{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T03:49:44Z","timestamp":1789271384177,"version":"build-2803163510"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,14]],"date-time":"2021-08-14T00:00:00Z","timestamp":1628899200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,14]],"date-time":"2021-08-14T00:00:00Z","timestamp":1628899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Federal Rural University of Pernambuco"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Equity Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The determinants of access to immunizers are still poorly understood, leading to questions about which criteria were considered in this distribution. Given the above, the present study aimed to analyze the determinants of access to the SARS-CoV-2 vaccine by different countries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The study covered 189 countries using data from different public databases, and collected until February 19, 2021. We used eight explanatory variables: gross domestic product (GDP), extreme poverty, human development index (HDI), life expectancy, median age, coronavirus disease 2019 (COVID-19) cases, COVID-19 tests, and COVID-19 deaths. The endogenous variables were total vaccine doses, vaccine doses per thousand, and days of vaccination. The structural equation modeling (SEM) technique was applied to establish the causal relationship between the country's COVID-19 impact, socioeconomic variables, and vaccine access. To support SEM, we used confirmatory factor analysis, t-test, and Pearson's correlation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We collected the sample on February 19, and to date, 80 countries (42.1%) had already received a batch of immunizers against COVID-19. The countries with first access to the vaccine (e.g., number of days elapsed since they took the first dose) were the United Kingdom (68), China (68), Russia (66), and Israel (62). The countries receiving the highest doses were the United States, China, India, and Israel. The countries with extreme poverty had lower access to vaccines and the richer countries gained priority access. Countries most affected by COVID (deaths and cases) also received immunizers earlier and in greater volumes. Unfortunately, similar to other vaccines, indicators, such as income, poverty, and human development, influence vaccines' access. Thus affecting the population of vulnerable and less protected countries. Therefore, global initiatives for the equitable distribution of COVID need to be discussed and encouraged.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Determinants of vaccine distribution consider the impact of the disease in the country and are also affected by favorable socioeconomic indicators. The COVID-19 vaccines need to be accessible to all affected countries, regardless of their social hands.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12939-021-01520-4","type":"journal-article","created":{"date-parts":[[2021,8,14]],"date-time":"2021-08-14T08:03:02Z","timestamp":1628928182000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Determinants of access to the SARS-CoV-2 vaccine: a preliminary approach"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0038-1053","authenticated-orcid":false,"given":"Brigitte Renata Bezerra","family":"de Oliveira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Iza Gomes","family":"da Penha Sobral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Luiz Monteiro","family":"Marinho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos Felipe Falc\u00e3o","family":"Sobral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"de Souza Melo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisleia Benini","family":"Duarte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,14]]},"reference":[{"issue":"2020","key":"1520_CR1","doi-asserted-by":"publisher","first-page":"138997","DOI":"10.1016\/j.scitotenv.2020.138997","volume":"729","author":"MFF Sobral","year":"2020","unstructured":"Sobral MFF, Duarte G, Sobral A, Marinho M, Melo A. Association between climate variables and global transmission oF SARS-CoV-2. Sci Total Environ. 2020;729(2020):138997. https:\/\/doi.org\/10.1016\/j.scitotenv.2020.138997.","journal-title":"Sci Total Environ"},{"key":"1520_CR2","doi-asserted-by":"publisher","first-page":"101205","DOI":"10.1016\/j.arr.2020.101205","volume":"65","author":"Y Chen","year":"2021","unstructured":"Chen Y, Klein SL, Garibaldi BT, Li H, Wu C, Osevala NM, et al. Aging in COVID-19: Vulnerability, immunity and intervention. Ageing Res Rev. 2021;65:101205. https:\/\/doi.org\/10.1016\/j.arr.2020.101205.","journal-title":"Ageing Res Rev"},{"key":"1520_CR3","unstructured":"World Health Organization (WHO). (2020, july 15). More than 150 countries engaged in COVID-19 vaccine global access facility. Retrieved mar 02, 2021, from https:\/\/www.who.int\/news\/item\/15-07-2020-more-than-150-countries-engaged-in-covid-19-vaccine-global-access-facility. Accessed 2 Mar 2021."},{"key":"1520_CR4","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1590\/S0103-73312007000100006","volume":"17","author":"PM Buss","year":"2007","unstructured":"Buss PM, Pellegrini Filho A. A sa\u00fade e seus determinantes sociais. Physis: revista de sa\u00fade coletiva. 2007;17:77\u201393.","journal-title":"Physis: revista de sa\u00fade coletiva"},{"issue":"1","key":"1520_CR5","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.jaci.2020.04.006","volume":"146","author":"X Li","year":"2020","unstructured":"Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110\u20138.","journal-title":"J Allergy Clin Immunol"},{"issue":"5","key":"1520_CR6","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1007\/s00392-020-01626-9","volume":"109","author":"B Li","year":"2020","unstructured":"Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531\u20138.","journal-title":"Clin Res Cardiol"},{"key":"1520_CR7","doi-asserted-by":"crossref","unstructured":"George, JA., Maphayi, MR., & Pillay, T. (2021). COVID-19 and Vulnerable Populations in Sub-Saharan Africa. Clinical, Biological and Molecular Aspects of COVID-19, 147-162","DOI":"10.1007\/978-3-030-59261-5_13"},{"key":"1520_CR8","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.annepidem.2020.05.003","volume":"47","author":"GA Millett","year":"2020","unstructured":"Millett GA, Jones AT, Benkeser D, Baral S, Mercer L, Beyrer C, et al. Assessing differential impacts of COVID-19 on black communities. Ann Epidemiol. 2020;47:37\u201344.","journal-title":"Ann Epidemiol"},{"issue":"4","key":"1520_CR9","doi-asserted-by":"publisher","first-page":"e480","DOI":"10.1016\/S2214-109X(20)30068-1","volume":"8","author":"Y Ji","year":"2020","unstructured":"Ji Y, Ma Z, Peppelenbosch MP, Pan Q. Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob Health. 2020;8(4):e480. https:\/\/doi.org\/10.1016\/S2214-109X(20)30068-1.","journal-title":"Lancet Glob Health"},{"issue":"4","key":"1520_CR10","doi-asserted-by":"publisher","first-page":"e186","DOI":"10.1016\/S2468-2667(20)30053-0","volume":"5","author":"J Tsai","year":"2020","unstructured":"Tsai J, Wilson M. COVID-19: a potential public health problem for homeless populations. Lancet Public Health. 2020;5(4):e186\u20137. https:\/\/doi.org\/10.1016\/S2468-2667(20)30053-0.","journal-title":"Lancet Public Health"},{"key":"1520_CR11","doi-asserted-by":"publisher","unstructured":"Peeling RW, Olliaro PL, Boeras DI, Fongwen N. Scaling up COVID-19 rapid antigen tests: promises and challenges. Lancet Infect Dis. 2021. https:\/\/doi.org\/10.1016\/S1473-3099(21)00048-7.","DOI":"10.1016\/S1473-3099(21)00048-7"},{"issue":"1","key":"1520_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12929-019-0592-z","volume":"27","author":"Y-D Li","year":"2020","unstructured":"Li Y-D, Chi W-Y, Su J-H, Ferrall L, Hung C-F, Wu T-C. Coronavirus vaccine development: from SARS and MERS to COVID-19. J Biomed Sci. 2020;27(1):1\u201323 https:\/\/jbiomedsci.biomedcentral.com\/articles\/10.1186\/s12929-020-00695-2.","journal-title":"J Biomed Sci"},{"issue":"2","key":"1520_CR13","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1111\/cei.13517","volume":"202","author":"JS Tregoning","year":"2020","unstructured":"Tregoning JS, Brown ES, Cheeseman HM, Flight KE, Higham SL, Lemm N-M, et al. Vaccines for COVID-19. Clin Exp Immunol. 2020;202(2):162\u201392. https:\/\/doi.org\/10.1111\/cei.13517.","journal-title":"Clin Exp Immunol"},{"key":"1520_CR14","doi-asserted-by":"publisher","unstructured":"Mills MC, Salisbury D. The challenges of distributing COVID-19 vaccinations. EClinicalMedicine. 2021;31. https:\/\/doi.org\/10.1208\/s12249-020-01744-7.","DOI":"10.1208\/s12249-020-01744-7"},{"key":"1520_CR15","doi-asserted-by":"publisher","first-page":"138882","DOI":"10.1016\/j.scitotenv.2020.138882","volume":"728","author":"I Chakraborty","year":"2020","unstructured":"Chakraborty I, Maity P. COVID-19 outbreak: Migration, effects on society, global environment and prevention. Sci Total Environ. 2020;728:138882. https:\/\/doi.org\/10.1016\/j.scitotenv.2020.138882.","journal-title":"Sci Total Environ"},{"key":"1520_CR16","unstructured":"WHO. More than 150 countries engaged in COVID-19 vaccine global access facility https:\/\/www.who.int\/news-room\/detail\/15-07-2020-more-than-150-countries-engaged-in-covid-19-vaccine-global-accessfacility (2020). Accessed 2 Mar 2021."},{"issue":"8","key":"1520_CR17","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1136\/jech-2020-214297","volume":"74","author":"S Khalatbari-Soltani","year":"2020","unstructured":"Khalatbari-Soltani S, Cumming RC, Delpierre C, Kelly-Irving M. Importance of collecting data on socioeconomic determinants from the early stage of the COVID-19 outbreak onwards. J Epidemiol Community Health. 2020;74(8):620\u20133. https:\/\/doi.org\/10.1136\/jech-2020-214297.","journal-title":"J Epidemiol Community Health"},{"key":"1520_CR18","unstructured":"University of Oxford. (n.d.). Our World in Data. Coronavirus (COVID-19) Vaccinations. Retrieved 02 25, 2021, from https:\/\/ourworldindata.org\/. Accessed 25 Feb 2021."},{"key":"1520_CR19","unstructured":"World Bank. World Development Report 2021: Data for Better Lives: The World Bank; 2021."},{"key":"1520_CR20","unstructured":"Hoyle RH. Handbook of Structural Equation Modeling: The Guilford Press; 2012."},{"issue":"1","key":"1520_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705510802561279","volume":"16","author":"W Herzog","year":"2009","unstructured":"Herzog W, Boomsma A. Small-Sample Robust Estimators od Noncentrality-based and incremental model fit. Struct Equ Model Multidiscip J. 2009;16(1):1\u201327. https:\/\/doi.org\/10.1080\/10705510802561279.","journal-title":"Struct Equ Model Multidiscip J"},{"issue":"3","key":"1520_CR22","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1177\/0049124114543236","volume":"44","author":"D Kenny","year":"2015","unstructured":"Kenny D, Kaniskan B, McCoach DB. The performance of RMSEA in models with small degrees of Freedom. Sociol Methods Res. 2015;44(3):486\u2013507. https:\/\/doi.org\/10.1177\/0049124114543236.","journal-title":"Sociol Methods Res"},{"issue":"10224","key":"1520_CR23","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1016\/S0140-6736(20)30251-8","volume":"395","author":"R Lu","year":"2020","unstructured":"Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565\u201374. https:\/\/doi.org\/10.1016\/S0140-6736(20)30251-8.","journal-title":"Lancet"},{"issue":"7830","key":"1520_CR24","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1038\/s41586-020-2798-3","volume":"586","author":"F Krammer","year":"2020","unstructured":"Krammer F. SARS-CoV-2 vaccines in development. Nature. 2020;586(7830):516\u201327. https:\/\/doi.org\/10.1038\/s41586-020-2798-3.","journal-title":"Nature"},{"key":"1520_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bmj.m4704","volume":"371","author":"W Wang","year":"2020","unstructured":"Wang W, Wu Q, Yang J, Dong K, Chen X, Bai X, et al. Global, regional, and national estimates of target population sizes for covid-19 vaccination: descriptive study. BMJ. 2020;371:1\u201312. https:\/\/doi.org\/10.1136\/bmj.m4704.","journal-title":"BMJ"},{"issue":"1","key":"1520_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4102\/safp.v62i1.5152","volume":"62","author":"V Bangalee","year":"2020","unstructured":"Bangalee V, Suleman F. Access considerations for a COVID-19 vaccine for South Africa. S Afr Fam Pract. 2020;62(1):1\u20134. https:\/\/doi.org\/10.4102\/safp.v62i1.5152.","journal-title":"S Afr Fam Pract"},{"key":"1520_CR27","doi-asserted-by":"publisher","first-page":"3579","DOI":"10.1590\/1413-81232020259.24542020","volume":"25","author":"R Guimar\u00e3es","year":"2020","unstructured":"Guimar\u00e3es R. Vacinas anticovid: um olhar da sa\u00fade coletiva. Ci\u00eancia & Sa\u00fade Coletiva. 2020;25:3579\u201385. https:\/\/doi.org\/10.1590\/1413-81232020259.24542020.","journal-title":"Ci\u00eancia & Sa\u00fade Coletiva"},{"key":"1520_CR28","unstructured":"World Health Organization. (n.d.). World Health Organization. Coronavirus disease (COVID-19) pandemic. Retrieved 02 25, 2021, from https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019. Accessed 25 Feb 2021."},{"issue":"5","key":"1520_CR29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13584-021-00441-5","volume":"10","author":"M McKee","year":"2021","unstructured":"McKee M, Rajan S. What can we learn from Israel\u2019s rapid roll out of COVID 19 vaccination? Isr J Health Policy Res. 2021;10(5):1\u20134. https:\/\/doi.org\/10.1186\/s13584-021-00441-5.","journal-title":"Isr J Health Policy Res"},{"issue":"6","key":"1520_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13584-021-00440-6","volume":"10","author":"B Rosen","year":"2021","unstructured":"Rosen B, Waitzberg R, Israeli A. Israel\u2019s rapid rollout of vaccinations for COVID-19. Isr J Health Policy Res. 2021;10(6):1\u201314. https:\/\/doi.org\/10.1186\/s13584-021-00440-6.","journal-title":"Isr J Health Policy Res"},{"key":"1520_CR31","doi-asserted-by":"publisher","unstructured":"Caspi G, Dayan A, Eshal Y, Taub SL, Twig G, Shalit U, et al. Socioeconomic Disparities and COVID-19 Vaccination Acceptance: Experience from Israel. medRxiv. 2021. https:\/\/doi.org\/10.1101\/2021.01.28.21250716.","DOI":"10.1101\/2021.01.28.21250716"},{"key":"1520_CR32","doi-asserted-by":"publisher","unstructured":"Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 2020:1\u20134. https:\/\/doi.org\/10.1038\/s41591-020-1124-9.","DOI":"10.1038\/s41591-020-1124-9"}],"container-title":["International Journal for Equity in Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-021-01520-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12939-021-01520-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12939-021-01520-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,14]],"date-time":"2021-08-14T20:03:25Z","timestamp":1628971405000},"score":1,"resource":{"primary":{"URL":"https:\/\/equityhealthj.biomedcentral.com\/articles\/10.1186\/s12939-021-01520-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,14]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1520"],"URL":"https:\/\/doi.org\/10.1186\/s12939-021-01520-4","relation":{},"ISSN":["1475-9276"],"issn-type":[{"value":"1475-9276","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,14]]},"assertion":[{"value":"17 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"183"}}