Sign up for our daily briefing

Make your busy days simpler with Axios AM/PM. Catch up on what's new and why it matters in just 5 minutes.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on the day's biggest business stories

Subscribe to Axios Closer for insights into the day’s business news and trends and why they matter

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Stay on top of the latest market trends

Subscribe to Axios Markets for the latest market trends and economic insights. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sports news worthy of your time

Binge on the stats and stories that drive the sports world with Axios Sports. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tech news worthy of your time

Get our smart take on technology from the Valley and D.C. with Axios Login. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Get the inside stories

Get an insider's guide to the new White House with Axios Sneak Peek. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Axios on your phone

Get breaking news and scoops on the go with the Axios app.

Download for free.

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Denver news?

Get a daily digest of the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Des Moines news?

Get a daily digest of the most important stories affecting your hometown with Axios Des Moines

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Twin Cities news?

Get a daily digest of the most important stories affecting your hometown with Axios Twin Cities

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Tampa Bay news?

Get a daily digest of the most important stories affecting your hometown with Axios Tampa Bay

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Charlotte news?

Get a daily digest of the most important stories affecting your hometown with Axios Charlotte

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sign up for Axios NW Arkansas

Stay up-to-date on the most important and interesting stories affecting NW Arkansas, authored by local reporters

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Illustration: Aïda Amer/Axios

Vaccinating the world will be perhaps the single greatest global challenge of 2021, and that process is now beginning in earnest.

The big picture: If you're reading this in Europe, the U.S. or one of several other wealthy countries, you will probably have access to a vaccine in 2021. But if you're in a lower-income country, particularly in sub-Saharan Africa, you could be waiting until 2023.

The first vaccines to gain regulatory approval in the West — from Pfizer/BioNTech and Moderna — are bound almost exclusively for wealthy countries, at least in the near term.

  • Many rich countries have hedged their bets by buying enough doses of several different vaccine candidates to cover their populations even if some candidates aren't approved.
By the numbers

At least 7.7 billion vaccine doses have already been purchased, with another 3.9 billion reserved should countries or blocs elect to expand their orders, according to Duke University's tracker.

  • If you combine both categories, the U.S. has reserved nearly one-quarter of the global supply with 2.6 billion doses.
  • Not a single country in sub-Saharan Africa has announced a deal to purchase vaccine doses, though Johnson & Johnson is aiming to produce 300 million doses in South Africa next year.
Data: Duke Global Health Innovation Center; Chart: Axios Visuals

It's not just that access to doses varies wildly by income level — richer countries are also buying different vaccines than poorer ones.

  • India is home to the world's largest vaccine manufacturer, and has sealed massive deals to begin to cover its population of nearly 1.4 billion.
  • Those deals are with Novavax, which has yet to release efficacy data, and AstraZeneca, whose vaccine appears to be about 70% effective but is undergoing further evaluation and testing.
  • The EU has purchased roughly the same number of doses but has a much more diversified portfolio. It includes 300 million doses of the Pfizer vaccine, the first shipments of which will begin on Thursday.
  • Several developing countries have struck deals for just one vaccine candidate, often from Russia (as with Kazakhstan, Nepal and Venezuela) or China.

Breaking it down: A forecast from The Economist Intelligence Unit projects that the most fortunate countries — including the U.S., U.K., EU and Japan — will spend the first half of 2021 vaccinating priority groups and the second half of the year vaccinating the remainder of their populations.

  • In other high-income countries — as well as in countries like China, Brazil, India and Russia that are producing or manufacturing vaccines at scale — mass vaccinations will begin next year but likely continue into early 2022.
  • Other middle-income countries aren’t expected to be able to vaccinate all high-priority groups until late 2021, with mass vaccinations continuing throughout 2022.
  • Low-income countries that can’t afford to purchase doses in bulk will still be vaccinating high-priority groups into early 2022, with mass vaccinations continuing throughout 2023 and perhaps into 2024.
What to watch

There are a number of variables that could shift that outlook significantly in either direction.

1. Further announcements on the safety, efficacy and scalability of additional vaccines, including those from Oxford/AstraZeneca, J&J, Novavax and Sanofi, which have together committed more than 2 billion doses to developing countries.

2. More news on Russia's Sputnik V vaccine and on the several vaccines in development in China.

3. The ability to increase manufacturing capacity in the developing world, and to build strong supply chains to ship and distribute doses globally.

4. The efficient distribution of unused doses by rich countries to poorer ones.

5. The engagement of the Biden administration. President-elect Biden has said he'll re-engage with the World Health Organization and restore America's global leadership, but he hasn't spoken about a U.S. role in global vaccine distribution.

State of play

The single biggest factor will be the success of the COVAX initiative, from the Gavi vaccine alliance, the Coalition for Epidemic Preparedness Innovations and the WHO.

Driving the news: Those groups told reporters in a briefing on Friday that they're on track to meet their ambitious goal of ensuring at least 20% of the population in virtually every country on earth has access to a vaccine by the end of 2021.

The big picture: COVAX is the only route to a vaccine for dozens of countries, and wealthier participants will effectively subsidize their access.

What to watch: The aim for the first half of 2021 is to provide enough doses to all participant countries to cover frontline health and social care workers.

  • Then comes the 20% wave, which is intended to reach the most vulnerable people in each country.
  • Dr. Krishna Udayakumar, director of Duke's Global Health Innovation Center, says the 20% target will be very difficult to hit next year, and 60%-70% vaccination rates — the target for herd immunity — are unlikely before the end of 2022 even in a best-case scenario.
  • Yes, but: Vaccinating the most vulnerable and combining vaccination with other public health measures to slow the spread will allow "a real reduction in death and disability but also really an uptick in economic activity," he adds.

Go deeper

Jan 29, 2021 - World

EU grants conditional approval of AstraZeneca vaccine

Photo: Sunil Ghosh/Hindustan Times via Getty Images

The European Commission on Friday granted conditional approval of the Oxford-AstraZeneca coronavirus vaccine for people 18 years and older.

Why it matters: This is the third vaccine to receive approval from the commission, coming hours after the Emergency Medicines Agency recommended its authorization.

Jan 29, 2021 - Health

Ex-CDC director Tom Frieden on the next COVID-19 vaccines

Americans fortunate enough to receive COVID vaccines now, outside of clinical trials, are getting shots made by either Pfizer or Moderna. But newly released data from Novavax and Johnson & Johnson suggests that more vaccines could be on the way, with J&J's requiring a single dose.

Axios Re:Cap digs into the news and why it matters with Tom Frieden, former head of the CDC, as COVID-19 variants spread globally.

Jan 29, 2021 - Health

WHO says most pregnant women can now receive coronavirus vaccine

A doctor administering Moderna's coronavirus vaccine at a university hospital in Essen, Germany, on Jan. 18. Photo: Lukas Schulze/Getty Images

The World Health Organization has altered its guidance for pregnant women who wish to receive the coronavirus vaccine, saying now that those at high risk of exposure to the COVID-19 or who have comorbidities that increase their risk of severe disease, may be vaccinated.

Why it matters: The WHO drew backlash for its previous guidance that did not recommend pregnant women be inoculated with vaccines made by Pfizer-BioNTech or Moderna, even though data indicated that pregnancy increased the risk of developing severe illness from the virus.