The choice for rich nations: Help vaccinate the developing world, or face a prolonged pandemic

Joaquim Cardoso @ BCG
5 min readApr 9, 2021


A recent study commissioned by the International Chamber of Commerce Research Foundation found that the global economy could lose $9.2 trillion in 2021 alone without adequate vaccine access in developing countries.

FORTUNE, March 19, 2021 6:30 AM GMT-3

Late last month, a plane carrying 600,000 COVID-19 vaccine doses arrived in Accra, Ghana, a shipment made possible by Covax, an ambitious initiative led by Gavi, the World Health Organization, and the Coalition for Epidemic Preparedness Innovations (CEPI) to speed procurement and delivery of inoculations around the world.
It was welcome news, but not nearly sufficient to the challenge:
Achieving the necessary immunity with the two-dose vaccine for more than 30 million Ghanaians will require many more shipments like it.

The world tumbled into the COVID catastrophe together, and we must emerge from it together.
Only by vaccinating the whole of the developing world can the U.S. and other advanced economies fully recover from the pandemic.
Unfortunately, the initiative that oversees Covax already faces a budget shortfall — around $23 billion as of this writing.
Ending the pandemic everywhere will require creativity, assertive diplomacy, and a commitment to swift action — for example, using innovative economic measures to close that budget shortfall. But it is imminently within our reach.

To date, COVID has killed millions and undermined life for billions.
An insufficient and inequitable response to the pandemic risks dividing the world in two.

  • Advanced economies, feasting on fiscal and monetary stimulus and freed up by early access to vaccines, look likely to move beyond the worst of the pandemic by later this year.
  • Meanwhile, developing economies, with less fiscal space and access to vaccines and other treatments, may be mired in the pandemic for years, losing lives and further ground against poverty, hunger, and disease.

The longer this crisis lasts, the wider this divergence will grow, exacerbating stark disparities between these two worlds and increasing health, economic, and eventually security risks for all of us.

  • Vaccine-resistant variants that mutate in an under-vaccinated country can quickly spread to one that’s been immunized.
  • As developing economies struggle with outbreaks and sluggish growth, developed economies will eventually suffer.
  • And amid outbreaks and recessions, nations are more likely to pose risks to others through the spread of unrest or even war.
    Even with so many problems demanding attention at home, the most critical step is getting the world vaccinated.

Unfortunately, vaccination distribution has thus far been deeply inadequate and inequitable.
According to Bloomberg, 22% of those in the United States have received at least one dose of the vaccine, while in Ghana, only 0.7% of the population have done the same.
With so few vaccinated in the developing world, new outbreaks and development of additional variants are inevitable.
Such variants may be more transmissible, more deadly, less responsive to existing vaccines and therapeutics, or a combination of these dangerous changes.

A recent study commissioned by the International Chamber of Commerce Research Foundation found that the global economy could lose $9.2 trillion in 2021 alone without adequate vaccine access in developing countries.

A similar study by the Rand Corporation revealed that even if the U.S. and other countries achieve herd immunity, there will be continued economic costs associated with COVID if it can mutate elsewhere.
Indeed, Rand estimated that for every dollar the U.S. and other advanced economies spend providing vaccines to poor countries, they would receive $4.80 in value.

Despite President Biden’s decisions to send vaccines to Canada and Mexico and to commit nearly $4 billion to WHO’s Access to COVID-19 Tools (ACT) Accelerator, of which Covax is one part,
the world does not have what it needs to end the pandemic.

  • For one thing, even with the U.S. pledge, the ACT Accelerator is already $23 billion short of the funds needed for this year alone.
  • For another, that budget only reflected a plan to achieve 20% immunization coverage in 92 low- and middle-income countries by the end of the year — far short of what is needed.

Economist Jeff Sachs suggests $50 billion will be needed through 2022 to reach herd immunity around the world.

We have ways to fund this shortfall.

  • For example, last month, G20 finance ministers recommended the International Monetary Fund explore issuing special drawing rights, which are supplemental foreign currency assets that can supplement member countries’ official reserves.
  • With creative thinking and the backing of the IMF and members of the G20, some of this liquidity should be leveraged to fund Covax and support the response to COVID-19 in low- and middle-income countries.

Sufficient funding is just one part of this challenge.
Covax, again with the support of wealthy nations currently consuming the vast majority of vaccines being produced, must also develop a multilateral plan on the equitable, consistent supply of vaccines and an operational plan to vaccinate entire populations within the next two years.
Some of these resources will need to be spent on the health workers and systems required to get a dose from a delivery plane to where it can be delivered into someone’s arm.

Until the whole world is vaccinated, the whole world will be at risk.
The longer the world lets the virus run free to infect and mutate, the more likely the world will face a prolonged pandemic or another outbreak altogether, pervasive economic decline, and other crises.
One year after the pandemic began, the question is not how the world can vaccinate itself, but whether the global commitment exists to do so.
Now is the time to decide — ending this pandemic depends on it.

Rajiv Shah is president of the Rockefeller Foundation.
From 2010 to 2015, he served as administrator of the United States Agency for International Development (USAID).

Edited for Brazil by:

Joaquim Cardoso, MSc

Senior Advisor for Health Care Strategy to BCG — Boston Consulting Group
Chief Researcher for Health Institute
Chief Editor for VBHC Review

MSc in BA from London Business School (LBS) — MIT Sloan Program
Post Graduation in Production Engineering
Bsc in Mechanical Engineering



Joaquim Cardoso @ BCG

Senior Advisor for Health Care Strategy to BCG — Boston Consulting Group