Global, regional, and national COVID-19 vaccination rate in 237 countries and territories, March 2022: a systematic analysis for World Health Organization COVID-19 Dashboard, Release 2

1. Introduction

Vaccines to cope with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed since 2020.[1] The rapid development and clinical trials of the coronavirus disease 2019 (COVID-19) vaccines lead to the initiation of COVID-19 vaccination in 2021.[2, 3] Almost all COVID-19 vaccines (including NVX-CoV2373 [Novavax], Ad26.COV2.S [Johnson & Johnson-Janssen], ChAdOx1-S [AstraZeneca], BNT162b2 [Pfizer/BioNTech], and mRNA-1273 [Moderna]) targeted the spike protein of SARS-CoV-2, which have been acknowledged as a crucial determinant of invasion and tropism.[4, 5] The main types of vaccines were mRNA (BNT162b2 [Pfizer/BioNTech] andmRNA-1273 [Moderna]), engineered recombinant SARS-CoV-2 nanoparticle (NVX-CoV2373 [Novavax]), and viral vector-based vaccines (Ad26.COV2.S [Johnson & Johnson-Janssen] and ChAdOx1-S [AstraZeneca]).[6-8] Clinical trials on COVID-19 vaccines were reported to have above 95% effectiveness in preventing COVID-19 without serious adverse effects.[9-11] Moreover, more clinical data regarding the effectiveness of COVID-19 vaccination is being discovered.[12, 13]

Although dedicated efforts in reducing the number of COVID-19 cases lead to the introduction of COVID-19 vaccination, there is an inconclusive status of global, regional, and national COVID-19 vaccine coverage. To better understand the impact of the COVID-19 pandemic, we aimed to estimate disruptions in the global, regional, and national status of COVID-19 vaccination coverage on a global scale and by World Health Organization region and World Bank income group, and each country. We then calculated and estimated numbers of persons vaccinated with at least one dose, persons vaccinated with at least one dose per 100 population, and persons fully vaccinated per 100 population, using the World Health Organization dataset.[14] The current data on COVID-19 vaccination trends can be an indicator for making efficient public policies regarding COVID-19 vaccination.

2. Method

Our main analysis involved three main steps: (1) synthesizing data available on the World Health Organization Dashboard of 237 countries and territories updated until March 5, 2022[14]; (2) calculating and estimating number of persons vaccinated with at least one dose, persons vaccinated with at least one dose per 100 population, and persons fully vaccinated per 100 population by pairing estimates of COVID-19 vaccination coverage by individual level, which were originally country level models form the World Health Organization Dashboard, Release 1,; and (3) analyzing and describing the data by a global scale and stratifying it according to World Health Organization regions (Eastern Mediterranean, Americas, Europe, Southeast Asia, the Western Pacific, and Africa), World Bank income groups (high, upper-middle, lower-middle, and low income), and each country (total n=237).

The numbers on referred from the World Health Organization Dashboard were generated from December 2019 to March 2020 and were estimated numbers of persons vaccinated with at least one dose, persons vaccinated with at least one dose per 100 population, and persons fully vaccinated per 100 population by the official ministries of health in each country collected. The World Health Organization Dashboard aimed to provide weekly updates on COVID-19 vaccine coverage of 237 countries and territories, which was last updated on March 5, 2022. The index date described is equivalent to the date of the first vaccine administrated. Suspension of COVID-19 vaccination were not taken into account in this study. Also, the specific vaccine types were excluded from our analysis (NVX-CoV2373 [Novavax], Ad26.COV2.S [Johnson & Johnson-Janssen], ChAdOx1-S [AstraZeneca], BNT162b2 [Pfizer/BioNTech], and mRNA-1273 [Moderna]). [15]

3. Results

A total of 4,964,626,775 persons worldwide were vaccinated with at least one dose, which is 63.69 per 100 population administered COVID-19 vaccines at least one dose, and 56.16 per 100 population were fully vaccinated (Table 1 and Fig. 1).

Fig. 1. Global COVID-19 vaccination coverage (number of vaccine used)

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In Fig. 2, the proportion of persons fully vaccinated was highest in the Eastern Mediterranean (81.25 per 100 population), followed by the Americas (65.08 per 100 population), Europe (61.59 per 100 population), South-East Asia (55.67 per 100 population), the Western Pacific (39.04 per 100 population), and Africa (11.62 per 100 population). The proportion of persons vaccinated with at least one dose have similar patterns of those fully vaccinated (Fig. 3); Eastern Mediterranean (84.18 per 100 population), the Americas (75.82 per 100 population), South-East Asia (68.97 per 100 population), Europe (66.28 per 100 population), Western Pacific (47.18 per 100 population), and Africa (15.87 per 100 population).

Fig. 2. Global COVID-19 vaccination coverage (persons fully vaccinated per 100 population)

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Fig. 3. Global COVID-19 vaccination coverage (persons vaccinated with at least one dose per 100 population)

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According to income groups classified by the World Bank, the proportion of persons fully vaccinated were highest in the high income group (72.25 per 100 population), followed by the upper-middle income group (70.73 per 100 population), lower-middle income (45.77 per 100 population), and low income (10.36 per 100 population).

According to country levels, the proportion of persons fully vaccinated were highest in Gibraltar (121.45 per 100 population), followed by United Arab Emirates (97.25 per 100 population), Cayman Islands (90.88 per 100 population), Puerto Rico (90.75 per 100 population), Chile (89.89 per 100 population), Qatar (89.41 per 100 population), Cuba (87.19 per 100 population), Republic of Korea (86.38 per 100 population), Malta (85.68 per 100 population), Portugal (84.12 per 100 population), and China (83.98 per 100 population).

In Table 2, the proportion of persons fully vaccinated were lowest in Burundi (0.08 per 100 population), followed by Democratic Republic of the Congo (0.50 per 100 population), Chad (0.87 per 100 population), Haiti (0.89 per 100 population), Yemen (1.29 per 100 population), Papua New Guinea (2.80 per 100 population), Cameroon (3.06 per 100 population), Madagascar (3.57 per 100 population), South Sudan (3.81 per 100 population), Nigeria (4.11 per 100 population), United Republic of Tanzania (4.18 per 100 population), Malawi (4.24 per 100 population), Niger (4.34 per 100 population), Mali (4.35 per 100 population), Sudan (5.32 per 100 population), Burkina Faso (5.51 per 100 population), Somalia (5.90 per 100 population), Syrian Arab Republic (7.25 per 100 population), Djibouti (10.15 per 100 population), Zambia (10.25 per 100 population), and Afghanistan (11.00 per 100 population).

4. Discussion

In this analysis, we provide a quantitative assessment of global, regional, and national disruptions to COVID-19 vaccination coverage up to March 2022. A total of 4,964,626,775 persons were vaccinated worldwide with at least one dose, which is 63.69 per 100 of the population being administered COVID-19 vaccines at least one dose, and 56.16 per 100 population fully vaccinated. Persons vaccinated with at least one dose or fully were highest in the Eastern Mediterranean, followed by the Americas, South-East Asia, Europe, Western Pacific, and Africa. In addition, the proportion of persons who were vaccinated at least one dose or fully was also greatest in the high income countries, followed by upper-middle, lower-middle, and low income. Our results suggested that COVID-19 vaccination strategies must be separately established according to region, especially in underdeveloped countries, and global efforts are needed for support in low income countries in order to improve COVID-19 vaccination programs.

Previous studies have described regional differences in the progress of COVID-19 vaccination.[19-21] Due to limited evidence because of the lack of long-term clinical outcomes, the acceptance of COVID-19 vaccination can vary according to cultural or regional differences. A meta-analysis demonstrated that the COVID-19 vaccine acceptance rate was approximately 62.79% (95% confidence intervals [CI], 58.98 to 66.60).[19] According to regions, South-East Asia showed a vaccine acceptance rate as high as 70.18% (95% CI, 58.12 to 82.25), while Africa showed a vaccine acceptance rate as low as 39.51% (95% CI, 23.42 to 55.59).[19] In addition, national guidelines or policies of individual nations for COVID-19 vaccination can influence the rate of COVID-19 vaccination.[1] For instance, COVID-19 vaccination in the pediatric population initiated from the USA.[1] The population’s age range may have an impact on the rate of COVID-19 vaccination.

5. Conclusion

A total of 4,964,626,775 persons worldwide were vaccinated with at least one dose, which is 63.69 per 100 population administered COVID-19 vaccines at least one dose, and 56.16 per 100 population were fully vaccinated. Although the COVID-19 vaccine coverage trajectories points towards global increasement in vaccination, persistent inequality in preventing the COVID-19 pandemic occurred in vulnerable groups such as under-developed and low income countries. These findings suggest that better understanding and international attention is needed in solving public health problems on emerging issues and health inequality on the COVID-19 pandemic.