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Research Special Paper

Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis

BMJ 2020; 371 doi: (Published 15 December 2020) Cite this as: BMJ 2020;371:m4750

Linked Research

Global, regional, and national estimates of target population sizes for covid-19 vaccination

Linked Editorial

Equitable global access to coronavirus disease 2019 vaccines

  1. Anthony D So, professor of the practice, director12,
  2. Joshua Woo, research assistant2
  1. 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  2. 2Innovation+Design Enabling Access (IDEA) Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  1. Correspondence to: A D So{at} (or @anthony_so888 on Twitter)
  • Accepted 7 December 2020


Objective To analyze the premarket purchase commitments for coronavirus disease 2019 (covid-19) vaccines from leading manufacturers to recipient countries.

Design Cross sectional analysis.

Data sources World Health Organization’s draft landscape of covid-19 candidate vaccines, along with company disclosures to the US Securities and Exchange Commission, company and foundation press releases, government press releases, and media reports.

Eligibility criteria and data analysis Premarket purchase commitments for covid-19 vaccines, publicly announced by 15 November 2020.

Main outcome measures Premarket purchase commitments for covid-19 vaccine candidates and price per course, vaccine platform, and stage of research and development, as well as procurement agent and recipient country.

Results As of 15 November 2020, several countries have made premarket purchase commitments totaling 7.48 billion doses, or 3.76 billion courses, of covid-19 vaccines from 13 vaccine manufacturers. Just over half (51%) of these doses will go to high income countries, which represent 14% of the world’s population. The US has reserved 800 million doses but accounts for a fifth of all covid-19 cases globally (11.02 million cases), whereas Japan, Australia, and Canada have collectively reserved more than one billion doses but do not account for even 1% of current global covid-19 cases globally (0.45 million cases). If these vaccine candidates were all successfully scaled, the total projected manufacturing capacity would be 5.96 billion courses by the end of 2021. Up to 40% (or 2.34 billion) of vaccine courses from these manufacturers might potentially remain for low and middle income countries–less if high income countries exercise scale-up options and more if high income countries share what they have procured. Prices for these vaccines vary by more than 10-fold, from $6.00 (£4.50; €4.90) per course to as high as $74 per course. With broad country participation apart from the US and Russia, the COVAX Facility—the vaccines pillar of the World Health Organization’s Access to COVID-19 Tools (ACT) Accelerator—has secured at least 500 million doses, or 250 million courses, and financing for half of the targeted two billion doses by the end of 2021 in efforts to support globally coordinated access to covid-19 vaccines.

Conclusions This study provides an overview of how high income countries have secured future supplies of covid-19 vaccines but that access for the rest of the world is uncertain. Governments and manufacturers might provide much needed assurances for equitable allocation of covid-19 vaccines through greater transparency and accountability over these arrangements.


  • Contributors: ADS conceived and designed the study. ADS and JW collected the data. JW visualized the data with feedback from ADS. ADS took the lead in writing the manuscript, but JW also actively participated in analyzing the data and writing and revising the manuscript. Both authors have read and agreed to the published version of the manuscript, and take responsibility as guarantors of its content. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: This study was supported by the Innovation+Design Enabling Access Initiative at the Johns Hopkins Bloomberg School of Public Health; the Johns Hopkins Alliance for a Healthier World; and the Open Society Foundation (grant OR2017-38241). JW was supported under the Johns Hopkins Alliance for a Healthier World. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: ADS received support from the Innovation+Design Enabling Access Initiative at the Johns Hopkins Bloomberg School of Public Health; the Johns Hopkins Alliance for a Healthier World; and the Open Society Foundation. JW was supported as a Global Health Equity Scholar under the Johns Hopkins Alliance for a Healthier World. Outside of the submitted work, both authors have provided unpaid advisory input to the Pan American Health Organization’s Revolving Fund for Access to Vaccines and have previously received grants for unrelated work from the World Health Organization within the past three years.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

  • The authors (ADS and JW) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Dissemination to participants and related patient and public communities: The authors plan to disseminate these findings to the general public both by press release and through an interactive data visualization made available on the Johns Hopkins Bloomberg School of Public Health’s Innovation+Design Enabling Access (IDEA) Initiative website.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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