Africa’s vaccine crisis: It’s not all about corruption

Domestic failures in themselves do not explain the global inequality of outcomes when it comes to vaccines.

A healthcare worker injects the Oxford-AstraZeneca COVID-19 vaccine into a woman in Siaya, Kenya, on May 18, 2021 [Brian Ongoro/AFP]

The third wave of the COVID-19 pandemic is taking its toll across the world, with many countries reporting higher than ever numbers of infections and hospitalisations. The good news is that in countries where vaccines are available there are overall lower mortality numbers, affirming that at a community level, vaccines are working. The bad news is that with a conspiracy of international politics, profiteering and domestic complacency, the vast majority of the world’s population remains unvaccinated. As of July 2021, only 25.3 percent of the world’s population has received at least one dose of a COVID-19 vaccine, and of the 3.4 billion doses that have been administered worldwide, only one percent has been administered in low-income countries.

We are free-falling into an era of unprecedented inequality, thanks in great part to the poor decisions being taken by the world’s political class. The world was already deeply unequal with poor countries carrying the lion’s share of the global disease burden with sparse resources. But despite assertions that this pandemic would be a great equaliser, it is instead turning out to be an accelerator of inequality. The wealth of the world’s billionaires grew by 45 percent or about $1.3 trillion since the first COVID-19 cases were recorded in China’s Wuhan province in December 2019, yet by United Nations estimates, global unemployment will rise to its highest levels in history with more than 200 million new cases as a direct result of the pandemic.

All of which makes the current global vaccine inequality particularly threatening. Billions of lives are at risk because rich countries are standing in the way of making vaccines more freely available, threatening to compound the already exacerbating inequalities. In contrast, 69 percent of Canada’s population of 38 million has received at least one dose of the vaccine while only 65,000 people in the Democratic Republic of the Congo (population 89 million) have received at least one dose. Between them, United States pharmacy chains Walmart and CVS have wasted at least 180,000 doses of vaccine – more than most African countries have administered. And the COVAX initiative, designed to make global access to vaccines more equitable by coordinating countries to buy enough vaccines for 20 percent of their populations so that at least all healthcare workers in the world could be vaccinated – has run out of vaccines. COVAX was purchasing most of its vaccines from India, but the “vaccine factory of the world” has introduced export controls after being battered by the third wave of COVID-19.

If countries like Haiti and Chad, which have not officially administered a single dose of any vaccine, do not quickly protect their front-line healthcare workers, the risk is not only that those people will lose their lives but that already weak healthcare systems will collapse. People have not stopped catching other diseases or needing treatment for other things just because of COVID-19, and if vulnerable countries lose a critical mass of their medical professionals, this may cause a lag that will take generations to overcome.

But it did not have to be this way. Since the start of the pandemic poor countries have been making the tough policy decisions needed to keep the outbreak at bay. Strict lockdowns have kept hospitalisations low. But these public health measures have also crippled economies and led to epidemics of unemployment and hunger. Millions of migrant workers and day labourers have lost their jobs because of the often brutally enforced shutdowns but have borne the burden because the promise was that it was a temporary situation designed to hold the outbreak back until a longer-term solution was found. People are hungry, angry and frustrated but instead of working fast to make the medium-term solution that now exists more quickly available, rich countries and the pharmaceutical industries they protect are playing for profits.

Certainly, the lack of vaccines in some poor countries is in part a function of their poor domestic policies. In Kenya, Cameroon and South Africa, the pandemic response has been riddled with allegations of corruption and the misappropriation of public funds. In September 2020, Kenya’s auditor general shared that the country had lost $2.3m in a procurement scandal at the Kenya Medical Supplies Authority (KEMSA) which was to oversee the purchase of PPE in the country. In South Africa, Health Minister Zweli Mkhize was put on leave in June 2021 after a scandal involving the irregular allocation of communications contracts in support of the pandemic. Tanzania and Madagascar had the misfortune of living under presidents who either denied the existence of the disease or the utility of scientific treatments.

But these domestic failures in themselves do not explain the global inequality of outcomes when it comes to vaccines. First, even within Africa, these countries are outliers. The majority of African countries have no corruption scandals associated with their pandemic responses to date and instead have been faithfully, if sometimes slowly, allocating resources to the rising threat of the pandemic. For example, Cote d’Ivoire (Ivory Coast) received 600,000 doses of vaccine from COVAX. Initial uptake of the vaccine was slow owing to a great deal of public hesitancy, but despite the political uncertainty in the country created by the 2021 election, the government countered the misinformation and has to date vaccinated 850,000 people. In short, Cote D’Ivoire has used up its COVAX allocation and then some, but now there are no vaccines left to buy.

More importantly, corruption in COVID-19 responses is not a uniquely African problem. In April 2021, international anti-corruption watchdog Transparency International found that one in five government contracts allocated by the UK government as part of their coronavirus response contained “one or more red flags for corruption”. And yet, just under 68 percent of adults in the UK have already been vaccinated. Indeed, according to the Lancet, the UK secured five bilateral deals for 270 million doses of vaccine against a population of 66 million, or enough for 225 percent of its population. Yet the UK also paid $98m for 27 million doses of vaccine from COVAX and in April 2021 received 500,000 doses of the Pfizer-BioNTech vaccine through COVAX. It is not enough to simply point to corruption as the reason why African countries do not have access to vaccines.

In fact, there is a global traffic jam in the vaccine supply chain, with manufacturers unable to keep up with the global demand. In large part, this is because rich Western countries broke an agreement to begin with vaccinating front-line healthcare workers around the world before opening up vaccination to the general population. At an April conference on vaccine availability in Africa, Stephane Bancel, CEO at Moderna, told attendees that he had no spare capacity – every time a box of vaccines is finished in the plant it is immediately shipped out for delivery. So what are we to infer, if, according to the company’s own website, not a single drop of Moderna vaccine has been made available in a poor country? And what will it mean now that rich countries are talking about diverting some of that capacity towards the manufacture of booster shots?

COVAX was supposed to be a fairness pause, an opportunity to give all the countries in the world a fighting chance in the context of the anthems of global solidarity that were being sung during the worst of the outbreak in the West. China has promised 110 million doses of its Sinopharm and Sinovac vaccines to COVAX which should help, but is not enough to bridge the gap. The third wave is already here, and with new variants that could undermine the efficacy of existing vaccines. We need a fairness pause, but in the medium term, the easiest way to ease this traffic jam would be to make it possible for more countries to make vaccines. Cuba is leading the way by making its vaccine technology more freely available. Gamaleya (the maker of the Sputnik vaccine) has also promised to share its technology with manufacturers in Argentina. This is a big part of the multi-pronged strategy that African countries – and indeed many other countries around the world, including India – are advocating for. Waiving patent rights would allow countries with manufacturing capacity to copy the formulae for the vaccines without fear of punishment.

It is perfectly valid, and indeed crucial, to demand accountability from corrupt governments. Domestic activists are already doing that because we cannot let governments off the hook for the theft and the waste. But these demands will come to nought if rich countries attempt to use charity as a buffer for injustice. We cannot demand that our governments reprioritise spending towards the purchase of vaccines if there are no vaccines to buy. And we cannot save the lives that are under threat right now because of this third wave if we are only expected to wait for leftovers that are scheduled to come long after the emergency has landed.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.