Inequality in COVID-19 vaccination in Africa.

Background: The COVID-19 pandemic has spread rapidly to all countries with significant health, socioeconomic, and political consequences. Several safe and effective vaccines have been developed. However, it is not certain that all African countries have successfully vaccinated their populations. Objective: To study the distribution and determinants of COVID-19 vaccination in Africa from March 2021 to June 2022. Methods: Using reliable open-access data, we used the proportion of fully vaccinated people with a complete schedule as a reference variable. To analyze the level of inequality in COVID-19 vaccination, we computed common inequality indicators including two percentile ratios, the Generalized Entropy index, the Gini coefficient, and the Atkinson index. We also estimated the Lorenz curve. To identify drivers of COVID-19 vaccination, we estimated univariate and multivariate regression models as a function of COVID-19-related variables, demographic, epidemiologic, socioeconomic, and health system-related variables. To overcome a potential endogeneity bias, we checked our results using simultaneous equation models. Results: 53 African countries with available data were included in the study. The proportion of fully vaccinated people increased during the study period. However, this increase remained unequal across African countries. Based on the inequality indicators and the Lorenz curve, inequalities in COVID-19 vaccination across African countries were high, although they have decreased in recent months. Total COVID-19 cases and human development index were identified as significant determinant factors that were independently associated with COVID-19 vaccination. Conclusions: Inequality in COVID-19 vaccination in Africa was high. Promoting adequate information to the general population and providing financial and logistical support to low-income countries can help expand COVID-19 vaccination in Africa.