Column: While we line up for a fourth shot, the world’s poor haven’t gotten their first

A masked Kenyan woman gets a vaccine shot in her arm.
A woman in Nairobi receives a dose of AstraZeneca COVID-19 vaccine, provided through the COVAX initiative.
(Brian Inganga/ Associated Press)

Go ahead — line up for your second booster shot, Americans. But as you do, take a moment to consider how lucky you are to live in a part of the world where the healthcare system, for all its flaws, puts protection from COVID-19 within reach.

Because it’s not that way everywhere.

The vaccine shots that you and I can schedule with a simple call to our local Rite-Aid or CVS are not available to everyone.

The outrageous truth is that two years into the pandemic that has killed 6 million people worldwide, 65% of Americans have received two vaccine shots and are considered “fully vaccinated.” (Many others have chosen not to be.) But only 14.5% of people in low-income countries have received even a single dose, according to data compiled by Oxford University.


It is a lesson in how the other half lives.

Opinion Columnist

Nicholas Goldberg

Nicholas Goldberg served 11 years as editor of the editorial page and is a former editor of the Op-Ed page and Sunday Opinion section.

Why should Americans be closing in on their second, third and fourth shots before millions of poor people around the world have received their first?

“People in the U.S. have no greater right to health than people elsewhere in the world,” says Brook K. Baker, a Northeastern University Law School professor who specializes in access to medicines. “We’re all human. Health is a positive good for everyone. Yet we’re living under a monopoly-based system where giant pharmaceutical corporations make billions in profits at the expense of poor people in poor countries who are denied access to life-saving medicines.”

Even for our own selfish reasons we should be fighting for universal access — because infectious diseases don’t respect national borders. If the virus continues to spread in lower-income nations, it will keep mutating until a more virulent variant emerges. And that variant will eventually reach us here at home.

“There is only one victor in a world of vaccine haves and vaccine have-nots: the virus itself,” said U.N. Secretary-General Antonio Guterres.

So what are we doing about this?

Not enough, it seems.

COVAX, the global initiative created to ensure equitable access to vaccines for people in low-income countries, fell woefully short of its 2021 vaccination goals. This year, doses are still going disproportionately to wealthy nations.

The company behind a COVID-19 vaccine touted as a key tool for the developing world will miss a target for giving doses to the U.N.-backed effort to deliver shots to poorer countries.

March 25, 2022

The developed world has repeatedly failed to rise to the occasion. Last week, for instance, U.S. senators announced they were close to a deal to pass the latest COVID response package but only at the cost of cutting $5 billion that had been designated for global vaccine efforts.


Today, 77% of Americans have received at least one vaccine dose. So have 87% of Canadians. The oil-rich United Arab Emirates tops the list with 99% having received at least one dose.

But in Burundi only 0.1% of the population has received a shot. In Congo, it’s 1%. In Haiti, 1.5%. In Chad, 1.8%. All across Africa, countries have posted rates well below 20%.

This is not to suggest that Americans should be denied vaccinations or boosters while others get them, but rather that more supply needs to be made available at more affordable prices.

How did we get to this point after developing such highly effective vaccines faster than ever before in history?

‘Don’t delay’: Now is the time for those at higher risk from COVID-19 to get a second vaccine booster dose, L.A. County’s public health director says.

April 1, 2022

Wealthy countries raced to grab what they could, buying up and stockpiling much of the initial supply before it could be more fairly allocated.

Pharmaceutical manufacturers, many of which received lavish public subsidies to fund their research, were allowed to sell the new vaccines with no strings attached, so they controlled the quantity they produced, the price they charged and whom they sold to.


The manufacturers also resisted sharing their intellectual property with other pharmaceutical companies, which would have allowed production and distribution to be accelerated.

In many cases when poorer countries did receive vaccine supplies, they were close to their expiration date, donated because they were leftovers. As a result they often had to be used quickly.

But that was a problem because having the doses in hand is just one step toward getting shots in arms. You also need syringes, trained workers, refrigerators for the mRNA doses, trucks and waste disposal equipment. Many poor countries lack the necessary healthcare infrastructure.

Then there’s the vaccine skepticism that is plaguing countries everywhere.

All those factors combined to keep vaccination rates unconscionably low in many less developed countries.

Are vaccines safe? When can I get a booster dose? Do I have to wear a mask? We’ve answered hundreds of newsletter readers’ questions. Here’s an archive.

Feb. 18, 2021

It is worth nothing that many countries in Africa appear to have relatively low COVID death rates. Some people attribute those rates to Africa’s younger population, its lower population density or the fact that people spend more time outside. Some say it argues for focusing the continent’s limited resources on inoculating the most vulnerable — rather than the general population.

But others believe the statistics are badly misleading — the result of drastic underreporting. This happens because so many COVID sufferers in poor countries never reach a hospital but die in their homes. They’re never tested and their deaths may never be counted, making the official COVID tallies unreliable, according to Baker of Northeastern University.


In March, Oxfam estimated that for every life lost in a rich country, another four people have died in a poorer nation.

I don’t mean by such comparisons to minimize American suffering. More than 978,000 people here have died.

And no one is happier than I am that we’re beginning, at least for the moment, to emerge from lockdown, drop our masks and fortify ourselves, if we’re eligible, with another round of protection.

But when I get my next shot I’m going to try to remember my privilege, wealth and luck, and keep in mind that the world’s poorest countries need our help. The U.S. has an obligation to do more — contact your representative and senators! — not just because it’s the smart thing to do (which it is), but because it’s the right thing to do.