‘A Moral Failure’: Global Vaccine Inequity Hits Africa Hardest

Low vaccination rates due to global health inequities

Posted on Feb 16, 2022

Sylvia Y. Kamara, a nurse with Sierra Leone's Ministry of Health, administers a COVID-19 vaccine in March 2021.
Sylvia Y. Kamara, a nurse with Sierra Leone's Ministry of Health, administers a COVID-19 vaccine in March 2021. Photo by Maya Brownstein / PIH.

As AIDS surged worldwide in the 1990s, the most effective treatments were made available in the United States and Western Europe within months of their regulatory approval. But those same treatments took years to reach Africa. Without access to these lifesaving drugs, millions in Africa died of the disease.

Now, Dr. Evrard Nahimana fears that scenario is playing out again—this time, with COVID-19.

Wealthy nations have surpluses of COVID-19 vaccines and have since rolled out booster programs. But more than 80% of people in Africa hadn’t received a single dose, as of December.

This disparity is no accident.

When COVID-19 vaccines were first developed and approved in 2020, wealthy nations bought up the world’s supply, leaving African countries to scramble for what few doses were left.

And instead of helping expand vaccine access in Africa and support delivery systems, wealthy nations blamed the continent for its low vaccination rates and put in place racist, discriminatory measures such as travel bans.

“It’s like punishing and blaming someone who is already sick,” says Nahimana. “Saying that these people don’t deserve the most effective vaccines…is cynical, racist, and very colonial.”

The Vaccine Gap

Africa is a continent of 1.3 billion people, with 54 countries and more than 2,000 languages. Partners In Health works in five of those countries—Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone.

As PIH’s Africa regional policy and partnerships advisor, Nahimana supports the COVID-19 response in these countries, where PIH has partnered with national governments to train health workers, strengthen supply chains, and provide tests, treatment, and vaccines.

Much of that crucial work began years before COVID-19, as PIH supported ministries of health in responding to Ebola, HIV/AIDS, and other infectious diseases and building up health systems weakened by centuries of colonialism and war.

Throughout Africa, COVID-19 vaccination rates vary by country. But as of December, only seven countries had vaccinated 40% of their population, meeting the target set by the World Health Organization for 2021. Africa may not reach the WHO’s mid-2022 target of 70% coverage until 2024.

Nahimana sees history repeating itself.

“It took years…decades…for communities across Africa in the 2000s to get access to the most effective antiretroviral treatments for HIV,” he says. “Those ARTs were already available a decade before in the U.S. and Europe.”

A COVID-19 vaccine.
A health worker prepares a COVID-19 vaccine in Sierra Leone. Photo by Maya Brownstein / PIH.

‘It’s So Cynical’

Cold chain, multiple-dose series, and weak health infrastructure are often cited in global conversations about the difficulties of providing and distributing COVID-19 vaccines in Africa.

But the root issue, says Nahimana, has less to do with supply chains and more to do with racism, colonialism, and capitalist greed.

“It’s so cynical to say, ‘Since they don’t have the ability to distribute, there’s no way to donate or we should hold sending vaccines,’ he says. “This behavior is racist.”

Even if all African countries had strong health systems, supply chains, and health workforces, there simply aren’t enough vaccines—Africa received just 6% of the world’s supply of vaccines, despite having 17% of the world’s population.

And the vaccines that are available on the continent—secured through COVAX, African Union deals, and bilateral agreements—are less likely to be mRNA vaccines, currently considered top-tier, and more likely to be lower-cost vaccines.

“I think the United States’ approach and the European Union’s approach to the global COVID pandemic was that it could be solved very cheaply in impoverished countries,” says Garrett Wilkinson, a health policy analyst on PIH’s global advocacy team. “I think what we’re seeing now is the effects of low-balling the cost of vaccinating the entire world.”

If wealthy nations wanted to, he says, they could build the capacity to mass produce vaccines and distribute them worldwide, including in Africa.

And that could happen independent of COVAX, the global initiative that was set up by rich countries simply to buy doses from pharmaceutical companies, rather than to expand production of vaccines, says Joel Curtain, PIH’s director of advocacy.

“This is really about double standards in vaccine access and quality, which is deeply colonial and unjust,” says Curtain.

A recent report that Wilkinson co-authored showed that it would cost the U.S. less than $12 billion to build the manufacturing capacity necessary to produce enough mRNA vaccines to protect the world’s unvaccinated. (For context, the U.S. recently approved $768 billion for military spending.)

But President Joseph R. Biden has continued to reject calls from PIH, others in the People’s Vaccine Alliance, and over half the Democratic Caucus in the House of Representatives to invest in new manufacturing capacity to expand vaccine supply and to increase global vaccine delivery spending.

That inaction continues to cost lives.

Supporters of the People's Vaccine participate in a rally for global solidarity against vaccine apartheid in Cambridge, Massachusetts, which is home to a heavy concentration of pharmaceutical and biotechnology companies.
Supporters of the People's Vaccine participate in a rally for global solidarity against vaccine apartheid in Cambridge, Massachusetts, which is home to a heavy concentration of pharmaceutical and biotechnology companies. Photo by Zack DeClerck / PIH.

Ending The Pandemic, Everywhere

It’s not difficult to find success stories in Africa. Just look to Rwanda, says Nahimana.

One day after receiving shipments of COVID-19 vaccines, he says, the country was able to quickly deploy those vaccines in every health facility across all districts. Prior investment in the primary health system and a strong commitment to equity were some of the drivers of this success.

The country of nearly 13 million has now fully vaccinated over 50% of its population and is expected to reach the World Health Organization’s target of 70% by mid-2022—showing that mRNA vaccination programs are entirely possible in both urban and rural settings in Africa, with access to funding, resources, and investment in the health system.

It’s also crucial to transfer the technology and build up the capacity for vaccines to be manufactured in Africa, says Nahimana. Africa currently relies on manufacturers in Europe, the U.S., and Asia for 99% of all of its vaccines.

“At PIH, we don’t just want to play the role of advocacy,” he says. “We want to push barriers.”

For Nahimana and others calling for global vaccine equity, the message is straightforward: If Western leaders wanted to save as many lives as possible, they could.

“It’s pretty clear that the only reason we’re in this situation is because our leaders don’t care enough whether poor people live or die,” says Wilkinson.

The inaction of U.S. and Western European leaders is not only a moral outrage—it’s a danger to public health. The longer that millions of people worldwide are unvaccinated, the greater the threat of new variants, putting everyone, including those in wealthy nations, at risk.

“It doesn’t make sense scientifically and it’s a moral failure,” says Nahimana. “When you think about a pandemic like COVID-19, with dangerous variants emerging in areas with low vaccination rates, it’s not about ending the pandemic in one country. It’s about ending the pandemic everywhere.”

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