Global landscape of the COVID-19 vaccination policy: Ensuring equitable access to quality-assured vaccines.

Ensuring equitable access to COVID-19 vaccines for all people has been challenging, hence, establishing relevant vaccination policies is required. This study delineates how vaccination policies have affected equitable access to COVID-19 vaccines. A situation survey was conducted in 201 countries and territories through 156 Japanese diplomatic missions abroad to capture the global state of COVID-19 vaccination policies. Questionnaire responses were received from 159 states (79%) as of March 31, 2021, and data from Japan were incorporated into the analysis. All questionnaire items were open-ended, covering the vaccines in use and five vaccination policies such as vaccine eligibility. Results reveal that first, 81 states (51% out of 160) had not started vaccinations as of February 24, 2021, but by March 31, this number had decreased dramatically to 37 (23%); in particular, the number of states in Africa without vaccination decreased from 40 to 16. Second, 43 (27%) states did not recommend the vaccine for pregnant women. Third, the vaccine was free of charge to the public in 116 states (73%), and 43 states (27%) offered no-fault compensation. Finally, vaccination was voluntary in 124 states (78%). In conclusion, the number of countries that had started vaccination increased by March 2021, especially in Africa, although many African countries seemed to lack access to the mRNA vaccine. To fix the uneven distribution, dose donations were accelerated since middle of July. Reviewing worldwide vaccine policies is useful not only for this pandemic but also to strengthen vaccination systems for preparedness for the next pandemic.