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Two years since SARS-CoV-2 first passed into humans, manufacturers have created enough vaccines to inoculate most of the world against Covid-19. But dozens of low-income countries still face dire shortages because rich nations are building stockpiles with hundreds of millions more doses than they need.

Even when booster shots for rich nations are taken into account, there’s ample supply to meet global vaccination goals for the end of 2021, STAT’s analysis of available data shows. The challenge is getting the vaccines to the right places.

Around 11 billion Covid-19 vaccine doses will have been manufactured by the end of 2021, according to estimates from Duke’s Global Health Innovation Center and the COVID Collaborative. The precise number is uncertain, said Krishna Udayakumar, the Duke center’s founding director, because both manufacturers and governments have failed to release details. His calculation is in line with the World Trade Organization-International Monetary Fund vaccine tracker, which showed a supply of 8.8 billion vaccines by the end of October.

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The World Health Organization set a target of vaccinating 40% of the population of every country this year, and 70% of the world by mid-2022, in an effort to reach a level of protection that will reduce the spread of the virus and development of new variants. With many vaccines requiring two doses, 11 billion shots is more than enough to vaccinate 40% of the 7.8 billion global population, and should cover 70% of those older than 5 around the world.

Overall, 56% of the global population has received at least one dose, but those vaccines are wildly unevenly distributed, with just 7.1% of people in low-income countries having received at least one dose. Some 847 million more doses is needed to bring all countries to 40% vaccination rate. COVAX, the WHO-led collaboration created to give all nations equal access to shots, is expected to deliver around 200 million more doses before the end of the year, but that still leaves a supply gap of around 650 million vaccines needed to vaccinate 40% of those in low-income countries.

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Olivia Goldhill / STAT Source: Duke University and COVID Collaborative.

“That number can be redistributed from what high-income countries expect to have by the end of this year. So it’s not an overall supply challenge,” said Udayakumar. “It’s very much an allocation challenge, as well as getting high income countries more and more comfortable that they don’t need to hold on to hundreds of millions of doses, for contingencies.”

The vaccine shortage for low-income countries is less than the surplus vaccines within the G7 countries and the European Union, according to separate analyses from both Duke and Airfinity, a life sciences analytics firm that is tracking vaccine distribution.

The G7 and European Union combined have 769.8 million vaccines to spare this year, even if 75% of the population is vaccinated and 20% gets boosters (which assumes a three-fold increase in the daily vaccination rates), plus 10% is set aside for waste, according to Duke’s analysis. The total population of these countries is around 1 billion, meaning there’s enough leftover to give an additional dose to more than three-quarters of their inhabitants.

Olivia Goldhill / STAT Source: Duke University and COVID Collaborative.

A UK Foreign, Commonwealth & Development Office spokesperson said the country was one of the first and largest donors to COVAX, and its funding of the Oxford-AstraZeneca allowed the vaccine to be delivered worldwide at non-profit prices.  “The UK is a global leader in delivering Covid vaccines to the most vulnerable countries around the world, including through the Prime Minister’s pledge to donate 100 million vaccine doses overseas by June next year,” said the spokesperson. The governments of other nations did not respond to requests for comment.

While prioritizing boosters for rich nations delays sending doses to those where most of the population still need their first shot, the steadily increasing supply of vaccines means there’s capacity to distribute more vaccines globally even while some countries give boosters.

“I do think it’s a false choice to be pitting booster doses against first and second doses,” said Jenny Ottenhoff, senior policy director of global health and education at the ONE Campaign, a nonprofit seeking to end extreme poverty and preventable disease. Both primary and booster rollouts should be able to happen simultaneously, she added: “We’re going to have to chew gum and walk.”

The bigger obstacle to global supply is in the stockpiles of excess vaccines that wealthier countries are holding onto. The levels of excess vaccines in the wealthiest countries is expected to grow as they acquire more vaccines while continuing to administer boosters in 2022.

The G7 and EU combined would have 1.39 billion surplus vaccines by the end of the first quarter of 2022, even if 80% of all adults had vaccines and boosters, according to Airfinity’s analysis. If donations continue at their current pace, just 500 million of these would be given away, according to the organization’s analysis, leaving 890 million to spare.

Olivia Goldhill / STAT Source: Airfinity.

These numbers are estimates, due to the lack of transparency on deliveries, but they still show that at a minimum, there are hundreds of millions of surplus vaccines within the wealthiest nations.

“As we feel more and more confident the overall supply is ramping up significantly, the really critical missing data right now is tracking what’s happening to them and where and how they’re being allocated and then delivered,” said Udayakumar.

Some wealthier countries have committed to re-allocating vaccines they receive to nations in greater need. But there’s little certainty on when the vaccines will arrive, and so when the donations can be expected, said Ottenhoff.

Vaccines could be distributed internationally faster if wealthier countries allowed COVAX or countries in dire need to take newly created vaccines first. So far, just Switzerland and the U.S. have done so, with the U.S. allowing the African Union to receive vaccines first, and Switzerland trading its place in line with COVAX.

There’s also a huge shortfall in funding for vaccines to be distributed within poorer countries. The staff and transportation needed to deliver vaccines from airports into arms often costs more than the vaccines themselves, said Udayakumar.

The costs are only heightened by the unpredictability of delivery: Countries often don’t know what kind of vaccine they’ll be getting, how much, and when, until a shipment arrives. Nigeria recently was unable to use 1 million Covid-19 vaccines, according to Reuters, largely due to a rollout that’s limited by shortage of funds and staff.

The Access to COVID-19 Tools (ACT) Accelerator, which brings together governments and global health organizations including the WHO and Gavi, the Vaccine Alliance, recently announced an additional $23.4 billion is needed for vaccine distribution by September 2022.

“Where the rubber hits the road, it’s going to be about delivering doses,” said Ottenhoff. Yet it’s not clear who’s taking responsibility for this crucial step, “There’s a weird ‘hands up, not me,’ on the delivery aspect,” she said. “That’s going to be the biggest challenge in 2022.”

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