The big western economies have dominated the COVID vaccine market, but rubbing shoulders with them – somewhat unexpectedly – is Chile. It’s secured enough doses to cover its population twice. While others have paid to get to the front of the queue, Chile has shown that you don’t have to be rich to emerge a winner in the vaccine race. It’s secured doses through canny bargaining, cutting deals with multiple providers and hosting vaccine trials.

So far, more than 100 million vaccines against COVID-19 have been administered. Only about 200,000 (0.2%) have been in Africa. This unequal distribution has led to angry questions about how vaccines are being procured, and what can be done to close the gap. But some people are also pointing fingers at developing countries themselves for failing to secure decent prices and access to the drugs. In the case of South Africa, Keymanthri Moodley and Theresa Rossouw argue, the country failed abysmally to take advantage of the fact that it participated in vaccine trials. Sponsors, researchers and research ethics committees had an obligation to negotiate post-trial access, especially in a pandemic.

In a number of wealthy countries, the number of COVID-19 vaccines ordered vastly exceeds what’s needed, while many poorer countries will have to wait – possibly for years – for vaccines to become widely available. Robin Cohen considers how the excess vaccines might be redistributed.