Coronavirus vaccination in Africa. II – African Conditions

Introduction

The previous brief discussed the distribution of vaccines globally and the reasons for the widening gap between high and low income countries in terms of vaccine procurement. This brief focuses on the African continent which has seen a slow roll out of vaccines. Apart from national vaccine procurement, there are other issues, such as logistics, which also need to be taken into consideration.

The African continent

Due to Africa’s weak position in securing vaccines privately, many countries on the continent remain in lockdown with various restrictions on everyday social and economic activity. This can be contrasted with countries such as the United Kingdom which are lifting lockdown restrictions due to 56.85% of the population being vaccinated.^[1] Some African countries are ‘in the throes of a third wave’ with ‘one third still living through a dangerous resurgence’.^[2]

A mere 1.6 % of the African population had been fully vaccinated by late July.^[3] On 21 August 2021, Seychelles, Mauritius and Morocco had the highest vaccination rates with over 80 doses per 100 people being administered in each country.^[4] By contrast, there were 14 African countries with less than 2 doses per 100 people having been administered.^[5]

A report from the World Health Organization (WHO) on 29 July 2021, indicated that there had been some improvements in recent weeks with regard to vaccine delivery to Africa. Almost 4 million doses were delivered in one week through the COVAX facility towards the end of July. The report stated that in order to ‘fully vaccinate 30% of Africa’s population by the end of 2021, the continent needs up to 820 million doses, considering a two-dose schedule’. COVAX has aimed to deliver only 520 million doses to Africa before the end of the year. The African Union’s Africa Vaccine Acquisition Trust (AVAT) has projected that they would be able to provide an additional 45 million doses by the end of 2021.This means that the African continent will have to rely on donations and aid for the remaining about 250 million doses.

Dr Matshidiso Moeti, the World Health Organization Regional Director for Africa, has urged all ‘countries with surplus doses to urgently share more in the spirit of life-saving solidarity and enlightened self-interest’.

The fact that Africa must rely on outside intervention for a vaccine which was acquired with little difficulty by first world countries indicates the type of inequality faced by most African countries in regards to service delivery and quality of life. Inequality permeates every society in one way or another. However, on the African continent where the top 10% of income earners, hold half of the national income, it permeates every facet of everyday life.^[6] The African continent also holds the most unequal country in the world, South Africa, as declared by the World Bank in 2019.^[7]

The South African situation

In South Africa, economic inequality portrays itself in the life style that different groups of people are able to live. Those in the top 10% can afford private medical care, private security, may live in private luxury estates and some may even ‘go off the grid’ by having their own water and energy supply. In contrast, the bottom 50% rely on the state for most of their basic needs such as food, medical care and, as a result, lack access to even the most basic resources such as electricity and water.

These inequalities were magnified during the level 5 lockdown where some South Africans lived comfortably with ample space, income and job security while others were prohibited from working to make an income, experienced police brutality unknown to the affluent, and faced imminent hunger and starvation. A year later and many industries continue to be affected by restrictions on economic activity. Businesses have had to close or limit their working hours. This has resulted in more unemployment and desperation, ‘according to the Quarterly Employment Statistics (QES) survey released by Statistics South Africa, the formal sector shed 648 000 jobs in the second quarter of 2020’.^[8] In other words, while some boats continued on without any disruption, other boats were starting to sink.

The gap between the upper and lower class has continued to widen as children from disadvantaged groups were unable to attend school and obtain their one (and sometimes only) meal of the day provided by the National School Nutrition Program. According to UNICEF ‘learners in South Africa are up to one school year behind where they should be’.^[9]

Furthermore,

‘Some 400,000 to 500,000 learners have reportedly also dropped out of school altogether over the past 16-months. This is most likely for children living in informal urban and rural settings, with household poverty also playing a critical role. The total number of out of school children is now up to 750,000.’^[10]

The impact on the lives of these children, and the South African economy, will still be seen for years to come, causing the gap between rich and poor to widen as they become not only unemployed, but unemployable. These children will be unable to break the cycle of poverty into which they are born and will most likely struggle to find employment and any type of income security.

On the other hand, the ‘light at the end of the tunnel’,^[11] the COVID-19 vaccine, has been made available without cost to everyone, either through medical aids or through government outlets.

Looking towards the future

The Secretary General of the United Nations has issued a statement in which he highlighted the importance of working together to end the spread of the virus. He stated that ‘only together can we end this pandemic and recover. And then, together, we can all get back to the things we love’.^[12]

But the return to a pre-COVID world would only benefit those who enjoyed certain privileges in such a world and should not be the only aim of the vaccine roll out. The problem with the approach of ‘togetherness’ is that many millions of people in the world do not simply want the world to go back to how it was pre-COVID, because for them, their pre-COVID lives were also characterized by poverty, unemployment and desperation. What we tend to forget is that people were already unemployed before COVID, people were already hungry and starving, women were always underpaid and carried a disproportionate load of responsibilities and the gap between rich and poor has always existed. Therefore, if our only goal is to go back to a pre-COVID world, then we are failing those same people who have always lived below the poverty line.

The best outcome that we could hope for at the end of this pandemic would be for developing nations to cultivate vaccine self-sufficiency in order to be able to deal with a pandemic of this nature in the future without having to rely on outside intervention.

Africa is waiting on the rest of the world for a vaccine which represents the most basic human right – the right to life. Steps that should be taken include the manufacture and development vaccines on home soil, sharing of medical knowledge and technology, and better infrastructure in order to enable health care systems to withstand the pressure of another pandemic.

There are currently 10 vaccine manufacturers on the African continent, with some having ‘capacity to manufacture the substance that a vaccine is made of’, others hoping to reach such capacity and two being ‘fill and finish’.^[13] African leaders have pledged to increase the share of ‘vaccines manufactured in Africa from 1% to 60% by 2040’.^[14]

In order to do this the following four ‘ingredients’ are necessary:

‘Financing amounting to hundreds of millions of dollars; expanded research capacity; a commitment from governments to purchase vaccines; and regulatory bodies that meet international standards. Compared with other regions, African countries are lacking in all four’.^[15]

Sophie Smit

Legal Researcher

sophie@hsf.org.za