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2 August 2021

How the world failed Africa on Covid-19 vaccination

Experts warn coronavirus risks becoming a “two-track pandemic”.

By Ido Vock

The African Union (AU) is to ship the first six million doses of the single-dose Johnson & Johnson Covid-19 vaccine to member states this week, its first delivery via the African Vaccine Acquisition Trust. The AU hopes its new trust will help secure doses faster than the other schemes it was previously reliant upon, such as the WHO’s Covax, which has fallen behind on deliveries to the world’s poorest countries.
Over eighty per cent of doses of Covid-19 vaccines have been administered in upper middle-income and high income countries, according to a New Statesman analysis, while only 0.3 per cent have so far gone to poor countries. Fewer Africans are fully vaccinated than inhabitants of any other continent: just 1.6 per cent, compared to 49.2 per cent in the US and 48.9 per cent in the EU.  
Even as African countries are administering only a small number of Covid-19 vaccines, the disease is hammering the continent. Although cases have recently begun falling across Africa, Matshidiso Moeti, the WHO’s regional director for Africa, has cautioned that the drop is largely to do with lower case numbers in South Africa, a country with some of the continent’s highest rates of testing. Even that fall may in part be due to recent widespread violence, the country’s worst in the post-apartheid era, which disrupted testing.  
Elsewhere, cases are rising, even though low rates of testing obscure the true scale of the pandemic in many African countries. Nigeria, the continent’s most populous nation, is recording its highest daily case rates in four months. In Tunisia, a surge in cases of the Delta variant is causing more than 150 deaths a day, overloading the hospital system and may have contributed to recent political instability.  
In Dakar, the Senegalese capital, the head of the public hospital system said last week that 99 per cent of beds are occupied and warned that the medical system was on the brink of collapse. Mesfin Teklu Tessema, the head of the Health Unit at the International Rescue Committee, a humanitarian organisation, tells me he worries about countries such as the Democratic Republic of Congo, where testing is close to non-existent and the healthcare system is weak. 
What went wrong? In part, it was a failure of Covax, the vaccine-sharing scheme lessd by the WHO, which was reportedly supposed to have delivered some 237 million doses to 142 countries – many of them in Africa – by May this year. Instead, it has so far provided just 153 million doses, according to Gavi, a global health organisation aiming to boost immunisation in the developing world.  

[see also: We cannot escape the threat of Covid-19 until we vaccinate the world]
That shortfall is largely due to an export ban imposed on vaccine doses by India’s government in April, as the country battled a brutal second wave of coronavirus. The Serum Institute of India, a pharmaceutical manufacturer headquartered in the state of Maharashtra, was contracted to produce the bulk of doses destined for Covax. Because of the export ban, virtually the entirety of its production capacity is now being used domestically.  
However, despite being behind on deliveries, Gavi’s latest supply forecast says that Covax will receive 1.9 billion doses by the end of the year, only just missing its original target of 2 billion doses. Hitting that number will depend on supply drastically ramping up from September. That objective could fall victim to some of the same challenges which have resulted in Covax failing to meet its delivery goals so far.  
Negotiations to waive patents on vaccines, a proposal backed, most prominently, by US President Joe Biden’s administration in May, have so far floundered. No agreement has yet been reached at the World Trade Organisation (WTO), an international organisation which regulates global trade. Generic vaccines still appear some way off.  
Though the main issue is supply, African countries have also struggled to administer doses. Malawi and South Sudan destroyed tens of thousands of doses they were unable to use before their expiry dates earlier this year. Bottlenecks in the administration of doses will become more apparent when supply picks up.  
Nor are lockdowns always an easy option for African countries. Many governments on the continent lack the fiscal firepower to compensate people for earnings lost when their businesses are forced to close. The recent violence and looting in South Africa is thought by some observers to be, at least in part, a result of economic devastation caused by repeated shutdowns.  
The risk is now that Covid-19 is becoming – outbreaks among the unvaccinated in rich countries a partial exception – a “two-track pandemic”, Tessema said. While rich countries will likely see significantly reduced mortality from their successful vaccine programmes, poor countries look set to suffer little respite for many months more.  

[see also: The poorest countries have received just 0.3 per cent of Covid-19 vaccine doses]

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