COVID-19 comes to Africa: are vaccines the new Apartheid?

Over the last 18 months we have become all too familiar with the language of COVID-19. Lockdown, test and trace, social distancing, vaccination centre and “have you had your jab yet?” have been the most often used words and phrases in the Western world. There is another one: “nobody is safe until everybody is safe”. I was reminded of this brutal reality when I heard the Director of the Africa Centres for Disease Control and Prevention (Africa CDC), John Nkengasong, point out this week that Africa has so far received only 40mn doses of the COVID-19 vaccine for its population of 1.2bn people. This is only 1% of the requirement. So far, nearly 5mn Africans have become infected with COVID-19 and 131,000 have died of COVID-19 related illnesses.

These figures may seem modest at first glance. Many have pointed out that Africa’s young population makes it comparatively more resilient to serious COVID-19 illness and death than the older and more obese populations of the developed world. Yet, John Nkengasong was clear that Africa is not winning the battle against the pandemic, particularly if the virus produces further, more infectious and deadly variants, in addition to the South African and Indian ones already criss-crossing the continent, or goes into a third wave later this year. Indeed, the official statistics undoubtedly under-report the extent of the problem. South Africa has more than its 1.7mn reported cases and Nigeria has acknowledged that 23% of the population of Lagos, a city of 20mn, have been exposed to the virus.

More transparency and accuracy about the real state of affairs are urgently needed. Yet, what is certain is that at the current rate of vaccine distribution, the African Union’s (AU) target to vaccinate 30% of Africans by the end of this year and 60% by the end of 2022 is not going to be achieved. The COVAX programme to distribute vaccines internationally, particularly to the poorer countries, will meet only 20% to 30% of Africa’s needs at current supply rates. Consequently, the AU has launched a parallel programme, the African Vaccine Acquisition Task Team, to complement COVAX by securing additional vaccines directly from producers. Here it has had some success. For instance, it has contracted with Johnson&Johnson to buy 220mn doses of its vaccine. As this is a single dose, unlike the other major two dose vaccines, this should enable 220mn more Africans to be vaccinated.

Nonetheless, the current shortage of vaccines for Africa has led to frustration and to deep-rooted feelings of neglect and lack of international solidarity, even when it is clearly in the West’s interests to vaccinate Africans to stop new virus variants from emerging. South African President Cyril Ramaphosa has spoken of ‘vaccine apartheid’. This may not seem so far-fetched when we consider that over 90% of the available vaccines have been snapped up by a small number of rich countries. Some have seven times more vaccines than they need to cover their entire populations. Hoarding makes no sense when not vaccinating the rest of the world could allow new variants to emerge that might be resistant to the existing vaccines. This would nullify the massive efforts and expenditure of those Western countries that have succeeded in vaccinating a majority of their populations thus far.

Yet, beyond expressing justified indignation at the unfairness of the global system, particularly when a crisis induces everyone to look after their own populations first and foremost, this is the moment for African leaders to focus urgently on how to fix the problem, at speed and at scale. What do they need to do?

Most immediately, they need to secure more vaccines. Africa made a bad bet in over-relying on the Serum Institute in India for most of its supply of the AstraZeneca vaccine. Unfortunately, the upsurge of the virus in India made the government in Delhi restrict vaccine exports, leaving Africa in the lurch. Now GAVI, the international vaccine alliance, is helping Africa by developing a portfolio of 10 to 12 vaccines that it can draw upon. Diversification and switching supply according to availability and bottlenecks, as well as according to what we learn about the effectiveness and health risks of the individual vaccines over time, is now very much the key to success. The United States, which before now was not exporting vaccines, has reversed course and this week announced that it was releasing from its stockpile 80mn doses for sale. Japan has committed to doing more as well. The EU has already led the way in exporting half of its domestic vaccine production – around 250mn doses. The recent Global Health Summit in Rome endorsed an initiative by the IMF and G20 to donate 1bn doses to developing countries, many of them to Africa. These are good intentions, but they need to be followed up quickly if Africa is to get ahead of the virus curve instead of falling farther behind.

A second challenge is to improve Africa’s health system. Back in 2001, African leaders signed the Abuja Declaration pledging to devote 15% of their GDP to improve their public health systems. Yet 20 years on, only 5 out of 54 African countries have met this goal. This leaves us with situations like Sudan, with 40mn people but only 300 ventilators. As in India, the locals have turned to social media to appeal for hospital beds, oxygen cylinders and ventilators. The African CDC has distributed 700 oxygen concentrators but this is tiny compared to the needs. The former AU President and current President of Rwanda, Paul Kagame, has been put in charge of mobilising more domestic and international finance to build better health systems in Africa, but this needs to be done before the crisis breaks, and not during the crisis when the system is under severe stress.

The next requirement is to build up local vaccine production capacity as Africa imports 99% of its vaccines. The AU has set a target of 2040 to achieve a 60% local production capacity. It has a number of health research institutes in Senegal, South Africa, Tunisia, Egypt and Morocco that could be scaled up to research and develop vaccines but they need international support and partnerships with the major commercial producers, such as AstraZeneca, Pfizer, Moderna and Johnson&Johnson. The AU has devised the Partnerships for African Vaccine Manufacturing, launched on 12 April under the auspices of the current AU President and President of the Democratic Republic of the Congo, Félix Tshisekedi. The EU has pledged €1bn to this initiative.

One issue in this respect is the release of patents and intellectual property rights by the major pharmaceutical companies to help Africans ramp up local vaccine production. The US has recently come out in favour of this but the EU has been more reserved, worried that the loss of patents would deter the big companies from making the multi-million dollar investments in the R&D to produce new vaccines or adapt the existing ones to protect against new COVID-19 variants. Africa needs in particular to be able to exploit the novel messenger RNA technologies if it is to develop the most modern vaccines at home. So, it would be useful if the US and the EU could come to a common view on intellectual property waivers and get the major pharmaceutical companies to come up with a joint and coordinated approach. For instance, could waivers be granted on a temporary basis and for certain specified products and production techniques exclusively associated with COVID-19 vaccines?

Certainly, patent waivers are not a panacea. Vaccines are highly complicated products with multiple ingredients sourced from many different places. It will take some time before Africa will have the resources, know how, scientific research base and production facilities to produce state of the art vaccines by itself. Yet, to avoid its current crippling dependency on the rest of the world, it needs to start moving towards vaccine autonomy by building its own capacity.

Finally, the tragedy for Africa is that the impact of the COVID-19 crisis may be more significant and last longer than the death toll from the pandemic itself. Compared to the 131,000 Africans who have died from COVID-19 thus far, 30mn have died from AIDS over the past four decades, and 500,000 die each year from malaria. The breakdown in African health systems caused by the COVID-19 pandemic has led to AIDS testing dropping by 40% and tuberculosis (TB) referrals dropping by 60%. Unlike the diseases of the rich world, where the search for vaccines proceeds at warp speed and with billions in government funding for research and development, there is still no vaccine for malaria. It is admittedly a more complex disease and, like HIV/AIDS, its pathogens are less amenable to vaccine treatment.

The Western world will too suffer a protracted health crisis from the deferred tests and operations, resulting from the priority given to COVID-19 treatment, not to speak of the challenges of Long Covid and mental health issues arising from lockdowns and curbs on social contact. Yet, the problem will be on a massively greater scale in Africa given its vulnerability to a number of entrenched tropical diseases and its weaker health systems. Here too it will need long-term and sustained international support.

The COVID-19 crisis has been a wake-up call to Africa’s leaders regarding the harsh realities of international life when pandemics and other major shocks strike. Africa is at the end of the life support chain and has to wait for the rich nations to eat before it can take its share of the crumbs remaining on the table. The well-known slogan of “African solutions to African problems” has to embrace public health as well. The African Union has an Agenda 2063 to be able to stand on its own feet and provide for its own people, a century after decolonisation. The African continental free market and the African peace and security architecture have been good places to start, but hoping that international cooperation will happen just because it makes eminent sense and is in everyone’s ultimate interest is more hope than strategy. Africans need to take care of their health as well.