Global disparities in the introduction, scale-up, and effectiveness evaluation of COVID-19 vaccines

Martina Pesce, Daniel R. Feikin, Melissa M. Higdon, Katherine L. O’Brien, Minal K. Patel, Analía Rearte, Carla Vizzotti, Annelies Wilder-Smith and Edward P. K. Parker ()
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Martina Pesce: London School of Hygiene & Tropical Medicine
Daniel R. Feikin: World Health Organization
Melissa M. Higdon: Johns Hopkins Bloomberg School of Public Health
Katherine L. O’Brien: World Health Organization
Minal K. Patel: World Health Organization
Analía Rearte: Universidad Nacional de Mar del Plata
Carla Vizzotti: Universidad Nacional de San Martín
Annelies Wilder-Smith: World Health Organization
Edward P. K. Parker: London School of Hygiene & Tropical Medicine

Nature Communications, 2025, vol. 16, issue 1, 1-12

Abstract: Abstract The global response to COVID-19 saw the most rapid and extensive vaccination rollout in history. Yet there were large disparities in the introduction, scale-up, and evaluation of programmes. To systematically quantify these disparities, we generate linkages across public datasets containing country- and territory-level income data, COVID-19 vaccination rates, and COVID-19 vaccine effectiveness (VE). Our results show that, compared with high-income countries, lower-income countries introduced vaccines later, were less likely to achieve key coverage milestones, and were slower to do so where these milestones were achieved. The literature on primary series COVID-19 VE has been dominated by studies of mRNA vaccines from high-income countries, with data for other vaccines and lower-income countries appearing later and in substantially lower quantities. For vaccines with available VE data across multiple income settings (BNT162b2, mRNA-1273, and ChAdOx1-S), our meta-regression highlights robust protection against severe COVID-19, with no significant differences in primary series VE according to country-level income status during the Delta and Omicron periods. Our findings demonstrate the strong protection conferred by COVID-19 vaccines across diverse populations. Nonetheless, our results quantify the stark disparities that pervaded each stage of COVID-19 vaccine implementation, and highlight evidence gaps related to products and platforms being used across much of the globe.

Date: 2025
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DOI: 10.1038/s41467-025-63950-w

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