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Africa’s vaccine drought challenges global solidarity

People wait in line near a vaccination truck to receive a vaccine against the coronavirus disease (COVID-19) during the visit of Sandra Kramer, director for Africa at the Directorate General for International Partnerships (INTPA) of the European Commissio

Global agencies battling to solve Africa’s glaringly low Covid vaccination rates face indifference, obstinacy and ‘me first’ attitudes in developed world.

Inadequate solidarity is still hampering the response to Covid-19 and endangering lives, nearly two years into the crisis. The international community is struggling to deliver on pledges to bring vaccination rates in Africa up many-fold, closer to Northern norms, due to a shortage of donations, co-ordination problems and insistence on patent protection.

In high income countries, 61% of people have had at least one dose of coronavirus vaccine — in low income states, 3.7%. The reasons why this figure remains stubbornly low are complex.

“The donations are not enough,” said Tedros Adhanom Ghebreyesus, director-general of the World Health Organisation, in a discussion at the IMF/World Bank meetings on Tuesday. “It’s very slow, very disappointing that it is taking so long for the world to commit. It’s epidemiologically wrong, economically wrong and morally wrong.”

There are also mounting fears this could impede the nascent economic recovery. Tobias Adrian, the IMF’s financial counsellor, said investors had become increasingly worried about the economic outlook, amid ever greater uncertainty about the strength of the recovery. “Uneven vaccine access, along with the mutations of the Covid-19 virus, have led to a resurgence of infections — fuelling concerns about more divergent economic prospects across countries,” he said.

With David Malpass of the World Bank, Kristalina Georgieva of the IMF and Ngozi Okonjo-Iweala of the World Trade Organisation, Ghebreyesus formed a joint taskforce in May to tackle the severe shortage of Covid vaccines, tests and treatments in developing countries.

Since June they have been calling on wealthy countries to donate surplus vaccines they are not going to use immediately, so that they could be used in the developing world.

$50bn needed

The taskforce believes that with $50bn, it could achieve its twin targets of having 40% of people in every country at least single-vaccinated by the end of 2021, and 70% by mid-2022. “We now see close to two-thirds of that available,” said Georgieva. “We still have a gap to fill.”

The World Bank has financing available for vaccines and has set up programmes to support delivery in 61 countries, aiming to reach 100.

By June, the World Bank and African Union, which are backing the Africa Vaccine Acquisition Task Team, had negotiated to secure 220m doses of the Johnson & Johnson vaccine, with an option for another 180m, financed by the Bank.

Strive Masiyiwa, coordinator of Avatt, said then “we now have the capacity to vaccinate at least 400m people, or 30% of our population of 1.3bn”.

But it has still not happened. Ghebreyesus said that in all regions more than 50% of people had received a single dose, except Africa, where it was only 7%. “Only 166m doses have been delivered to Africa, for 1.3bn people,” he said.

Georgieva tried to emphasise the positive, saying there was now “much more awareness of the economic significance of overcoming this. That’s slowly translating into more willingness to act. It matters to rich countries, because if the world continues to be slow to recover… it not only causes supply disruptions, which is one of the factors pushing prices up, but also creates space for new variants.”

Okonjo-Iweala insisted it was still not too late to hit the December target: “it’s very ambitious but not impossible”.

Georgieva said it would be tough to get to 40% everywhere, but believed it could be reached in many countries, with others close. She pointed to two bottlenecks. One was having the health service infrastructure and organisation to actually vaccinate people.

The UN Development Programme estimates that to cover the cost of vaccinating 70% of their populations, rich countries need to increase their health budgets by 0.8% — poor ones by 57%.

The World Bank is ready to help support vaccination programmes and advertising to combat hesitancy.

The other bottleneck, Georgieva said, was the timing of supply of doses. “If a rich country has vaccines coming but doesn’t need them in November but February, they could move the delivery to a developing country,” she said.

However, developed countries are beginning to offer people a third booster shot. Ghebreyesus said that, except for special cases, “for countries to start boosters is wrong” when millions had not been vaccinated at all.

Okonjo-Iweala said one way to solve the problem would be to decentralise manufacturing. Pfizer and Moderna have both said they will set up manufacturing sites in Africa. But many believe they are still putting profits before people.

“It has been a year since South Africa and India first called for the suspension” of intellectual property rules to allow other companies to produce Covid vaccines, said Okonjo-Iweala. “The UK, Norway, Switzerland and the EU are still blocking the waiver needed.”

Georgieva said: “Production capacity can deliver doses for people who have not been vaccinated yet and boosters. The problem is to prioritise delivery for those who don’t have access. What we are pressing for is transparency of contracts and delivery dates. In our view that will go a long way to optimising it.”

But Ghebreyesus said: “I think the IP waiver will be very important. As a global community, we should ask ourselves — why do we have [the Trips agreement for waiving IP rights in a crisis] if we are not going to use it?”

He added, pointing particularly to the G20, “There should be a political commitment to address these problems.”

Looking ahead, he backed calls for a Pandemic Treaty to set out how countries should interact in the next health emergency.

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