Inequality in COVID-19 vaccination in Africa

Authors

  • Saad Zbiri International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca; Laboratory of Public Health, Health Economics and Health Management, Mohammed VI Center for Research and Innovation, Rabat https://orcid.org/0000-0001-7059-0577
  • Chakib Boukhalfa National School of Public Health, Rabat https://orcid.org/0000-0001-6562-4189

DOI:

https://doi.org/10.4081/jphia.2023.2353

Keywords:

COVID-19, vaccination, vaccine, inequality, Africa

Abstract

Background. The COVID-19 pandemic has spread rapidly to all countries with significant health, socioeconomic, and political consequences. Several safe and effective vaccines have been developed. However, it is not certain that all African countries have successfully vaccinated their populations. Objective. To study the distribution and determinants of COVID-19 vaccination in Africa from March 2021 to June 2022. Methods. Using reliable open-access data, we used the proportion of fully vaccinated people with a complete schedule as a reference variable. To analyze the level of inequality in COVID-19 vaccination, we computed common inequality indicators including two percentile ratios, the Generalized Entropy index, the Gini coefficient, and the Atkinson index. We also estimated the Lorenz curve. To identify drivers of COVID-19 vaccination, we estimated univariate and multivariate regression models as a function of COVID-19-related variables, demographic, epidemiologic, socioeconomic, and health system-related variables. To overcome a potential endogeneity bias, we checked our results using simultaneous equation models. Results. 53 African countries with available data were included in the study. The proportion of fully vaccinated people increased during the study period. However, this increase remained unequal across African countries. Based on the inequality indicators and the Lorenz curve, inequalities in COVID-19 vaccination across African countries were high, although they have decreased in recent months. Total COVID-19 cases and human development index were identified as significant determinant factors that were independently associated with COVID-19 vaccination. Conclusions. Inequality in COVID-19 vaccination in Africa was high. Promoting adequate information to the general population and providing financial and logistical support to low-income countries can help expand COVID-19 vaccination in Africa.

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References

Van Damme W, Dahake R, Delamou A, Ingelbeen B, Wouters E, Vanham G, van de Pas R, Dossou JP, Ir P, Abimbola S, Van der Borght S, Narayanan D, Bloom G, Van Engelgem I, Ag Ahmed MA, Kiendrébéogo JA, Verdonck K, De Brouwere V, Bello K, Kloos H, Aaby P, Kalk A, Al-Awlaqi S, Prashanth NS, Muyembe-Tamfum JJ, Mbala P, Ahuka- Mundeke S, Assefa Y. The COVID-19 pandemic: diverse contexts; different epidemics how and why? BMJ Glob Health. 2020;5(7):e003098. DOI: https://doi.org/10.1136/bmjgh-2020-003098

COVID-19 Government Response Tracker [Internet]. [cited 2022 September 30]. Available from: https://www.bsg.ox.ac.uk/research/research-projects/covid-19-government-response-tracker

Parodi SM, Liu VX. From Containment to Mitigation of COVID-19 in the US. JAMA. 2020 Apr 21;323(15):1441–2. DOI: https://doi.org/10.1001/jama.2020.3882

Carneiro DC, Sousa JD, Monteiro-Cunha JP. The COVID-19 vaccine development: A pandemic paradigm. Virus Res. 2021 Aug;301:198454. DOI: https://doi.org/10.1016/j.virusres.2021.198454

Liu Y, Salwi S, Drolet BC. Multivalue ethical framework for fair global allocation of a COVID-19 vaccine. J Med Ethics. 2020 Aug;46(8):499–501. DOI: https://doi.org/10.1136/medethics-2020-106516

ACT Together to End COVID-19 | United Nations [Internet]. [cited 2022 September 30]. Available from: https://www.un.org/en/coronavirus/act-accelerator

The ACT-Accelerator [Internet]. [cited 2022 September 30]. Available from: https://www.theglobalfund.org/en/act-accelerator/

Our World in Data [Internet]. Our World in Data. [cited 2022 September 30]. Available from: https://ourworldindata.org

Data collections - WHO [Internet]. [cited 2022 September 30]. Available from: https://www.who.int/data/collections

World Bank Open Data | Data [Internet]. [cited 2022 September 30]. Available from: https://data.worldbank.org/

Cowell F. Measuring Inequality. OUP Oxford; 2011. 252 p. DOI: https://doi.org/10.1093/acprof:osobl/9780199594030.001.0001

Chotikapanich D. Modeling Income Distributions and Lorenz Curves. Springer Science & Business Media; 2008. 323 p. DOI: https://doi.org/10.1007/978-0-387-72796-7

Palma W. Time series analysis. John Wiley & Sons; 2016. 590 p.

Krishnakumar J. Estimation of Simultaneous Equation Models with Error Components Structure. Springer Science & Business Media; 2012. 371 p.

StataCorp. Stata Statistical Software: Release.USA: College Station, TX: StataCorp LP.

Galizzi MM, Miraldo M, Stavropoulou C, van der Pol M. Doctor-338 patient differences in risk and time preferences: A field experiment. J Health Econ. 2016 Dec;50:171–82. DOI: https://doi.org/10.1016/j.jhealeco.2016.10.001

Goodman K, Mossad SB, Taksler GB, Emery J, Schramm S, Rothberg MB. Impact of Video Education on Influenza Vaccination in Pregnancy. J Reprod Med. 2015 Dec;60(11– 12):471–9.

Milcent C, Zbiri S. Prenatal care and socioeconomic status: effect on cesarean delivery. Health Econ Rev. 2018 Mar 10;8(1):7. DOI: https://doi.org/10.1186/s13561-018-0190-x

Alaran AJ, Adebisi YA, Badmos A, Khalid-Salako F, Gaya SK, Ilesanmi EB, et al. Uneven power dynamics must be levelled in COVID-19 vaccines access and distribution. Public Health Pract (Oxf). 2021 Nov;2:100096. DOI: https://doi.org/10.1016/j.puhip.2021.100096

Bollyky TJ, Gostin LO, Hamburg MA. The Equitable Distribution of COVID-19 Therapeutics and Vaccines. JAMA. 2020 Jun 23;323(24):2462–3. DOI: https://doi.org/10.1001/jama.2020.6641

Gupta R, Morain SR. Ethical allocation of future COVID-19 vaccines. J Med Ethics. 2020 Dec 17;medethics-2020-106850. DOI: https://doi.org/10.1136/medethics-2020-106850

Sun X, Andoh EA, Yu H. A simulation-based analysis for effective distribution of COVID-19 vaccines: A case study in Norway. Transp Res Interdiscip Perspect. 2021 Sep;11:100453. DOI: https://doi.org/10.1016/j.trip.2021.100453

Tatar M, Shoorekchali JM, Faraji MR, Wilson FA. International COVID-19 vaccine inequality amid the pandemic: Perpetuating a global crisis? J Glob Health. 2021 Jul 3;11:03086. DOI: https://doi.org/10.7189/jogh.11.03086

Suárez-Álvarez A, López-Menéndez AJ. Is COVID-19 vaccine inequality undermining the recovery from the COVID-19 pandemic? J Glob Health. 2022 May 23;12:05020. DOI: https://doi.org/10.7189/jogh.12.05020

Çakmaklı C, Demiralp S, Kalemli-Ozcan S, Yesiltas S, Yıldırım MA. Economic costs of inequitable vaccine distribution across the world [Internet]. VoxEU.org. 2021 [cited 2022 September 30]. Available from: https://voxeu.org/article/economic-costs-inequitable363vaccine-distribution-across-world

COVID vaccines: Widening inequality and millions vulnerable | | UN News [Internet]. [cited 2022 September 30]. Available from: https://news.un.org/en/story/2021/09/1100192

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Published

24-05-2023

How to Cite

Zbiri, S., & Boukhalfa, C. (2023). Inequality in COVID-19 vaccination in Africa. Journal of Public Health in Africa, 14(7). https://doi.org/10.4081/jphia.2023.2353

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Original Articles