Rich countries are snapping up vaccines even before they’re ready, and it could mean fewer—as well as delays in vaccination—for billions in less wealthy nations, according to a new study.

The global assessment of purchasing agreements shows that high-income countries, as well as a few middle-income countries flush with manufacturing capacity, have already purchased nearly 3.8 billion doses of the COVID-19 vaccine, with options for another five billion.

The analysis shows that many of these countries will be able to vaccinate their entire populations—and some will be able to do so many times over—before billions of people are vaccinated in low-income countries.

“An ambitious effort to create a global system of vaccine equity is being undermined as a handful of countries—including those who made a commitment to equality—secure as many doses as they possibly can,” says Elina Urli Hodges, who leads the Duke University Global Health Innovation Center’s Launch and Scale Speedometer, an initiative that identifies impediments to delivering health innovations to low-income countries.

“Countries are hedging bets by making direct deals while also participating in multilateral platforms, which drives inequality and threatens to prolong a global pandemic,” Urli Hodges says.

While other assessments have warned of potential inequalities in vaccine access, the new analysis is the first to carefully quantify the amount of vaccine doses that are being claimed by country-level agreements and how this could delay access to COVID-19 protection across large regions—including sub-Saharan Africa—until almost the middle of the decade.

Read the full article about COVID-19 vaccine distribution from Duke University at Futurity.