Uneven COVID-19 vaccine take-up, distribution remain a threat

Global vaccine distribution remains inequitable and up-take is uneven in nations where vaccines are widely available. These factors add to risks that new virus variants like the Omicron variant will emerge, potentially leading to COVID-19 infection waves and renewed restrictions on economic activity.

While progress in vaccination and lower mortality in many countries is seen to be bolstering insurers' 2022 profitability, disparities in vaccine distribution and vaccination rates remain a threat - resurgent infections could strain healthcare systems, mute the economic recovery, and add to already significant insurance claims.

Key takeaways

  • Vaccination remains the most effective means of preventing severe disease and death from COVID-19, but only a fraction of vaccine doses pre-purchased by or for low-income countries have been delivered i,ii.
  • Renewed waves of COVID-19 infections, hospitalisations and deaths have emerged even in developed countries where vaccines are widely available but where a portion of the population opted against vaccination.
  • As infections persist globally, COVID-19 is all but certain to become endemic, necessitating vaccinations in at a minimum, vulnerable at-risk groups iii.
  • The effectiveness of vaccines does not last forever. "Breakthrough infections" in the previously vaccinated population are prompting more nations to initiate boosters. There are concerns that boosters and third doses could further limit developing nations' access to vaccines iv,v.
  • As infections persist, new variants of the SARS-CoV-2 virus including the Omicron variant that has been documented now in numerous countries in Africa, Asia, Europe and the Americas are likely to emerge, with unpredictable effects on the course of the pandemic.

Rapid development and administration of COVID-19 vaccines has been an extraordinary accomplishment, with 7 billion-plus doses administered, so far vi. However, the global vaccine rollout has not been without challenges.

Even in nations where vaccines are widely available, a share of the population has opted against inoculation, leaving these groups more vulnerable to reinfection, hospitalisation and potentially death.

Meanwhile, many people around the world are still awaiting a first dose, as inequities persist in developing countries. COVAX, the United Nations-backed effort to equitably supply vaccines to developing nations, has shipped 500 million doses to 144 countries, but needs hundreds of millions more doses to reach the new goal of inoculating 40% of every country's adult population by year's end v.

As the Northern hemisphere move into its winter season, many countries are expanding eligibility for vaccines to younger children vii. Use of boosters is also accelerating as initial inoculations wane in effectiveness. However, such re-vaccinations in nations where shots have been plentiful, have been the target of objections from the World Health Organization, which has long argued that getting first doses to developing nations' populations should take priority over repeated vaccinations.

Uneven and inequitable vaccine distribution

The world’s wealthiest nations have ordered and received vast quantities of vaccines, with some reserving several times the volume of their respective populations from vaccine makers including Oxford/AstraZeneca, Johnson & Johnson, Pfizer/BioNTech and Moderna viii.

A resurgence of COVID-19 cases, as has been observed in recent weeks and months in regions including Europe and North America. This resurgence remains a key risk because a sizeable portion of some countries' populations remain unvaccinated. Incidence of COVID-19 infection, hospitalisation and death is higher in unvaccinated than in vaccinated persons, according to the U.S. Centers for Disease Control and Prevention ix. Germany, where about one-third of the total population of Europe's largest economy remains unvaccinated, estimates the health risk from a COVID-19 infection among people who are not fully vaccinated as "very high" x.

While 57% of the population in the US and 75% of the population in China have been fully vaccinated, global coverage remains around 40%, and in many places the figure is substantially lower ii.

Poorer nations, particularly in Africa, that are largely reliant on the UN-backed COVAX programme have had significantly less access to vaccines than wealthier countries xi,xii. Despite securing around 5.9 billion doses via donations and administering some 500 million vaccines across 144 countries, COVAX leaders have revised targets downwards to having 1.4 billion doses available, from 2 billion doses originally, by the end of 2021 xiii.

Roadblocks to vaccine distribution in less developed countries also include infrastructure and healthcare logistics challenges, especially given the demanding storage conditions required for some COVID-19 vaccines.

Some of these nations have turned to vaccines from manufacturers whose products have yet to win or seek approval in wealthier countries: buying them, accepting donations or, in some instances, developing their own vaccines xiv,xv. Russia has three domestically produced and authorised COVID-19 vaccines including Sputnik V, which has been delivered to more than a dozen countries including India and Hungary. Latin American governments have been among primary recipients of Russian as well as Chinese vaccines, including from pharmaceutical companies Sinovac and CanSino.


Booster shots on the rise amid progress on vaccines, treatments

COVID-19 will almost certainly become an endemic disease that may wane in severity, but which will still require vaccination, in particular for vulnerable populations, for the foreseeable future.

Moreover, the emergence of the Omicron variant, which has been declared a variant of concern by the World Health Organization and has prompted some renewed travel restrictions, shows how the coronavirus is changing as infections pass from person to person. Scientists are now studying Omicron, to determine whether its multiple mutations will impact disease severity, transmissibility or the ability of existing vaccines to prevent infections.

Against this backdrop, many countries have ordered COVID-19 vaccine doses to cover deployment of booster shots needed, as the initial inoculations' efficacy wanes. One study suggests vaccine efficacy may be around 90% in the first month but falls to around 70% after six to seven months xvi. The use of boosters is accelerating in countries that are already heavily vaccinated with first and second doses, with health authorities in the US, Canada, UK and Europe recommending them especially for older people, at-risk and more vulnerable groups. The scale and use of booster injections is seen by governments and health officials as critical to combating the recurrent surges xvii

The WHO has been critical of rapid deployment of booster shots in developed and heavily vaccinated populations, adding that vaccine doses should instead be prioritised for nations relying on the COVAX scheme where deliveries have, so far, come up short xviii.

Efforts are also underway to enhance vaccines and to find novel treatments for COVID-19 as the pandemic progresses. Several vaccine manufacturers have already adjusted their sights to developing updated versions of vaccines and boosters designed to target variants of SARS-CoV-2.

Promising early-stage trials by Moderna found that people who received a booster that incorporated a viral protein unique to the Beta variant had greater protection against infection by the variant strain compared to those who received a third dose of the original vaccine . Researchers at Novavax, another vaccine maker, are also trialling a potential vaccine booster to protect against the Beta and Alpha variants, with early results showing that immune response increased for enhanced protection against several variants and the original virus xx.

Moreover, developments on the COVID-19 treatment front are providing new options to fight the pandemic, including oral anti-viral drugs from Pfizer and Merck which have shown promising results in clinical trials. These treatments add to previous COVID-19 monoclonal antibodies, as well as the older, repurposed corticosteroid, dexamethasone, that have given medical professionals options to tackle this disease in patients suffering from severe illness xxi.

Vaccines, accompanied by appropriate hygiene and social-distancing measures, remain the most effective first line of defence against COVID-19, as they continue to reduce transmission and shield people from long-term consequences that could follow an acute infection.

Insurance impact

Many countries are pinning their hopes on vaccines as a way of shifting COVID-19 from a pandemic to an endemic disease.

Though the Northern hemisphere winter of 2021-2022 may add pressure to the healthcare systems of many advanced countries, the combination of vaccines, booster doses and a better understanding of healthcare will likely mean fewer deaths than in previous waves of the pandemic. For life insurers that paid substantial claims during earlier waves of the pandemic, advances in vaccination and lower mortality are expected to bolster profitability in 2022.

However, unequal global distribution between wealthy and developing nations as well as uneven vaccination rates where vaccines are plentiful mean that there are still billions of people yet to be vaccinated. If a new, more dominant variant were to develop and spread, this could lead to a return to higher levels of excess mortality. Looking towards 2022, insurers should remain vigilant against the persistent threat of COVID-19.

 This article was updated on 30 November 2021, to include information about the recently discovered Omicron variant.


i https://www.who.int/news/item/30-07-2021-joint-statement-of-the-multilateral-leaders-task-force-on-covid-19-vaccines-therapeutics-and-diagnostics-for-developing-countries-following-its-second-meeting
ii swiss-re-institute-sigma-5-2021-en.pdf (swissre.com)
iii https://www.chathamhouse.org/events/all/members-event/living-covid-19-conversation-dr-anthony-fauci
iv https://www.cdc.gov/media/releases/2021/p1021-covid-booster.html
v https://www.who.int/multi-media/details/who-press-conference-on-coronavirus-disease-(covid-19)---12-november-2021
vi https://www.statista.com/statistics/1194934/number-of-covid-vaccine-doses-administered-by-county-worldwide/
vii https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age
viii https://www.bmj.com/content/371/bmj.m4809
ix https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm
x COVID: Angela Merkel says no plans for mandatory vaccines in Germany | News | DW | 13.07.2021
xi https://www.unicef.org/supply/covid-19-vaccine-market-dashboard
xii https://www.unicef.org/supply/covid-19-vaccine-market-dashboard
xiii https://www.gavi.org/sites/default/files/covid/covax/COVAX-Supply-Forecast.pdf
xiv Can Cuba beat COVID with its homegrown vaccines? (nature.com)
xv Access to COVID-19 vaccines: looking beyond COVAX - The Lancet
xvi Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection | Nature Medicine
xvii https://www.nytimes.com/2021/09/15/health/covid-booster-shot-data.html.
xviii https://www.who.int/news/item/10-08-2021-interim-statement-on-covid-19-vaccine-booster-doses
xix https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-positive-initial-booster-data-against-sars-cov
xx Novavax offers first evidence that COVID vaccines protect people against variants (nature.com)
xxi Innovative treatments for COVID-19 | Swiss Re



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