Global vaccine distribution increased throughout the 6-year study period, although the rate of growth slowed substantially during the last two years (Fig. 1). Total worldwide distribution increased 72% from 262 million doses in 2004 to 449 million in 2009. On a regional A-1210477 manufacturer basis, distribution increased in each of the six WHO regions (Fig. 2), although the growth was not uniform. Notably, Europe and the Americas received the majority of vaccine distribution throughout

the period. Together, these regions consistently accounted for 75%–80% of global supply, despite growth elsewhere and a drop in vaccine provision in the Americas following a peak in 2007. Of the remaining vaccine supply, the Western Pacific region received the vast majority, with the combined African, Eastern Mediterranean, and South–East Asian regions accounting for between 1% and 4% of global distribution each year. Between the beginning and the end of the surveyed period, vaccine provision CCI-779 mouse grew in over 70% of the 157 study countries. Notable increases took place in Europe (in France, Germany,

Italy, the Netherlands, Spain and the UK), the Americas (in Brazil, Colombia, Mexico and the USA) and, elsewhere, in China, Japan and Thailand (Fig. 3). However growth was non-uniform. Only four of these countries (Mexico, Spain, Thailand and the UK) achieved year-on-year increases from 2004 to 2009, while dose distribution in the US peaked in 2007 and subsequently decreased 23% in the following 2 years. Dose distribution fell in a number of countries, although the

declines were less marked than the growth in other nations. The most notable decrease occurred in the Republic of Korea, where distribution fell 27% during the study period, from over 16.5 million doses in 2004 to approximately 12 million in 2009. Analysis of per capita dose distribution data shows that, despite growth at the global, regional and national levels, no country distributed sufficient vaccines for half of its population and only 20% of WHO Member whatever States reached the conservative study “hurdle” rate of 159 doses per 1000 population (Fig. 4). Over two-thirds of countries did not distribute sufficient doses to cover 10% of their populations, while more than one-third distributed too few doses to protect even 1% of inhabitants. Population-based comparisons show that vaccine supply and national income do not correlate directly (Fig. 5). Overall, 46 countries were more developed and 108 were less developed. Twenty-two of 46 more developed countries (48%) achieved vaccine provision >159 doses/1000 population and nine of 108 less developed countries (8%) reached this level. Therefore, of the 31 countries with vaccine provision ≥159 doses per 1000 population, 29% (nine countries) were less developed. Four of these nine countries were in Latin America.