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*Corresponding author: E-mail: albertopk2000@yahoo.co.uk; 
 
 
 

Asian Journal of Immunology 
 
4(1): 53-58, 2021; Article no.AJI.68275 
 

 
 

 

 

Inequalities in COVID-19 Vaccination; a Call for 
Global Community Concern 

 
Jefferson Asare Danquah1, Albert Opoku2*, Thomas Boansi Gyamerah3,  

Monica Pili Bernard4, Prince Twene5 and Rebecca Kuma6 
 

1
University of Aberdeen, UK, MSc Global Health and Management, National AIDS/STI Control 

Programme, Ghana. 
2
Nursing and Midwifery Training College, Tepa, Trinity Hospital, Pankrono, Kumasi, Ghana.   

3
Nursing and Midwifery Training College, Asankrangwa, Ghana.   

4
Global Health and Management, University of Aberdeen, UK, Healthy Shield Foundation, Tanzania.  

5
Food and Drugs Authority, Ghana.  

6
Ga East Municipal Hospital, Ghana. 

 
Authors’ contributions  

 
This work was carried out in collaboration among all authors. Author JAS designed the study and did 

the literature review with authors AO TBG, and MPB. Authors AO and JAS wrote the protocol and the 
first draft of the manuscript. Authors PT and RK edited the manuscript. All authors read and approved 

the final manuscript 
 

Article Information 
 

Editor(s): 
(1) Prof. Cynthia Aracely Alvizo Báez, Autonomous University of Nuevo Leon, Mexico. 

(2) Dr. Wagner Loyola, Brazilian Agricultural Research Corporation, Brazil. 
(3) Dr. Jaffu Othniel Chilongola, Tumaini University, Tanzania. 

Reviewers: 
(1) Ivy Deirdre Mangkau, University College of Technology Sarawak (UCTS), Malaysia. 
(2) Abhilasha Kapoor, University College of Medical Sciences and GTB Hospital, India. 

(3) Rian Ka Praja, Khon Kaen University, Thailand. 
(4) R. Sankaranarayanan, Mepco Schlenk Engineering College (Autonomous), India. 

(5) Vijay Kumar Barwal, Indira Gandhi Medical College and Hospital, India. 
Complete Peer review History: http://www.sdiarticle4.com/review-history/68275 

 
 
 
 

Received 25 April 2021  
Accepted 09 June 2021 
Published 15 June 2021 

 
 

ABSTRACT 
 

Introduction: Universal and global accessibility to COVID-19 vaccination is a vital tool for the 
reduction in the rate of infection, the severity of symptoms, the occurrence of death, and the 
acquiring of herd immunity. This is the major strategy in the reduction of the global socio-economic 
effects aimed by all counties. To bring this pandemic to an end, a large share of the world needs to 
be immune to the COVID-19 virus. The safest way to achieve this is with equal access and 
distribution of the COVID-19 vaccine through global cooperation. 

Mini-review Article 



 
 
 
 

Asare Danquah et al.; AJI, 4(1): 53-58, 2021; Article no.AJI.68275 
 

 

 
54 

 

Objectives: The objective of this article was to review literature to raise the awares globally to 
enure that all nations whether rich or poor get vaccination for COVID 19. 
Conclusion: The debate about the global plan for ensuring equal access to vaccines should 
include people of all race, socioeconomic, geographical, and political trend to achieve desirable 
success. 
 

 

Keywords: Vaccination; COVID-19; global community. 
 

1. INTRODUCTION  
 

The organisation of novel vaccines, during a 
global pandemic, accompanies constraints in 
beginning antibody supply, which requires 
prioritization of populace gatherings [1]. With 
regard to COVID-19 vaccines, the significant test 
is the disparity of distribution of the novel 
vaccines. The dire choices concern whom, which 
nations, and what landmass should be inoculated 
first which is an intricate general medical problem 
[2]. 
 

The current trend of unequal accessibility to 
COVID-19 vaccines which is determined by a 
country’s economic status, income levels, share 
of purchased doses, geographical location, race 
and immigration status, if unregulated will be 
detrimental to the efforts and gains being made 
to overcome this pandemic. The high income 
countries representing only a fifth of the 
worldwide grown-up populace, have bought the 
greater part of all the vaccine’s portions, bringing 
about the differences between grown-up 
populace offer and dosages bought by other 
remaining countries, with vaccination rate of 25 
times more than those within the lowest income 
brackets making the wealthiest 27 countries 
receiving 38.6% of the vaccines [3]. 
 

More than 869 million doses have been 
administered across 155 countries covering 5% 
of global population [4], and it remains the 
world’s biggest vaccination campaign in history 
with a daily vaccination rate of an average of 
17.4 million doses, the distribution is lopsided. 
 
In the U.S., 202 million doses have been 
administered on an average of 3.35 million doses 
per day, but unfortunately, the same cannot be 
said about the other part of the world [5]. 
 

As can be seen in  the global distribution map  
(Fig. 1), the global delivery of vaccines remains 
shockingly unbalanced. Nearly one in every four 
people in high-income countries have received 
the COVID-19 vaccine as against one in every 
500 people in low-income countries according to 
WHO. High-income countries such as the United 
States, the United Kingdom, and Israel has 

received more than half of the 869 million doses 
worldwide, while the poorest countries received 
just 0.1 per cent of the doses [6]. 
 

2. ALTERNATIVE SOLUTION  
 
The main challenge while overcoming the novel 
coronavirus will be ensuring the equitable 
access, especially in the countries that do not 
have universal health coverage and the financial 
strength to compete logistically. 
 
Providing universal global access to COVID-19 
vaccinations, which is vital for reducing morbidity 
and mortality rate and contributing to global 
population immunity, is a major contributing 
factor that could help jeopardize the pandemic's 
power. The following strategies has been 
suggested; 
 

1. The latest COVAX program introduced by 
the WHO needs the support of wealthy 
nations to promote inclusion and equal 
vaccine coverage for all the poor countries, 
taking into account the disadvantaged, 
underrepresented, and oppressed 
communities. 

2. Stronger cooperation between 
stakeholders as well  as government, 
academia, researchers, suppliers, and 
multilateral partners should be intense in 
all part of the world. 

3. Africa, Asia and Middle East governments 
should step up their efforts to combat 
COVID-19 in terms of accurate data 
generation and estimates, national 
vaccination coordination and Socio-
economic Support for its citizenry. 

4. Governments should own up to their 
responsibilities and should provide funds to 
the local scientists and researchers in 
order to scale up the vaccine research on 
the various deprived continents. 

5. Partnership cooperation with 
manufacturers to share technologies and 
even waive their intellectual property rights 
will aid in adequate vaccine production. 

6. Encouraging vaccine trade and 
redistribution among the countries who  



 
 
 
 

Asare Danquah et al.; AJI, 4(1): 53-58, 2021; Article no.AJI.68275 
 

 

 
55 

 

have purchased an unethical surplus of 
vaccine doses. 

 

3. WORLD HEALTH ORGANISATION 
STRATEGY ON INEQUALITIES 

 
Currently, the major intervention to curtail the 
inequalities, is the introduction of a strategy 
known as the COVAX program by the WHO, 
which aims to make vaccines accessible to the 
developing countries. More than 38 million doses 
have been shipped to over 100 countries in less 
than a year. COVAX plans to provide over two 
billion doses to 190 countries. So far, nearly 900 
million doses have been secured through various 
programs, which is enough to vaccinate roughly 
30% of Africa's 1.3 billion population this year. 
This is a reverse of vaccine inequality and 
vaccine nationalism which will fuel the scarcity of 
vaccines. A me-first strategy would be 
counterproductive, as it would promote hoarding 
and prolong the pandemic [7]. The need to 
urgently support this global initiative to promote 
universal access, is of much importance since it 
has made massive strides in solving the issues 
of inequalities amid the pandemic. 
 
Below is a graphical presentation (Fig. 2) of the 
economic income level of countries and the 

percentage of global age population distribution 
as against the percentage of covid vaccines 
purchased and progress of COVAX distribution 
program. 
 

4. BILATERAL AGREEMENTS AND 
COOPERATION 

 

Though there is an evidence of vaccine hoarding 
among high-income countries but also there is an 
urgent need to encourage and promote vaccine 
donation by these countries [8]. 
 

Below is a graph (Fig. 3) to indicate the number 
of doses being purchased by the high-income 
economies. 
 

The graph above shows unequal proportional 
access to the COVID 19 vaccines. There is then 
a need to encourage cooperation among these 
countries to promote vaccine donation. Currently, 
China has donated 50,000 shorts of Sinopharm 
vaccines to 53 countries. Making countries such 
as Philipines, Pakistan, Indonesia, Lebanon and 
some African countries have now been able to 
roll out their vaccination programs [9]. It is 
therefore commendable for countries who have 
bought the vaccines in excess need to freely 
donate to the low income countries to improve 
vaccine access and equity.  

 

 
 

Fig. 1. World map showing distritbution of doses of vaccine administered 



 
 
 
 

Asare Danquah et al.; AJI, 4(1): 53-58, 2021; Article no.AJI.68275 
 

 

 
56 

 

 
 

Fig. 2 – 2a. Without COVAX redistribution   Fig. 2b.  With COVAX redistribution 
 

 
 

Fig. 3. Vaccine Doses Purchased by High Income Level countries 
 

5. POLICY IMPLICATION 
 
Recognising race and immigrational status 
inequalities during this pandemic, is a key tool for 

eradicating the coronavirus. Various countries 
and territories should endeavour to carry out 
vaccination programmes devoid of immigrational 
status, race and religious orientation. 



 
 
 
 

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57 

 

A case of Israelis’ refusal to vaccinate non-
citizens in Palestinian territories offers a stark 
illustration of the divide as the world steps up 
what is already on track to become a highly 
unequal vaccine drive, Israel shipped 
Pfizer/BioNTech vaccine batches deep into the 
West Bank, however, they only distributed to 
Jewish settlers and more than half (5.3 million) of 
its residents have been vaccinated but 
meanwhile not the nearly 2.7 million Palestinians 
who live nearby west bank had access to the 
vaccines. Even young and healthy Israelis who 
came to the clinics are sometimes compensated 
with surplus stock to prevent wasting unused 
vials. This trend will have a negative effect on 
Israel's target of herd immunity, keeping infection 
rates high [10]. 
 

The focus on vaccine nationalism will aid the 
coronavirus's global spread, allowing further 
opportunities for vaccine-resistant variants to 
evolve and Covid-19 outbreaks to resurface, 
even in developed countries. 
 
In England, there is more pressing concerns of 
vaccine equity as data show substantially lower 
rates of COVID-19 vaccination among the over 
80s in the ethnic minority with the white people 
receiving 42.5%, black people 20.5% and 
deprived communities (least deprived 44.7%, 
most deprived 37.9%) as at 15 January 2021. 
Similar data from an NHS trust show lower 
COVID-19 vaccination rates among ethnic 
minority healthcare workers representing 70.9% 
in white workers, 58.5% in South Asian and 
36.8% in black workers [11,12]. This has serious 
implications as the pandemic continues to have a 
disproportionate effect on people from ethnic 
minorities, with higher COVID-19 morbidity and 
mortality and greater adverse socioeconomic 
consequences [13]. 
 

5.1 Policy implication focus on Africans 
and Asia 

 

Costs associated with COVID-19 diagnosis and 
care have the potential to exacerbate [14]. In 
light of the likelihood of the vaccine and the need 
for Africa as a continent to have access to and its 
use, remains a serious threat to global health, 
the question remains: 
 
Who will pay for Africa?  
 
Inequality with antiretroviral drugs, resulting in 
the deaths of millions. Raise serious concerns 
among African governments and its over, 
1.341billion population [15] about the potential 

risk posed by COVID-19 due to the unavailability 
of vaccines, based on previous experience.  
 
With regards to these previous indications, it has 
become necessary for this policy to be 
implemented to its fullest and ensure several 
African countries not face the significant logistical 
challenges in implementing and delivering of 
COVID vaccines [16]. This needs a Global 
Strategy to overcome the world health threat. 
 
In the case of lower-middle-income economies in 
Asia and the Middle East which have been 
heavily hit by this pandemic with 33,434,000 
infections and 464,000 death so far recorded, 
have India currently leading the world in the daily 
average number of new infections of 204,186 
and 1,125 death [10]. 
 
The donation of vaccines among countries such 
as India, Myanmar, Ecuador, and Indonesia, 
among the poorest of the middle-income nations 
will be the greatest milestone in this fight against 
the world’s biggest pandemic. 
    

6. CONCLUSION  
 

The debate about the global plan for ensuring 
equal access to vaccines should include people 
of all race, socioeconomic, geographical, and 
political trend to achieve desirable success. 
 

The COVID-19 pandemic has overwhelmingly 
affected our already disadvantaged social 
classes. Emphatically, world leaders and heads 
of state around the world must choose between 
flattening the epidemiological curve or flattening 
the economy, policymakers must take concrete 
steps to resolve the emerging gaps in vaccine 
accessibility and distribution among High income 
and low-income economies with the help of 
multilateral organizations such as WHO.  

 
CONSENT  
 
It is not applicable.  
 
ETHICAL APPROVAL  
 
It is not applicable.  
 
ACKNOWLEDGEMENTS 
 
The authors appreciate Dr. Aravinda Meera 
Guntupalli and Dr. Bhattacharya Sohinee 
both senior lecturers of University of 



 
 
 
 

Asare Danquah et al.; AJI, 4(1): 53-58, 2021; Article no.AJI.68275 
 

 

 
58 

 

Aberdeen for their remarkable support 
towards this publication. 
 

COMPETING INTERESTS 
 

Authors have declared that no competing 
interests exist. 
 

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_________________________________________________________________________________ 
© 2021 Asare Danquah et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution 
License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any 
medium, provided the original work is properly cited. 

 
 

 
 

Peer-review history: 
The peer review history for this paper can be accessed here: 

http://www.sdiarticle4.com/review-history/68275 

https://www.worldometers.info/
https://www.bbc.com/news/world-56698854
https://www.bbc.com/news/world-56698854
https://www.vox.com/2021/1/29/22253908/rich-countries-hoarding-covid-19-vaccines
https://www.vox.com/2021/1/29/22253908/rich-countries-hoarding-covid-19-vaccines
https://www.vox.com/2021/1/29/22253908/rich-countries-hoarding-covid-19-vaccines
http://creativecommons.org/licenses/by/4.0

