Council on Foreign Relations

COVID-19: Why Vaccination Coverage Is Important

Author(s): Claire Felter
Council on Foreign Relations (2020)
Stable URL: https://www.jstor.org/stable/resrep29829
Accessed: 04-12-2021 20:34 UTC

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide
range of content in a trusted digital archive. We use information technology and tools to increase productivity and
facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
https://about.jstor.org/terms

Council on Foreign Relations is collaborating with JSTOR to digitize, preserve and extend
access to this content.

This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms
3/23/2021 COVID-19: Why Vaccination Coverage Is Important | Council on Foreign Relations

IN BRIEF

COVID-19: Why Vaccination Coverage Is Important

Last updated December 22, 2020
By Claire Felter
7:00 am (EST)

Vaccines are a major public health success story, but the COVID-19 pandemic
underscores the many challenges involved in getting a vaccine to everyone who
needs it.

The coronavirus pandemic has highlighted the challenges of not only developing
vaccines, but also making sure everyone who should get them does. High hopes have
been placed on the global distribution of promising vaccines from Pfizer and BioNTech
and from Moderna, among others, but vaccination campaigns can face many hurdles:
limited availability, public mistrust, and dosage and storage requirements can all
jeopardize vaccination coverage. A look at previous vaccine distribution efforts
showcases some of the main challenges.

How do existing vaccines stack up?

Global Vaccine Coverage Has Stalled in Recent Years

Percentage of one-year-olds with immunizations, selected vaccines

100%
Tuberculosis (BCG)
90%

https://www.cfr.org/in-brief/covid-19-why-vaccination-coverage-important 1/8
This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms
3/23/2021 COVID-19: Why Vaccination Coverage Is Important | Council on Foreign Relations

80%
Polio (Pol3)
70% Hepatitis BB
Hepatitus
Diphtheria, tetanus, and (HepB3)
pertussis (DTP3)
60%

50%

40% Measles
(MCV2)*
30%
Rotavirus
20% (RotaC)

10%

0%
1980 1985 1990 1995 2000 2005 2010 2015
*Data represents immunization coverage by the nationally recommended age.

Source : World Health Organization, compiled by Our World in Data.

Public health experts consider vaccines to be among medicine’s most important

achievements, helping to reduce the prevalence of some diseases—such as polio—to
near zero worldwide. Yet, even for diseases with vaccines, achieving and maintaining
high coverage can be difficult. The World Health Organization (WHO) has warned of a
“dangerous stagnation” of vaccination rates in recent years.

There are many

More From Our Experts
factors that
Rachel B. Vogelstein
affect a vaccine’s
There Will Be Another Pandemic. Women Can Stop It.
coverage rate.
These include: Jennifer Nuzzo
Visualizing 2021: Trends to Watch

Tom Frieden

https://www.cfr.org/in-brief/covid-19-why-vaccination-coverage-important 2/8
This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms
3/23/2021 COVID-19: Why Vaccination Coverage Is Important | Council on Foreign Relations

Availability. COVID-19 Response

Countries can
face vaccine shortages for a range of reasons, including conflict and insufficient
production capacity. The WHO has noted a global shortage [PDF] of the human
papillomavirus (HPV) vaccine in recent years due to limited manufacturing capacity
amid rising demand. In the case of the COVID-19 crisis, production capacity is being
tested on an unprecedented scale, with vaccine makers turning to dozens of third-party
manufacturers in order to fulfill orders for hundreds of millions of doses. U.S.
distribution has already seen hiccups: Pfizer executives and state and federal officials
offered conflicting information on state allotments in the first week of the vaccine
rollout.

Distribution also presents a hurdle. Some vaccines, such as that for chickenpox
(varicella), must be kept at very low temperatures when transported and stored, a
process known as the cold chain. While this is typically an issue only for rural or remote
areas, several COVID-19 vaccines pose broader cold-chain challenges: the Pfizer-
BioNTech vaccine must be stored at -70°C (-94°F), meaning warehouses, trucks and
planes, and points of care all require ultra-cold freezers.

https://www.cfr.org/in-brief/covid-19-why-vaccination-coverage-important 3/8
This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms
3/23/2021 COVID-19: Why Vaccination Coverage Is Important | Council on Foreign Relations

A boy receives polio vaccine drops during an immunization campaign in Karachi, Pakistan. Akhtar Soomro/Reuters

Public understanding and trust. Health officials can build trust in their communities
through clear and transparent communication about vaccines. This includes
information about their effectiveness, any expected side effects, and when to return for
booster shots. Experts have raised alarm about increasing vaccine skepticism, which has
led to measles outbreaks in a number of countries. Mistrust similarly undermined
efforts to fight Ebola outbreaks in the Democratic Republic of Congo. Hesitancy about
COVID-19 vaccines is high in the United States, with roughly 40 percent of Americans
surveyed saying they would not get one if it were available now. Only 37 percent said
they would be comfortable being among the first to get vaccinated. “There will have to
be a terrific amount of education, coupled with reassurance,” says William Schaffner, a
professor at the Vanderbilt University School of Medicine.

More From Our Experts

https://www.cfr.org/in-brief/covid-19-why-vaccination-coverage-important 4/8
This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms
3/23/2021 COVID-19: Why Vaccination Coverage Is Important | Council on Foreign Relations

Complexity of the Rachel B. Vogelstein

There Will Be Another Pandemic. Women Can Stop It.
vaccine series.
Sometimes two Jennifer Nuzzo
or more doses Visualizing 2021: Trends to Watch
are
Tom Frieden
recommended
COVID-19 Response
for maximum
protection, with
weeks or even months between doses. The Moderna and Pfizer-BioNTech vaccines both
require two doses, and individuals will have to receive the same vaccine for both doses.
Schaffner says this will require a meticulous tracking system.

Backgrounder
What the World Is Doing to Distribute COVID-19 Vaccines

Recommendations. Health authorities often designate a vaccine for particular age

groups or for people that share certain health risks. In the United States and some other
countries, visits to the pediatrician are largely determined by vaccination schedules,
making it much easier to achieve high coverage among infants and toddlers. Teens and
adults typically don’t make routine doctor visits, lowering their coverage. The U.S.
Centers for Disease Control and Prevention has issued guidance for a phased COVID-19
vaccination campaign, with health-care workers and residents of nursing homes and
long-term care facilities first in line.

How do these variables affect coverage globally?

Recommendations for a particular vaccination can vary significantly across countries.

For example, in the United States, an annual flu vaccine is recommended for anyone six
months or older, while in some European countries, such as Belgium and Lithuania, it is

https://www.cfr.org/in-brief/covid-19-why-vaccination-coverage-important 5/8
This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms
3/23/2021 COVID-19: Why Vaccination Coverage Is Important | Council on Foreign Relations

only recommended for high-risk groups, which include health-care workers, pregnant
women, and people with weakened immune systems. As a result, coverage rates can
look very different around the globe.

Influenza Vaccination Rates Vary Widely Across OECD

Percentage of population aged 65 or older, 2019 or latest available

South Korea 85.1

United
72
Kingdom
United States 68.7
Ireland 68.5
Chile 68.3
Netherlands 62.7
New Zealand 62
Portugal 60.8
Israel 59.8
Belgium 59.1
Canada 59
Greece 56.2
Spain 54.9
Italy 53.1
Sweden 52.2
Denmark 52
France 51
Finland 49.5
Japan 48
Iceland 47.5
Luxembourg 39.8
Norway 38.2
Germany 34.8
Hungary 24.1
Czech
21.5
Republic
Lithuania 14.8
Slovenia 12.9
Slovakia 12.5

https://www.cfr.org/in-brief/covid-19-why-vaccination-coverage-important 6/8
This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms
3/23/2021 COVID-19: Why Vaccination Coverage Is Important | Council on Foreign Relations

Latvia 11.7
Estonia 10.2
Turkey 7

S O i ti f E i C ti dD l t

The WHO’s Europe office has expressed concern about declining use of influenza
vaccines across the region, citing limited procurement of vaccines, health-care providers
not advising the vaccination, out-of-pocket costs, and low public confidence.

How is the pandemic affecting vaccination coverage?

Amid the coronavirus pandemic, a major concern among health experts has been a
drop in coverage for routine vaccinations, as many families avoid visits to doctors’
offices and pharmacies out of fear they could be exposed to COVID-19.

The World This Week

A weekly digest of the latest from CFR on the biggest foreign policy stories of
the week, featuring briefs, opinions, and explainers. Every Friday.

Email Address

Subscribe

View all newsletters >

Health officials around the globe have urged citizens to get their flu shot to avoid a
“twindemic” of seasonal influenza and COVID-19. In the United States, more than
seventy million doses of the flu vaccine were administered to adults by late November

https://www.cfr.org/in-brief/covid-19-why-vaccination-coverage-important 7/8
This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms
3/23/2021 COVID-19: Why Vaccination Coverage Is Important | Council on Foreign Relations

—up from about fifty-nine million a year earlier—and the number of flu cases appeared
unusually low.

What’s in store for COVID-19 vaccinations?

Even in the best of times, successful vaccination policy involves many moving parts. In
the COVID-19 crisis, it’s the entire global population that needs protection, and
scientists and health officials are working to achieve that within an unprecedented
timeframe. Ultimately, developing safe and effective vaccines is only the beginning. “It’s
not a magic wand,” says Vanderbilt’s Schaffner. “It won’t make the virus disappear.” It
will take months before vaccinations are widely available to the public in wealthier
countries, and even longer in poorer countries that are struggling to secure enough
doses. That means following safety guidelines, such as physical distancing and mask
wearing, for some time to come.

Creative Commons: Some rights reserved.

https://www.cfr.org/in-brief/covid-19-why-vaccination-coverage-important 8/8
This content downloaded from 185.44.146.29 on Sat, 04 Dec 2021 20:34:40 UTC
All use subject to https://about.jstor.org/terms