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For people in the U.S., Europe, and much of East Asia, a coronavirus vaccine is starting to seem right around the corner. But in 67 developing or poor countries from Mongolia to Mozambique, only one out of every 10 people will be vaccinated by the end of 2021, according to a new analysis.

The finding, detailed Tuesday by the People’s Vaccine Alliance, a coalition including Oxfam and Amnesty International that advocates for equitable and low-cost vaccine access, highlights the disparities between richer and less well-off countries. It also shows that a large part of the world will likely be grappling with COVID for some time to come, even after wealthy countries get it under control.

The 67 low or lower-middle-income countries, according to PVA, will have access to a vaccine only through COVAX, a project that aims to pool resources from many countries to broaden vaccine access. So far, COVAX has secured 700 million vaccine doses from the developers of leading vaccine candidates—but those doses will be shared across 3.6 billion citizens of COVAX's 92 lower- and middle-income recipient countries.

COVAX also includes some middle-income countries, such as Vietnam and Brazil, which are negotiating independently for additional vaccine supplies. But for the poorest countries, that means a two-dose vaccination sequence has been secured for only 10% of residents.

In addition to ongoing illness and death in those countries, that could have worldwide economic impacts if it hampers travel or trade.

“This pandemic is a global problem that requires a global solution,” said Lois Chingandu, director of Frontline AIDS, a People’s Vaccine Alliance member. “The global economy will continue to suffer so long as much of the world does not have access to a vaccine.”

The People’s Vaccine Alliance cites two factors in the shortfall: what it calls “hoarding” of the vaccine by wealthy nations, and limits on vaccine production because of intellectual-property controls.

“Rich countries have enough doses to vaccinate everyone nearly three times over, whilst poor countries don’t even have enough to reach health workers and people at risk,” says Dr. Mohga Kamal-Yanni of the PVA.

That’s because early in the vaccine race, many rich countries reserved supplies from multiple vaccine candidates. Now a large number of separate vaccine programs have shown promise in large-scale trials, potentially leaving those countries with more earmarked doses than they need.

According to Nicholas Lusiani of Oxfam, “very early” discussions are taking place about how to redistribute those extra doses. “But the logistical, not to mention political, challenges make this not the most ideal solution.”

Instead, Lusiani says, the answer is “a proven public health measure of mass, low-cost production by a small army of producers worldwide.”

To make that possible, the People’s Vaccine Alliance is calling on all pharmaceutical makers working on COVID-19 vaccines to share their technology and intellectual property through the World Health Organization. India and South Africa recently went a step further, calling on the World Trade Organization to exempt COVID-19 vaccines from intellectual-property protections so that more companies could manufacture the vaccine, potentially improving access worldwide.

In a statement, Pfizer did not address the technology-sharing call. Instead, it emphasized that it has developed the “capability to distribute the vaccine globally upon approval or authorization.”

Moderna did not reply to a request for comment about the new analysis.

“Quite frankly, right now, there's too much of a gap between the rhetoric and the reality [to] deliver on a fair and equitable result for people around the world,” says Dr. Mike Ryan, executive director of the World Health Organization’s Health Emergencies program. “We have the architectural drawings for this moonshot, but we still don't have the financing to make that happen.”

The United States has declined to help with that financing. The Trump administration announced in September that the U.S. would not contribute to COVAX. Today, the federal government announced further measures to reserve COVID vaccine supplies for Americans before assistance goes to other countries.

By contrast, the EU has committed €100 million to the COVAX effort. EU member states have also contributed to COVAX individually, including an additional €100 million commitment from France.

“No one should be blocked from getting a lifesaving vaccine because of the country they live in or the amount of money in their pocket,” said Anna Marriott, Oxfam’s health policy manager. “But unless something changes dramatically, billions of people around the world will not receive a safe and effective vaccine for COVID-19 for years to come.”