By Begoña Arechalde
"The world is on the verge of a moral failure," said Director-General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus, in reference to the unequal global distribution of vaccines on January 18. "The poorest countries will suffer without collective global action."
Since an approximate date for the manufacture of COVID-19 vaccines was announced, wealthy countries rushed to secure the supply of doses to their territories. By August of last year, the United Kingdom had signed contracts with eight different pharmaceutical companies for a total of 340 million doses, a figure five times higher than its population count. The United States secured 800 million doses, while the European Union signed a contract with the British firm AstraZeneca for 300 million doses.
In the same period, COVAX, a multilateral fund created to ensure the distribution of vaccines in low and middle-income countries (LMICS), had secured only 300 million vaccines out of the two billion needed. One billion out of these doses would go to 92 LMICS, who would pay little or nothing for them. The total project budget amounted to $18 billion.
The rationale behind COVAX aimed to prevent hoarding, disorganized responses, chaotic markets, and the continuation of economic and social disruption.
In December 2020, the multilateral fund announced that it had finally secured the two billion doses for which it had been created. The vaccines began to be distributed in proportion to population size in February, three months later than in rich countries, where most of the supplies have been obtained bilaterally. Africa will receive 600 million doses, but the distribution process faces logistical, structural, and economic challenges.
In terms of the virus, Africa is doing relatively better than other regions of the world, with 3,742,000 cases and 87,300 deaths related to COVID-19. Although responses to the pandemic vary among different countries, some continental trends can be observed. Africa has more experience with viral outbreaks than other areas of the world due to previous epidemics such as HIV and Ebola. As a result, health personnel are well prepared, and many countries already have contact tracing protocols in place. A young population, a favourable climate, and the existence of population pre-immunity from past coronavirus outbreaks may have contributed to improve the continent’s figures.
On the downside, unreported cases are estimated to be in the millions. The low testing capacity and the lack of intensive care beds--1 per 100,000 inhabitants--make it impossible to publish accurate figures. The death toll is also not reliable in many countries such as Nigeria or Niger, where even before the pandemic only 10% of deaths were recorded.
Although African economies have suffered somewhat less during the pandemic when compared to the economies of other regions, no country on the continent has as of yet manufactured its own vaccine. The continent thus depends on the global effort to access vaccines, which is problematic given that the global effort has proved itself to be deeply hypocritical.
A report from Duke University states that "several COVAX [vaccine provider] signatories are effectively undermining the pact by negotiating side deals for large vaccine shipments that will result in a smaller piece of the pie available for equitable global allocation." For example, the UK, the largest contributor to COVAX, is also the largest vaccine hoarder only behind Canada. The report concludes that vaccines will not be available to everyone in the global population until 2024.
Several factors underpin the opaque bilateral agreements’ undermining of COVAX objectives. In a phenomenon labeled “vaccine nationalism”, the pharmaceutical companies leading the vaccination race have prioritized profits, striking deals with wealthy nations desperate to revive their economies. Speculation and the lack of transparency in the deals have caused price inflation, putting countries that cannot afford to divert public funds at a disadvantage.
Intrinsic limitations have also hindered COVAX’s success. The fund does not cover for expenses beyond the acquisition and delivery of doses such as adequate transportation, personnel, supplemental technologies, and local research projects.
In addition, the distribution process in Africa faces unique challenges. Only 22 African countries have the cold supply chains that some of the doses require. Supply chains must often extend into rural areas, where technical capacity is limited and medical personnel are scarce. Even more worrying is the emergence of a South African variant of the virus which has shown high resistance to certain vaccines, reducing its immunizing effect to 10%.
Clearly, COVAX has proven insufficient to ensure timely and equitable access to vaccines in Africa in the face of hoarding by rich countries. The relevant questions now are what else could have been done and what the continent should do next.
Critics easily fall prey to the notion that African governments have played a passive role in vaccine development and thus bear some responsibility for the shortage. According to the Vaccine Advocacy Resource Group’s South African chapter, however, increased manufacturing capacity would not have automatically translated into access.
"We are under no illusion of the power, the influence, the agenda-setting, and the politics at play that ultimately will decide who lives and who dies," said the group in a statement.
Intellectual Property (IP) rights have been one of the main barriers to the development of regional research. Countries like South Africa have demanded a temporary ban on patents for COVID-19-related products from the World Trade Organisation, only for the organization to reject them on the grounds that the IP system is key to the sector’s competitiveness and innovation.
In these circumstances, the African Union Commission is planning to make its own bilateral agreements which, given the waiting list for European and American doses, will focus on the purchase of vaccines from Russia and China.
Moving away from short-term solutions, Africa must diversify sources of funding and push for a change in the IP system that allows exceptions for crises of the magnitude of COVID-19. Drawing on their epidemiological expertise, governments should prioritize the development of local vaccine research and healthcare industry’s entrepreneurship as well as expand research facilities to lower their dependency on foreign pharmaceutical companies.
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