Middle East and North Africa most unequal globally for Covid-19 vaccinations

Two years into pandemic, some countries in region lead world in their response, while others face disaster

Moderna vaccines are administered at a school in Tunis, Tunisia. EPA

The world’s efforts to vaccinate against Covid-19 have highlighted stark inequalities between nations – and nowhere have these been more apparent than in the Middle East and North Africa.

Within the Mena region there are countries that have vaccinated almost all of their residents, and others that have barely got out of the starting blocks.

Conflict has severely restricted campaigns in Yemen and Syria, mirroring scenarios that played out in certain African nations.

“The levels of wealth, the levels of social organisation, war and conflict desperately damage the foundations of health care,” says Prof David Taylor, emeritus professor of pharmaceutical and public health policy at University College London.

According to The New York Times Covid-19 vaccination database, 48 per cent of people in the Middle East have received at least one dose of a coronavirus vaccine.

This compares to 73 per cent in the US and Canada, 70 per cent in Latin America, 66 per cent in Asia-Pacific and 64 per cent in Europe. Africa trails much further behind, with only 12 per cent of people having had at least one jab.

Israel forged ahead early in the immunisation drive, but factors including vaccine hesitancy among some religious and ethnic groups means other nations in the region have now overtaken it.

Now, 71 per cent of the country’s population has received at least one dose and 45 per cent have been given boosters.

The UAE moved fast to forge links with vaccine developers, hosting clinical trials and securing access to supplies from around the world.

The government reports that 100 per cent of eligible people have had at least one vaccination, the highest figure in the world, and a booster campaign is well under way.

While none is close to this, other Gulf Arab nations have also used their financial muscle and well-developed healthcare systems to buy and administer vaccines.

In Qatar, 83 per cent have had at least one jab. In Kuwait, the figure is 79 per cent, in Bahrain 73 per cent and in Saudi Arabia 72 per cent.

Iran, after a heavily criticised initial refusal to use western vaccines, has 70 per cent of its population at least partly vaccinated, while in both Morocco and Oman the figure is 67 per cent.

Covax plays catch-up

Covax, the international vaccine alliance that plays a major role in distributing vaccines to poorer countries, was due to have delivered two billion doses globally by the end of this year, but has lagged heavily.

Covax was hampered when high-income countries bought up much of the global supply, while India, the world’s biggest vaccine manufacturer, suspended exports early this year in favour of domestic use when its own Covid-19 situation deteriorated.

By the end of July, only 95 million had been delivered. The campaign has accelerated recently, though, and by the end of December close to 600 million are likely to have been delivered.

Covax has supplied to much of the region, including Jordan (42 per cent at least partly vaccinated), Palestine (38 per cent), Lebanon (29 per cent), Egypt (28 per cent), Libya (26 per cent), and Iraq (20 per cent).

Iraq received 2.9 million doses of the Pfizer-BioNTech vaccine from Covax in November, bringing to six million the total number of doses supplied to the country by the initiative and illustrating the way in which supplies have recently increased.

Prof Taylor says while headline vaccination rates in some countries look relatively low, they may be enough to safeguard the most at-risk people.

“If you have a really young population and nearly all your population over 60 [has been vaccinated], even 25 per cent is very, very valuable,” he says.

“What we must focus on is improving it further in 2022.”

Analysts think that improvements are likely next year as global vaccine supply increases, and demands in those countries that were furthest ahead in their campaigns become limited to boosters.

“This year it was obvious that large quantities of vaccines were bought up by high-income countries, that the pledges of donations to Covax were on paper but not actually in product, and this has held back the target of delivering two billion doses,” says Prof Beate Kampmann, of the London School of Hygiene and Tropical Medicine, who has directed vaccine research and trials in the developing world.

“That’s going to be different next year, I think, because there’s more product on the market.”

New variants such as Omicron may compromise efforts to improve campaigns in poorer regions, as they may cause demand for vaccinations to increase in developed nations.

Syria and Yemen, both of which have experienced civil war, have the lowest figures in the Mena region for Covid-19 vaccinations.

In Syria, 5.2 per cent of the population has received at least one dose, while in Yemen the figure is 1.9 per cent, or fewer than one person in 50.

“Those are major conflict zones. Advancing vaccine roll-out in major conflict zones is going to be extremely difficult,” says Prof Kampmann.

“These are the same countries that already have seen a significant drop in all sorts of healthcare deliveries, including immunisation for children. Until wars stop, I fear that’s not going to change.

“Where there is conflict, there’s impairment of health systems, including impairment of vaccination programmes, whichever vaccine you’re talking about.”

Covax has sent shipments to Yemen, but the country still has far too few vaccines for its population. Effective vaccination programmes across the country have been severely hindered by the division of Yemen’s territory between the internationally recognised government and Iran-backed Houthi rebels.