COVID-19 vaccine success is cause for optimism but the rollout may take years in poorer countries. Here are the major challenges they face.

  • Throughout November, the developed world has celebrated milestones in the race for a COVID-19 vaccine.
  • But lower-income countries may have to wait for years before they can vaccinate the majority of their population.
  • Cost and availability, combined with transport, storage, and distribution issues pose serious problems. 
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Every American could have access to a COVID-19 vaccine by the end of April. This is not the case, however, for the majority of people in low-income countries, who may have to wait years longer.

As drugmakers ramp up their efforts, governments across the world are negotiating deals to buy prospective COVID-19 vaccines – but this "frenzy of deals" could prevent poorer countries from accessing enough vaccines for most of their population until 2024.

This is according to researchers at Duke University's Global Health Innovation Center. Scientists at the center's Launch and Scale initiative have looked into the barriers that could affect access to a vaccine – and found a myriad of factors.

It isn't just the cost and availability of vaccines that is pricing lower-income countries out. Many of the most vulnerable segments of society also lack the infrastructure to transport, store, and distribute the vaccine.



Pfizer, Moderna, and AstraZeneca all marked major milestones in the global race for a vaccine earlier this month.

However, when vaccines are approved, it takes time to manufacture doses.

The leading vaccines use several different technologies, such as mRNA, recombinant protein, and adenoviruses. Each of these has its own complex manufacturing process, meaning the vaccines take a long time to make.

It could take three to four years to produce enough vaccines to immunize the global population, the researchers found. Wealthier countries may be able to issue multiple doses of the vaccine to their populations before the immunization becomes widespread in poorer countries.

Specially-adapted vehicles may also be needed, Alison Copeland, professor of human geography at Newcastle University, told Business Insider. Lower-income countries may not be able to afford them, however. 


When doses do reach local communities, vaccines such as Pfizer's still have to be kept in cold-chain storage. Even some of the most reputable US hospitals, such Minnesota's Mayo Clinic, lack adequate facilities to store the vaccine, leading to a scramble for hyper-cold freezers – and in lower-income countries, this access to ultra-cold freezers is even less likely.

After the shots reach health centers, they can be thawed in a regular fridge – but they have to be injected within five days.

In many low-income countries, only metropolitan areas are well-resourced, Schrecker explained, and some villages and informal settlements may not have a working fridge.

Even if communities are able to afford storage for the vaccine, they may not have working electricity, Copeland explained.

And the various vaccine candidates being developed by drugmakers have different storage needs, making it difficult for countries to know how to prepare and whether to invest in cold-chain facilities.

AstraZeneca's vaccine, for example, can be stored, transported, and handled at normal fridge temperatures of between 36 and 46 degrees Fahrenheit for at least six months.

Once it reaches its destination, it can be "administered within existing healthcare settings," AstraZeneca said, rather than requiring investment in expensive ultra-cold storage equipment.

Moderna's vaccine can also be transported and stored at fridge temperatures, but only for a month.

Low-income countries may also have to launch vaccination drives where health literacy is poor. While childhood vaccinations are becoming increasingly common in low-income income countries, people of all age groups, especially the elderly, will need the COVID-19 vaccine. This will require the counties to carry out major vaccination education campaigns, Taylor and Copeland both said.

Another challenge is that most vaccines require two shots, including Pfizer's, which needs two shots injected three weeks apart. In rural parts of India, where people are harder to contact or may live a long way from vaccination centers, some people don't come back for a second shot, public health experts told Bloomberg.

The country will also have to roll out mass paramedical training to teach healthcare staff how to administer the two-shot doses, Pankaj Patel, chairman of drugmaker Cadila Healthcare, told the publication.

Cause for optimism

Despite the hurdles that lower-income countries face, mass global vaccination is still a possibility.

After their mid-November summit, the G20 states said they will "spare no effort to ensure their affordable and equitable access [to COVID-19 diagnostics, therapeutics, and vaccines] for all people."

Wealthier countries could also be motivated to provide aid to ensure all countries have access to a vaccine, because of herd immunity beliefs. 

"In order to control the virus, we need worldwide herd immunity, so between 60% and 72% of the population need immunizing," Copeland told Business Insider. "This will hopefully be enough incentive for richer countries to help out."

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