(Source: The New Humanitarian, ) –
Vaccine inequality, health systems under pressure, socio-economic fallout.
Many countries are rolling out coronavirus vaccination plans, but it’s unclear when – and in some cases, how – these vaccines will reach people caught in crisis zones. The COVID-19 pandemic is driving record-breaking humanitarian needs: Global aid response plans total more than $35 billion this year.
Below you’ll find data exploring coronavirus trends and vaccine issues in key crisis areas, a table showing the worldwide picture, and a global map with select stories.
Data on this page is updated once a day, and other information is revised frequently.
Trends in key crises
COVID-19 surges in populous South Asia are driving record global totals: There were 5.7 million new global cases in the week leading up to 25 April – the highest weekly total since the pandemic began. India recorded more than 380,000 new infections on 30 April – the largest single-day total in any country. Bangladesh and Pakistan have also seen rapid rises, which have had a “catastrophic” impact on frontline workers, the Red Cross says.
In 2020, the pandemic doubled the number of people who needed humanitarian aid worldwide, according to the UN, setting up this year’s record $35 billion appeal.
As of February 2021, the UN’s refugee agency, UNHCR, had tallied more than 49,000 COVID-19 cases among refugees and displaced people around the world, including 446 deaths.
Beyond the immediate humanitarian impacts, the cost of helping the world’s most vulnerable 10 percent facing COVID-19’s socio-economic repercussions could total $90 billion, according to UN estimates. The World Bank estimates the pandemic pushed between 119 million and 124 million “new poor” into extreme poverty last year – a shift unlikely to be reversed in 2021.
Vaccines: Queue-jumping, unequal rollouts, and humanitarian stockpiles
There’s a clear divide in who has early access to coronavirus vaccines.
Public health officials warn of “vaccine nationalism”, hoarding, and queue-jumping as wealthier countries buy up early supplies.
“Most countries do not have anywhere near enough vaccines to cover all health workers, or all at-risk groups, never mind the rest of their populations,” said the WHO’s director-general, Tedros Adhanom Ghebreyesus. “There remains a shocking imbalance in the global distribution of vaccines.”
As of 9 April, low-income countries had received just 0.2 percent of the 700 million vaccine doses administered worldwide. The vast majority of doses – 87 percent – were in high-income or upper middle-income countries. Most countries began initial rollouts by early April as vaccine distributions picked up pace: 190 countries had started vaccinations as of 6 April; in mid-February, some 130 countries hadn’t administered a single dose.
The WHO has inked agreements to reserve some 1.3 billion doses for 92 low- and middle-income countries under the COVAX programme, which was created with the goal of ensuring equal vaccine access, including doses for at least 20 percent of countries’ populations.
But Tedros said wealthier countries are circumventing COVAX by signing dozens of bilateral deals with manufacturers – driving up prices and potentially delaying COVAX deliveries. He urged countries to vaccinate health workers and older people, then share excess doses with COVAX.
Countries began receiving their first COVAX doses in late February and early March. Initial planning called for some 330 million doses – enough to cover 3.3 percent of participating countries’ populations – in the first half of 2021. In late March, the WHO warned of delays from India’s Serum Institute, which is supplying the majority of the doses. As of 28 April, COVAX had delivered 49 million doses worldwide. It had aimed for 100 million doses by the end of March.
As of 23 April, funding for the Access to COVID-19 Tools (ACT) Accelerator, the WHO-led partnership that includes the COVAX programme, was short $19 billion – roughly two thirds of the projected budget for 2021.
Beyond vaccine access at the country level, there are fears that marginalised groups often left out of government health planning at the best of times – migrants, refugees, and other people in crises, for example – may be at the very back of the queue. Some 60 to 80 million people live in areas controlled by non-state armed groups, the International Committee of the Red Cross estimates.
“Those living in humanitarian emergencies or in settings that are not under the control of national governments are at risk of being left behind and must be part of COVID-19 vaccination efforts,” warned the Inter-Agency Standing Committee, an umbrella group for humanitarian responders. Some 167 million people worldwide could be excluded from COVID-19 vaccination programmes, the IASC estimates.
Jordan, Nepal, Rwanda, and Serbia are among 20 countries where refugees are receiving COVID-19 vaccines “on an equal footing to citizens”, the UNHCR said on 7 April. At least 153 countries include refugees in their immunisation plans, but in practice, vaccine shortages, shorthanded health systems, red tape, or fear of arrest also keep refugees and migrants on the outside.
The COVAX programme includes plans for a “humanitarian buffer”, which would see five percent of the total doses stockpiled for “acute outbreaks” or for use by humanitarian groups. The buffer was formally approved by the board of Gavi, the global vaccine alliance, on 23 March. The buffer is a “last resort” for people with no access to vaccines – especially in areas controlled by armed groups that are out of reach of government health systems. Countries can apply for vaccines from the buffer, as can humanitarian groups – including UN agencies, Red Cross and Red Crescent societies, local and international NGOs, and civil society groups. Assuming COVAX secures its goal of two billion doses in 2021, the humanitarian buffer would equate to 100 million doses. The costs of actually delivering vaccines from this stockpile aren’t clear – current global humanitarian appeals do not include vaccine rollout costs.
At the same time, vaccine hesitancy is growing around the globe, according to researchers at the Duke Global Health Innovation Center, and could become “the primary obstacle to global immunity”. Researchers pointed to multi-country surveys that suggest rising reluctance to vaccinate. “If this is the case, we will soon find that producing enough vaccines does not translate to enough vaccinations,” the researchers said.
Other vaccine news:
India’s COVID-19 burden has direct repercussions for global vaccine rollouts. India is the leading vaccine supplier to much of the world through COVAX, and touted generous donations as part of its “vaccine diplomacy” push. Now, it’s struggling to vaccinate its own population amid reported shortages and the world’s fastest-rising COVID-19 caseload. In recent weeks, it has fast-tracked foreign-made vaccines and restricted exports – delaying COVAX deliveries to many countries almost entirely reliant on the UN-backed programme.
Another sign of how India’s vaccine problems reverberate: Facing rising caseloads and vaccine shortfalls, Bangladesh has postponed COVID-19 vaccinations for some 900,000 Rohingya refugees until COVAX supplies arrive, the UNHCR reported. Rohingya are included in national vaccination plans, which were set to launch in the refugee camps on 27 March. There have been relatively few COVID-19 cases among Rohingya refugees – about 535 as of late April. But infections and test-positivity rates are rising in the wider Cox’s Bazar district, the WHO says, pushing health workers to double down on prevention measures. Frontline workers and refugees older than 40 are to be prioritised when vaccines reach the camps, according to government plans. The refugee camps have a young population – more than half of residents are under 18. There are an estimated 30,000 people older than 60.
“Who you are and where you live should not determine access to the vaccine.”
On paper, many countries have committed to including refugees, migrants, and other frequently neglected groups in COVID-19 vaccination plans, but there are plenty of obstacles. In Pakistan, some 1.4 million Afghans who hold refugee cards will be included, the UNHCR reported in April, but it’s unclear whether unregistered Afghans – numbering in the hundreds of thousands – will be. In neighbouring Iran, the government says it will include both refugees and undocumented Afghans. But like many countries, it’s reliant on COVAX and donations for early stocks, and supplies are limited. Some countries require government-issued documents to get vaccines; the UNHCR said it’s asking authorities in India to let refugees use UNHCR-issued documents. Amnesty International said vulnerable groups across South Asia – including Dalits, ethnic minorities, day labourers, refugees, and migrants – are often excluded, partly due to lack of documentation or online access, and because of poor communication. “Marginalised groups across South Asia have been effectively locked out by practical barriers,” Amnesty’s Yamini Mishra said. “Who you are and where you live should not determine access to the vaccine.”
There’s a widening COVID-19 vaccine gap between richer and poorer countries in Europe. Only 0.4 percent of people in low-income countries like Kyrgyzstan, Moldova, and Ukraine have been vaccinated, while richer European countries have immunised about 17.7 percent of their populations, the International Federation of Red Cross and Red Crescent Societies said on 21 April. Ukraine received its first 117,000 doses through COVAX on 16 April.
Jordan has launched what the UNHCR says are the world’s first vaccination centres in refugee camps. Vaccination centres opened in Zaatari camp in February and in Azraq camp in mid-March. Jordan was already one of the world’s first countries to begin coronavirus vaccinations for refugees. Some 3,500 refugees in Jordan have received a COVID-19 vaccine as of 16 April, the UNHCR reported, and more than 10 percent of camp residents have registered for vaccinations.
The US hit pause on its rollout of the Johnson & Johnson vaccine on 13 April – before declaring it “safe and effective” days later – in a move that could have repercussions for countries with spiralling COVID-19 infections but few vaccine options. The US Centers for Disease Control and Prevention reviewed the vaccine produced by J&J after six people – from more than 6.8 million doses administered – developed rare blood clots. It’s unclear what caused the blood clots, which can occur naturally (and can also be caused by COVID-19 itself). Soon after, South Africa paused its J&J rollout as a precautionary measure, before also lifting the suspension days later. Several countries previously paused use of the Oxford-AstraZeneca vaccine for similar reasons, though Europe’s drugs regulator and a WHO committee later declared the vaccine safe. The COVAX equity scheme, which is supplying much of the world’s vaccines, is heavily reliant on both vaccines. Precautionary suspensions are unnecessarily eroding vaccine confidence in countries where there are no other options, said Ayoade Alakija, co-chair of the African Union’s Africa Vaccine Delivery Alliance. “People are saying, ‘If you don’t want it out there … why are you saying we should take it?’ This is the problem we are running into,” she told the BBC.
“People are saying, ‘If you don’t want it out there … why are you saying we should take it?’”
Decades-worst flooding in Timor-Leste hit the country’s COVID-19 vaccination plans just as they were getting underway. Severe floods and landslides triggered by days of heavy rain killed at least 45 people. At least 12,000 people were displaced. There has been extensive damage to health facilities, including COVID-19 quarantine and isolation centres, the UN said, as well as a medical supply facility where vaccines were to be kept. The country’s first COVID-19 vaccines were delivered on 5 April, and 16,700 doses had been administered amid the flood’s aftermath, as of 21 April. Many essential staff set to work on COVID-19 programmes are now “at the front line of the floods response”, the UN said. Parts of Indonesia were also deeply affected, including the western part of Timor Island, which was directly hit by Cyclone Seroja in early April. Indonesia has recorded at least 163 deaths with dozens more missing.
Venezuelan healthcare students, and the country’s medicine and science academies, are urging the government to speed up vaccination plans, Reuters reported, amid a rise in infections and deaths of frontline health workers. At least 440 healthcare staff have died from COVID-19 as of 5 April, according to Médicos Unidos de Venezuela, a diaspora group. The country has received about 750,000 vaccine doses from Russia and China, for a population of about 28 million. Venezuela is eligible for vaccines through the COVAX programme (which had distributed 38 million doses around the world as of 8 April), but President Nicolás Maduro has said the country will not approve the AstraZeneca vaccine, which forms the bulk of COVAX supplies. Bloomberg reported that Venezuela wants to buy the single-shot vaccine made by Johnson & Johnson, but these vaccines may not be available through COVAX until at least July.
Refugees and migrants are being “left behind” in Lebanon’s vaccine rollout, Human Rights Watch said on 6 April. Non-Lebanese comprise 30 percent of the country’s population, but less than 3 percent of those who have been vaccinated, according to government statistics. “A third of the population risks being left behind in the vaccination plan,” said Nadia Hardman, an HRW researcher. Health officials have said Palestinian refugees “and all the other residents on Lebanese territory” will be included in vaccination planning, but rights groups have warned of mixed signals. In January, Lebanon inked a deal with the World Bank to fund vaccines for two million people, under a programme set up specifically for countries hosting refugees.
Syria’s first shipment of vaccine doses through the COVAX programme will be delayed until “some time around May”, the UN said on 5 April, in a sign of how global supply bottlenecks are affecting crisis-hit areas. Some 912,000 AstraZeneca doses were bound for Syria, but India’s Serum Institute – which is supplying the bulk of COVAX doses – has announced delays due to export restrictions in India, which is in the middle of a coronavirus surge.
Afghanistan is planning a COVID-19 vaccine rollout stretching to the farthest corners of a nation that the government doesn’t fully control. The health ministry’s target is to vaccinate 20 percent of its population this year, and 60 percent by the end of 2022. To do this, health officials are relying on local and international humanitarian groups to go where the government cannot, including Taliban-controlled areas, officials told The New Humanitarian. Groups prioritised for vaccines include displaced people between 30 and 50 years old, some of the hundreds of thousands of yearly returnees from neighbouring Iran and Pakistan, people in urban slums, and people older than 50 living in hard-to-reach districts. Like many countries, Afghanistan has been entirely dependent on donors and on COVAX for its vaccine supply. As of 8 April, Afghanistan had enough doses to fully vaccinate fewer than half a million people – about 1.3 percent of the population. But the UN warns there is also a “low demand” for vaccines among health workers, who comprise about 8 percent of Afghanistan’s COVID-19 cases. Some 100,000 people, including 68,000 health workers, had been vaccinated as of 8 April: “Vaccine uptake remains slow,” the UN said.
“Vaccine uptake remains slow.”
Deliveries of vaccines produced by India’s Serum Institute will be delayed, officials with the UN-backed COVAX scheme confirmed on 25 March, as India struggles with rising COVID-19 infections. The announcement deals a blow to lower-income countries, which are almost entirely reliant on COVAX to fuel their initial rollouts. The Serum Institute’s version of the AstraZeneca vaccine, known as Covishield, represents nearly 60 percent of COVAX supplies through the end of May. In late March, India severely restricted vaccine exports as it struggled with a surge in coronavirus cases. In February, the head of the Serum Institute said the company had been “directed to prioritise the huge needs of India” and warned of delays to global supplies. The institute was slated to deliver at least 110 million doses to COVAX by the end of May. COVAX says it had received 28 million doses as of 25 March.
Nearly all COVID-19 testing and treatment has stopped in Myanmar since a 1 February military coup, the UN says, and it’s unclear how coronavirus vaccine rollouts, started just before the coup, will continue. Violent crackdowns on protests and a civil disobedience movement have shut down Myanmar’s economy and pushed its health sector to the brink of collapse.
The global picture
The following sortable data shows the share of people who have received a COVID-19 vaccine dose. Countries with no information available are not displayed. The information is gathered by Our World in Data, a project run by University of Oxford researchers.
COVID-19 tracker: The global picture
Search the table by location. Highlighted areas indicate locations with global humanitarian appeals in 2021.
|Location||Total confirmed cases||Deaths|
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