News & Events

Imagine: It’s late 2020. The world has been dealing with the COVID-19 pandemic for months. In some places, schools are shuttered. In other places, whole communities are shuttered. Every day, new reports of people dying from this novel virus circulate — some of these stories hit closer to home than others. You wonder … when will we be able to get back to life as it once was?

As 2020 becomes 2021, a beacon of hope appears in the form of vaccines. The horror stories you were hearing are now replaced by stories of rejoicing as family members, neighbors and friends share pictures and videos of themselves receiving these life-saving miracles. Now, … you think to yourself … maybe things can start to return to normal.

Most of us remember the fear and anxiety in 2020 when the COVID-19 pandemic spread across the globe unchecked — and the flood of relief when vaccines started rolling out. But the transition from fear to hope was not equally shared everywhere on Earth. Millions around the world would not benefit from COVID-19 vaccines in 2020 or 2021 or, for some, even in 2022. Citizens of Ghana, for example, would have to wait years before vaccine doses made it to the people who needed them. This was true of countless people around the globe, especially in low- and middle-income countries. While the push to vaccinate the world’s population against COVID-19 was rapid and effective by historical standards, it wasn’t equal. For example, by late 2022, about 70% of the world’s population had been vaccinated, but a closer look revealed that at the same time, only about 25% of people in low- and middle-income countries had been vaccinated. For millions of people around the globe, the beacon of hope arrived way too late.

Today, after a concerted effort, most countries have access to enough doses of COVID-19 vaccine for their citizens. However, infectious diseases disregard borders, and vaccine distribution remains unequal. The reasons for vaccine inequity are complex, but three examples demonstrate some of the reasons why the place you were born could mean the difference between living or dying at the hands of an infectious disease. 

Reason 1: Lack of infrastructure  

Distributing vaccines around the world is difficult, often requiring a lot of infrastructure. For example, many vaccines require refrigerators, and refrigerators require a steady source of electricity, so the storage of these vaccines is limited to areas of a country that have such infrastructure. One such vaccine protects against typhoid fever, a deadly disease that infects 20 million people a year and is especially common in places that suffer from contaminated water sources or poor sanitation. The need for stable, robust healthcare infrastructure can make it difficult for vaccines, like the typhoid vaccine, to reach those who live far from the closest hospitals or doctor’s offices where doses are stored and administered. Likewise, to be effective, people need to receive boosters of the typhoid vaccine every two to five years. When vaccines require a series of boosters, the effort to keep people protected becomes even more difficult. Frequent boosters mean the vaccine either needs to reach remote communities regularly or that individuals need to travel to more populated communities multiple time, (and on a schedule that is appropriate for receipt of the subsequent doses). 

Reason 2: Cost 

Vaccine development and distribution takes time and money. As a result, many vaccines are too expensive for low- and middle-income countries. In order to purchase enough doses to vaccinate their citizenry, a country may work with vaccine manufacturers or nongovernmental organizations (called NGOs). Often manufacturers will scale their pricing so that vaccines can be disseminated more broadly, but even with such assistance, many countries still struggle to afford enough vaccines for their population alongside other pressing healthcare expenses. 

The effects of cost can be demonstrated by one of the most expensive vaccines — the human papillomavirus, or HPV, vaccine. HPV-associated cervical cancer causes more than 300 thousand deaths a year. About 90% of those deaths occur in low- and middle-income countries, where treatment for cervical cancer is often unattainable either because of associated costs or availability of resources. In this case, despite its high price, the HPV vaccine is still less expensive than treatment, so being able to effectively disseminate that vaccine could not only prevent hundreds of thousands of deaths, but also reduce the overall costs of healthcare in a country where resources are limited.  

Global humanitarian initiatives, like GAVI and UNICEF, have programs to purchase and donate vaccines to countries in need, but the burden still falls largely on those countries. In low-income countries, where the median wage can be below 5 US dollars a day, the cost of acquiring and distributing expensive vaccines, like the HPV vaccine, is simply too high. Even in countries that have been able to afford HPV vaccine, the cost has led to programs that limit vaccinations to females, the group most at-risk from the disease. Unfortunately, this means that males do not benefit from protection against other cancers caused by HPV, such as anal, penile and oropharyngeal cancers, and that overall the programs do less to stem transmission. The cost of HPV vaccine has also led to recommendations for fewer doses of vaccine in some places. Fortunately, studies of protection following receipt of fewer doses of HPV vaccine have demonstrated protection, allowing updated recommendations for decreased doses per individual in well-resourced countries as well.

Reason 3: Geopolitics 

Even when a vaccine is inexpensive and easy-to-distribute, social or political obstacles can prevent doses from getting to the people that need them. Political upheaval or violent conflict typically disrupt local healthcare services. Moreover, these instabilities can halt outside humanitarian efforts. As a result, already-vulnerable populations can become more vulnerable as the violence amplifies existing issues, compromises prevention programs, and often introduces new health-related situations, such as infectious diseases. 

The polio vaccine offers a good example of how quickly progress can be undone by geopolitical strife. As of 2025, we have managed to eliminate natural poliovirus infection from every country on Earth except for two: Afghanistan and Pakistan. Unfortunately, due to geopolitical barriers, vaccinating the last vulnerable populations in those two countries has proven difficult. As a result, polio remains a danger — not only to unprotected communities in those countries but also to others around the world, should the virus begin to spread, as experts fear it may. Likewise, the dangers to healthcare workers in high-conflict areas are enormous. For example, in February of 2022, eight vaccine workers were killed while administering polio vaccines in Afghanistan. While many healthcare workers are willing to risk danger to deliver vaccines, ever-changing geopolitical conditions will always remain an obstacle to vaccine distribution.

In Summary 

We live in an interconnected world, and infectious diseases don’t respect borders. That means we all benefit when vulnerable populations are protected and helped in their struggles. Limited infrastructure, high costs, and local conflict can all act as barriers to prevent vaccines from reaching the people who need them most, and while humanitarian organizations, like Gavi and UNICEF, are working to overcome obstacles in some of these places, there’s always more work to be done. So, when you think back to the relief you felt when the COVID-19 vaccines became available in your community, consider that you may have only had that feeling by the grace of where you were born. Shouldn’t everyone have an opportunity to feel that relief — not just for COVID-19, but for all vaccine-preventable diseases?