By ZOE MAGEE, ABC News

(LONDON) — “The world is on the brink of a catastrophic moral failure,” World Health Organization Chief Tedros Adhanom Ghebreyesus said Monday at the opening of the WHO’s annual executive board meeting. “The price for this failure will be paid for with lives and livelihoods in the world’s poorest countries.”

Since the start of the pandemic, the WHO has said that lower-income countries could get left behind in the race to vaccinate the world, a message echoed by virologists’ warnings that large swathes of the world must be vaccinated to build up a form of global herd immunity.

According to Dr. Penny Ward, visiting professor in pharmaceutical medicine at Kings College London, even if wealthier nations are vaccinated, there is a chance “if a new mutation arises in strains circulating elsewhere which is a poor match to the vaccine, then a new outbreak can occur in a vaccinated population.”

But even high-income countries are experiencing problems with their vaccine rollout. The Trump administration has been criticized for its effort, vaccine supply is in short demand in some places, and anti-vaxxers are campaigning hard across the globe. Through it all, the WHO is attempting to meet inequities with a global effort, COVAX, that’s facing challenges to get major players onboard to release vaccine supplies to lower-income countries.

The state of vaccinations

To date, 40 million doses of COVID-19 vaccines have been administered — 12 million in the U.S., followed by 10 million in China, four million in the U.K. and two million in Israel, according to Our World in Data, a U.K.-based nonprofit that has been tracking vaccine statistics.

Those numbers only equate to 3% and 0.6% of the U.S. and Chinese populations, respectively. The countries that have administered vaccine shots the most per capita are Israel (24%), Bahrain (16.8%), the United Arab Emirates (8.3%) and the U.K. (5.3%).

Meanwhile, the European Union is playing catch up, having begun its rollout on Dec. 27, with some countries within the union proving more successful than others. Those on its periphery are eying the vaccine rollout with jealousy, with many in the Balkans feeling abandoned by their European neighbors.

“Just like in the Titanic sinking, the rich have grabbed all the available lifeboats leaving the less fortunate behind,” Professor Dragan Danilovski, a retired epidemiologist from Macedonia, told ABC News. “We have fallen behind in the race, but did we have a fair chance? It’s a chronic global inequality.”

Among the most recent contenders to join this race are Indonesia and India. India’s mass vaccination program will be the world’s largest with its bid to reach more than 1.3 billion people. Since it started this weekend, 224,000 people have been dosed according to Our World in Data.

Of the four frontrunners, the U.K. had a small head start as the first country in the world to approve a vaccine and began administering it, on Dec. 8. The Israelis started their program on Dec. 19 and it is being widely hailed as the most efficient, but it is not without controversy. Human rights organizations have condemned the Israeli government as the rollout does not include the more than five million Palestinians living in the West Bank and Gaza.

Vaccine approvals

Both Bahrain and the UAE approved two vaccines late last year — one from the U.S., Pfizer-BioNTech, and one from China, Sinopharm. The decision to tap both producers has clearly helped make them serious contenders in the race to vaccinate.

Few Western countries, however, have been happy to approve the Sinopharm vaccine due to incomplete trial data and confusion around its efficacy. Similarly, the Russian Sputnik V is being met with mistrust in some parts of the world and has not been approved in either the U.K. or the U.S.

“For this vaccine to go forward it’s going to have to be that it satisfies the level of scrutiny that we expect in the West, in Europe and the U.S. and the U.K.,” Paul Hunter, professor of health protection at the University of East Anglia, said.

But the Russian and Chinese vaccines are making significant in-roads in other parts of the world. The Sputnik V vaccine has so far received emergency use authorization in Algeria, Argentina, Bolivia, Serbia, Belarus, Palestine and Venezuela.

The Gamaleya Institute, responsible for developing Sputnik V, has also signed production agreements with India, Brazil, Mexico, Egypt and Kazakhstan and has allocated millions of doses to Uzbekistan, Nepal and Saudi Arabia, with this list expected to grow.

Likewise, the three Chinese vaccines — from Sinopharm, Sinovac and CanSino — are all reaching a diverse market. According to Chinese state media, more than 40 countries have ordered China-made vaccines, among them the Philippines, Brazil, Turkey, Indonesia, UAE, Bahrain, Pakistan, Hungary, Egypt and Morocco.

Western pharmaceutical companies have also been making bilateral agreements with governments around the world, with several authorizations granted. The vaccine from Oxford University and AstraZeneca has been authorized for use in the U.K., India, Argentina, Dominican Republic, El Salvador, Mexico and Morocco.

The U.S.’ Moderna’s jab is in circulation in the U.S. and Canada and has also been approved in the U.K., with the first batches expected to be shipped sometime this spring. And Pfizer-BioNtech, the frontrunner, has been approved not only in Europe, Israel, the U.K. and the U.S. but has also been given the WHO’s stamp of approval.

COVAX efforts

In a bid to prevent some countries getting left behind, the WHO partnered with Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI) to develop COVAX, a global enterprise to coordinate procurement and access to vaccines in an equitable way, with a mantra that “we are only safe once we are all safe.”

Importantly, China has signed up with COVAX, with President Xi Jinping pledging last May that the Chinese vaccine would be a “global public good.”

In contrast, President Donald Trump refused to sign up with COVAX, and it remains to be seen whether the Biden administration will revert that decision. When asked about it by ABC News, a transition spokesperson declined to comment, but said, “We understand that global threats require global solutions.”

A Gavi spokesperson told ABC News they are hopeful about the prospect: “The U.S. has already been helpful through its recent approval of U.S. $4 billion for Gavi to use for procurement and delivery of COVID-19 vaccines for lower-income countries. We welcome U.S. engagement as we move ahead with COVAX’s mission.”

That mission is, however, still in the preparatory phases. Pledges have been made and vaccine doses allocated in their millions, but the only vaccine that has been granted Emergency Use Listing by the WHO and can therefore be administered under WHO auspices is the Pfizer vaccine. Crucially, COVAX has yet to strike a deal with the Pfizer-BioNTech partnership.

A Pfizer spokesperson told ABC News they are “in active negotiations with COVAX … and hope to finalize an agreement very soon.”

A GAVI spokesperson said, “Those discussions are continuing, and we’re hoping for an announcement soon.”

But these negotiations have been ongoing for months, and the longer they drag, the longer lower-income countries are forced to wait for their vaccines.

Plus, lower-income countries don’t just need the deals — they need to be logistically ready to receive, distribute and administer vaccines to a population willing to receive them. The Pfizer vaccine with its need to be transported at ultra-cold temperatures poses a particularly difficult logistical hurdle for some countries.

And while Gavi may be bullish about the level of commitment COVAX has received, a spokesperson for UNICEF, which will be supporting the global vaccine rollout, said, “We need more money to get countries ready to receive the vaccines.”

Tedros, at the WHO, is amplifying this message and criticizing governments he thinks have not done enough to help the global effort.

“Not only does this me-first approach leave the world’s poorest and most vulnerable at risk, it is also self-defeating,” he said Monday. “Ultimately these actions will only prolong the pandemic.”

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