By Laura da Silva

The coronavirus pandemic has emphasized and deepened much inequality around the world, but perhaps the most glaring is the great disparity in access to a steady covid-19 vaccine supply. While high-income countries such as Canada, the UK, and the USA have reached vaccination rates of 69%, 67%, and 55% respectively, Africa has been excluded with only around 2% of the entire continent having been fully vaccinated. This huge gap in vaccination has allowed the steepest surge of covid-19 cases across Africa, as the continent battles its third wave, costing many lives and setting struggling economies back once more. Ngozi Okonjo-Iweala, Director General of the World Trade Organization, has described this great disparity in vaccine supply and its destructive effects as “morally unconscionable”.

Much of the unequal rollout is due to vaccine hoarding by wealthier countries who made deals with vaccine manufacturers to secure a supply of doses before they had passed clinical trials. By the beginning of December 2020, Canada had ordered enough doses to vaccinate its population four times over, whilst the UK and Australia had ordered enough for more than 295% and 269% of their populations respectively. Moreover, analysis by ONE Campaign shows that by February 2021 rich countries had stockpiled over 1bn doses more than they will need. This hoarding of vaccines has created a huge deficit in the supply of doses for middle- and low-income countries globally. Such inequality in vaccination rollout will prolong the pandemic as the virus continues to mutate, leaving everyone vulnerable to new variants of covid-19. A delay such as this means that the world economy could lose as much as $9.2t. 

What is Covax?

Vaccine inequality is not new. In 2009, the World Health Organisation (WHO) declared Swine Flu a pandemic. Soon after, nine high-income countries secured bilateral deals to vaccinate their populations, depleting global vaccine availability. These nine counties also pledged 120 million doses to lower-income countries, but only sent the promised doses after they realised that the outbreak was not as bad as initially predicted. The vaccines were only distributed once the epidemic had peaked in Africa, rendering them less useful. In April 2020, Covax was established to prevent similar vaccine nationalism from unfolding during the coronavirus pandemic.

Covax is led by the WHO, Gavi (a public-private vaccine-promoting alliance), and the Coalition for Epidemic Preparedness Innovations (a foundation that finances research into vaccines for pandemics). It aims to ensure that all participating countries have access to a supply of vaccines. All countries in Africa have signed up to the scheme, and it now has 190 members in total which include 92 low- and middle-income countries. 

Self-financing participants will be guaranteed sufficient doses of COVID-19 vaccines to protect a certain proportion of their population, depending on how much they buy into the scheme. Additionally, wealthier countries will pay a premium for doses to subsidize access for poorer countries. For countries without bilateral deals with manufacturers, Covax is the only viable way in which to secure vaccine supply. For the wealthiest countries that have secured bilateral deals, Covax serves as an insurance policy to protect their populations.

Covax aims to provide free Covid-19 vaccines to at least 20% of the populations of the world’s 92 poorest countries by the end of 2021, which should be enough to protect their high-risk and vulnerable people as well as front-line health care workers, according to Gavi. Although Covax places high importance on ensuring vaccine supply to countries that are unable to finance their own vaccine doses, all participating countries have equal access to the flow of vaccines as they are developed. This means that the number of available doses is spread equally across participants based on the available amount, up until a participant has received enough doses to vaccinate 20% of their population (in which case countries still below this 20% threshold are prioritised).

As of April 2021, Covax has delivered an estimated 40 million doses to 100 countries, and although this may seem a great feat, it falls short of the 100 million doses that the WHO expected to have distributed in the same period. During the “Vaccines For All” meeting which brought together senior members of the United Nations, governments, and the scientific community, Tedros Adhanom Ghebreyesus (Director-General of the WHO) emphasized that many countries have yet to receive any vaccines from the Covax initiative, and those who have received vaccines have not received enough. Additionally, he underscored that the problem with the slow delivery of vaccines in poorer countries stems mainly from problems with the supply of vaccines into the Covax program.

For the Covax initiative to be successful, enough rich countries had to buy into Covax at the beginning of the pandemic, and commit to getting their doses through the fund. This would ensure enough money for Covax to secure contracts with vaccine manufacturers and provide a supply of vaccines for lower-income countries. Instead, many wealthy governments made bilateral deals with vaccine manufacturers, like Pfizer and Moderna, which led to the hoarding of doses by wealthy countries and left Covax unable to secure contracts for enough vaccine doses to cover its 20% goal by the end of 2021. 

Although this initial vaccine-grab by wealthy countries has set the Covax fund back, and drastically slowed the delivery of vaccines to low- and middle-income countries, it is crucial that the fund receives donations to prevent further delay in the rollout. “For some populations, it could mean being immunized in the third quarter of 2021 rather than the fourth; for others, it could mean the difference between early and mid-2022”. As we have seen throughout this pandemic, a delay of a few months can cost thousands of lives. 

Donations

The good news is that, having vaccinated the majority of their populations, wealthier nations have begun to pledge donations of their leftover vaccine stocks to lower-income countries. After the G7 Summit in June, the leaders of some of the biggest economies committed to donating 1 billion doses by the end of 2022 – 870 million more than previously announced. Both these vaccine doses and the funds being donated to Covax will go a long way in ramping up supply throughout Africa. Considering that these G7 countries had purchased over a third of the world’s vaccine supply despite making up only 13% of the global population, these donations are long overdue.

Manufacturing an African supply

Although donations are beginning to flow into the Covax fund, there are still concerns that Africa will not be able to receive a large enough quantity to boost vaccine distribution and avoid large resurgences in cases. This concern to secure a steady supply of vaccines has been exacerbated by the recent shortage of AstraZeneca vaccines from India, which restricted exports from their largest manufacturer in response to the catastrophic second wave of infections in India. 

A Covax manufacturing task force and the ‘Partnership for African Manufacturing’ (PAVM), have been created to address this supply concern. The PAVM, founded by the African Union, has aimed to build five vaccine production hubs throughout Africa. Moreover, several private companies have announced their intention to produce covid-19 vaccines in Africa. Most notably, Aspen in South Africa (the continent’s largest pharmaceutical company) claims that it will produce 600 million doses by the end of 2022. This comes after a statement from the International Finance Corporation (IFC) that it has raised $711 million to support Aspen Pharmacare: “And thanks to the agreements concluded between Johnson & Johnson and the African Union (AU), the company will be able to prioritise the African market,” says Diop, director-general of the IFC. 

Implementing a comprehensive framework to boost local vaccine manufacturing in Africa is key for securing enough doses to contain future surges. Additionally, this infrastructure is critical to ensure that the continent can respond to future pandemics and health crises, and will help address the current narrative that 99% of all vaccines in Africa are imported.

Additional challenges to vaccine rollout

Yet the supply of vaccines is not the only problem. Whilst a few African countries have been swift with their vaccination programs (specifically Ghana who drew on their 2018 experience of vaccinating 6 million people against yellow fever in just a week), many countries across the continent have struggled to distribute the doses they have received. This is due to shortages of trained professionals, remote populations, and inadequate rollout planning. Additionally, under-developed healthcare infrastructure is holding back some countries from receiving the doses that they need, as Gavi says Covax will not deliver doses to those that cannot store and distribute them. However, the glaring problem is a lack of money. CARE, an international charity delivering emergency relief, has estimated that for every $1 spent on vaccines, another $5 is needed to make sure they are administered. The additional donations into the Covax fund from governments and NGOs are hoped to help overcome this financial hurdle.

Unfortunately, these logistical problems are coupled with vaccine hesitancy. In a five-country survey published on March 9th by Afrobarometer, a pan-African pollster, about 60% of respondents said that they were unlikely to try to get vaccinated. Whilst mistrust of COVID-19 vaccinations is widespread, African epidemiologist Charles Wiysonge of the South African Medical Research Council argues that demand will respond to supply. Wiysonge believes that “hesitancy is partly a function of so few doses”, and that it is hard to run mass vaccination campaigns without masses of vaccines. 

Moving forward

Africa has faced many obstacles to vaccinating its population and providing some relief from the onslaught of the pandemic. The greed of wealthier nations has set the continent back drastically in securing a supply of covid-19 vaccines through the early monopolising of bilateral contracts with manufacturers, continuous hoarding of vaccine stocks, and failure to participate meaningfully in a global sharing fund. Although this vaccine nationalism has prolonged the covid-19 pandemic in Africa, the international community must now come together to ensure that the pandemic can be ended swiftly. The more the virus is allowed to spread, and the longer vaccination rollout takes, the greater chance the virus has to continue to mutate in ways that put the whole world at risk. 

The international community cannot neglect a continent of 1.3 billion people if it is to overcome the pandemic. With two billionaires launching space programs in the coming weeks, it is clear that with the resources available to those most fortunate in the global community, we are capable of funding worldwide vaccine distribution to end the pandemic and the non-discriminating suffering it has brought. The greater question is whether those who have the power to do so will.

The views expressed in this article are the author’s own, and may not reflect the opinions of The St Andrews Economist.