The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent. Policy Research Working Paper 9260COVID-19 can be described as a heat-seeking missile speeding toward the most vulnerable in society. That metaphor applies not just to the vulnerable in the rich world; the vulnerable in the rest of the world are not more immune. Yet, despite the extensive spread of the virus, the mortality toll remains highly concentrated in high-income countries. Developing countries represent 85 percent of the global population, but only 21 percent of the pandemic's death toll. This unusual inequality creates the impression that the world is subjected to two different pandemics in terms of their impact. This paper documents the observed inequality with a new indicator that expresses severity relative to pre-pandemic patterns. It argues that the excessive skew towards rich countries is inconsistent with demography. Simulations based on reasonable ranges for infectivity and fatality suggest that the developing country share in global fatalities could rise by a factor of three (from 21 to 69 percent). Environmental and host-specific factors will influence these results but are unlikely to overturn them. While data quality has a role in explaining 'excess inequality', the more compelling explanation is that the pandemic has yet to run its course through the age distributions of the world.

Gavin Yamey and colleagues say that a new, urgent push for global vaccine equity could help avert suffering and deaths, protect economies, and prevent new virus variants

The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

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