-19 vaccine doses to 137 countries
Force on COVID-19 Vaccines, Therapeutics and
worldwide. On June 11, the Group of 7 (G7) nations, at its
Diagnostics for Developing Countries (the Task Force). The
2021 annual meeting, committed to donate 870 million
Task Force is seeking an additional $50 billion in support of
additional vaccine doses to COVAX by the end of 2022.
COVAX and the Access to COVID-19 Tools Accelerator
G20 governments have also pledged $22 billion toward
(ACT-A), so that at least 40% of all people worldwide
COVAX and ACT-A. As of June 23, 2021, the United
could be vaccinated by the end of 2021.
States was the largest donor to COVAX, having pledged
Global COVID-19 Vaccine Distribution
$3.5 billion. Other key donors include Germany ($1
billion), the United Kingdom ($1.05 billion), Japan ($376
In April 2020, WHO and partners launched ACT-A to
million), Canada ($360 million), Saudi Arabia, ($300
advance the development, production, and distribution of
million), and the Gates Foundation ($246 million).
COVID-19 diagnostics, therapeutics, and vaccines. Within
less than a year, multiple safe and effective COVID-19
Challenges. WHO and partners have decried the sluggish
vaccines had been developed. To date, several countries
delivery of pledged vaccines and estimated that by July 31,
and WHO have approved eight COVID-19 vaccines for
2021, less than 5% of vaccines that were pre-purchased by
emergency use, including those made in China. WHO has
or for LMICs had been delivered. Many LMICs are
not authorized emergency use for vaccines produced in
expecting large donations via COVAX during the second
Russia, though some countries that do not have sufficient
half of 2022, but questions remain about their ability to
access to authorized vaccines have used them. More than
rapidly distribute the vaccines, particularly in remote
200 other COVID-19 vaccine candidates are in clinical
settings. The World Bank estimates an additional $35
trials. Numerous therapeutics are also in development.
billion in grants is needed to fund the Task Force on
COVID-19 Vaccines, Therapeutics and Diagnostics for
Although manufacturers expect to produce about 11 billion
Developing Countries, and to rapidly scale up vaccine
COVID-19 vaccine doses by the end of 2021, many experts
production and delivery in LMICs by 2022.
assert that at current vaccine distribution rates, COVID-19
vaccines will not be widely available in LMICs until at least
Global Vaccine Access
2022. The vast majority of manufactured COVID-19
Insufficient vaccine supply, coupled with uneven capacity
to pay for and disseminate the vaccines, has led to global
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Global COVID-19 Vaccine Distribution
vaccine-access gaps. Whereas some countries have
doses. A variety of efforts are underway, including through
purchased enough doses to vaccinate their populations
the U.S. International Development Finance Corporation
several times over, others lack enough supply to vaccinate
and its partners, to scale up vaccine manufacturing capacity
even their most vulnerable populations. Roughly 60% of
in LMICs. Some advocates note these efforts are vital but
the world’s vaccine supply, according to WHO, has been
will likely take several years to fully operationalize and
purchased by rich countries whose populations account for
increase COVID-19 vaccine supply. In light of this
less than 20% of all people in the world.
discussion, Members may consider whether existing efforts
Each Task Force member is leveraging its resources to
are sufficient, or if efforts should be scaled up—including
generate additional support for closing the equity gap. On
providing additional support for bolstering vaccine
July 26, 2021, the Task Force announced a new financing
manufacturing capacity in LMICs, specifically for mRNA
mechanism that allows certain COVAX countries to use
vaccines.
World Bank and multilateral development bank financing
Getting shots in arms. The average cost of COVID-19
to purchase advance vaccine doses in addition to their
vaccines ($2-$40 per dose, depending on the type of
existing vaccine allotment. The IMF is also preparing a
vaccine, number of shots required, and other factors) is
Special Drawing Rights allocation to boost the reserves and
equivalent to the average annual per capita health spending
liquidity of member states toward reaching these goals.
on all health issues in many low-income countries ($41).
Public health experts hope that ongoing WTO discussions
Additional distribution costs ($3.70 per person for two
over a potential waiver of certain WTO Agreements on
doses) place further challenges on LMICs and limit the
Trade-Related Aspects of Intellectual Property Rights
ability of their governments to reach needy populations,
(TRIPS) obligations for COVID-19 vaccines and other
particularly outside major cities. The United Nations
trade policy responses to the pandemic might facilitate
Development Program (UNDP) estimates that low-income
knowledge and technology transfers that might accelerate
countries would need to increase per capita health
COVID-19 vaccine production worldwide.
expenditure by 57% to vaccinate 70% their populations.
U.S. Government Role
Three COVAX donors (Canada, Germany, and the United
States) have given explicit permission to use funds for
Bilateral efforts. The U.S. Agency for International
vaccine delivery, and USAID has allocated $500 million to
Development (USAID), the Department of State, and the
support COVID-19 vaccine delivery in 88 countries.
U.S. Centers for Disease Control and Prevention (CDC) are
Congress may consider arguments for and against using
leveraging long-standing infectious disease control
donor funds for vaccine delivery. Some argue that the
programs for the global COVID-19 response. Since March
limited funds should be used exclusively for vaccine
2020, USAID and the State Department have committed
purchase; others advocate using a portion of donor
more than $1.6 billion in health, humanitarian, economic,
resources on vaccine delivery to protect the integrity of the
and development assistance for global COVID-19 control.
donated commodities.
CDC has committed $800 million for related efforts. These
agencies are also supporting countries’ efforts to implement
COVID-19 “vaccine passports .” In January 2021,
National Deployment and Vaccination Plans, required by
President Biden issued Executive Order 13998 to study
WHO for countries receiving vaccines through COVAX.
whether the U.S. government should issue “vaccine
passports” to indicate whether one has been vaccinated or
Multilateral efforts. In March 2021, the Biden
recovered from COVID-19. Many health experts have
Administration announced the United States would donate
endorsed the idea, citing precedents for using immunization
over 500 million vaccines to COVAX and other countries
records for various official purposes, including international
in need. Related pledges include

travel. No federal policy has been announced, though four
jointly manufacturing and delivering 1 billion COVID-
U.S. states have active vaccine certification apps, and 19
19 vaccines to Southeast Asia by the end of 2022
states have banned such systems. In July 2021, the
through “the Quad,” the coalition of Australia, India,
European Union launched the EU Digital COVID
Japan and the United States;
Certificate Regulation to verify that a person has been
 donating 84 million vaccine doses, 75% of which will
vaccinated or received a negative test.
be provided through COVAX in LMICs;
Members of Congress have not introduced legislation in
 purchasing 500 million Pfizer-BioNTech COVID-19
support of or opposition to vaccine passports, though some
vaccine doses for donation to COVAX; 200 million are
bills cite key concerns. H.R. 906, for example, would
to be delivered by the end of 2021, with the remaining
prohibit the Secretary of Transportation from requiring an
300 million to be delivered by the end of 2022.
individual to test negative for COVID-19 to travel by air.
Outlook and Issues for Congress
Similarly, S. 82 calls for a joint task force, compris ing the
Many Members of Congress have demonstrated strong
Secretaries of Transportation, Homeland Security, and
interest in bolstering global vaccine manufacturing and
Health and Human Services, to make recommendations for
distribution capacity to support COVID-19 control. While
addressing privacy and civil liberty issues that may arise
deliberating how to balance international and domestic
from such monitoring of air travelers’ health.
vaccine demand, Members may consider a variety of issues,
Alexandria Lee, CRS Summer Research Associate,
including the following:
contributed to this product.
Vaccine manufacturing capacity in LMICs. WHO and
Tiaji Salaam-Blyther, Specialist in Global Health
other groups have decried the limits of current vaccine
Sara M. Tharakan, Analyst in Global Health and
manufacturing capacity and pointed out that existing
International Development
capacity cannot meet global demand for COVID-19 vaccine
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Global COVID-19 Vaccine Distribution

IF11796

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https://crsreports.congress.gov | IF11796 · VERSION 3 · UPDATED