Why Africa is perilously far behind on coronavirus vaccination

In recent weeks, Africa has seen its worst spike yet in recorded cases, in an overwhelmingly unvaccinated population. New cases of infection on the continent as a whole have dipped from an all-time peak in mid-July. Removing data from South Africa, though, “reveals a uniquely steep and unbroken nine-week surge” across the continent, the World Health Organization said last week.

Low- and middle-income countries around the world have struggled to inoculate their populations against the novel coronavirus after wealthy countries snapped up much of the global vaccine supply. But among all regions, nowhere is the global inequality starker than in Africa, where only 2.2 percent of people had received at least one dose as of July 23, compared with nearly half the population in North America.

Global health officials have voiced increasing frustration and alarm at the sharp divergence between wealthy nations and poorer countries left waiting for vaccines.

“There is no other word for it but a betrayal of trust, the consequences of which are now playing out in Africa, in lives lost that should not have been, had the wealthiest countries allowed poorer countries access to their fair share of vaccines,” WHO Director General Tedros Adhanom Ghebreyesus said in an email to The Washington Post. Tedros served as Ethiopia’s health minister and foreign affairs minister before becoming the World Health Organization’s first African director general.

Many countries were cut out of the vaccine race before the first emergency-use approvals were granted.

Last summer and fall, while coronavirus vaccines were being developed and tested, wealthy nations cut deals directly with vaccine-makers, securing a disproportionately large share of early supply and undermining a fledgling Covax, the WHO-backed push to distribute shots equitably.

The idea behind the Covax facility was for countries to pool resources and distribute doses to all participating countries, regardless of their means.

Africa has been especially dependent on Covax. Most African governments cannot afford to buy vaccines themselves, so for years they have relied on GAVI, the global vaccine alliance behind Covax, to deliver vaccines for a range of illnesses, said Githinji Gitahi, global chief executive of Amref Health Africa and the African Union’s commissioner for coronavirus response.

But after rich countries snapped up much of the near-term coronavirus vaccine supply, there was little left for Covax. Then, just as the rollout got underway, a surge of cases in India, where a significant portion of the Covax supply was to be manufactured, led to further delays.

The result: painfully slow progress. The program initially aimed to deliver up to 2 billion doses by the end of 2021. More than seven months into the year, it has delivered just under 154 million doses to 137 countries.

Covax has so far delivered more than 31 million doses to 46 countries in Africa. It aims to supply 520 million doses to the African continent by the end of this year and 1 billion by the end of the first quarter of 2022.

The African Union, meanwhile, has booked hundreds of millions of Johnson & Johnson doses to be provided over 18 months. Around 6 million will be delivered in the coming weeks. But funding to purchase doses through the AU facility remains a challenge for many countries, Gitahi said.

“The pandemic is a test. And the world is failing,” Tedros said in a speech last week, warning that the reluctance of wealthy countries to share doses more widely would rebound against them if more dangerous variants emerged.

Just 20 million Africans, or 1.5 percent of the continent’s population, are fully vaccinated, according to the WHO. Of the 3.7 billion doses administered globally, 1.7 percent have been given in Africa.

The WHO set a target of vaccinating at least 10 percent of the population of every country worldwide by the end of September, at least 40 percent by the end of the year and 70 percent by the middle of next year. Meeting that goal globally will require 11 billion doses, Tedros said.

Africa is a long way off. Tedros said he is “concerned” that almost 70 percent of African countries won’t meet the WHO target for September. To do so, the continent needs to administer roughly five times more doses per week than it is administering now.

Some countries, including Tanzania, are just starting their vaccination campaigns. Logistical challenges have also slowed vaccine rollouts in some places. But on the whole, Tedros said, many countries have prepared well to administer the vaccines.

Meanwhile, weak health systems on the continent mean that Africans who do become severely ill with covid-19 have a greater chance of dying of the disease, public health experts say.

Donations from the United States of around 25 million vaccine doses to 49 African countries began arriving on the continent this month. The European Union, Britain and China also are sending doses, the New York Times reported.

Leaders of the Group of Seven industrialized nations pledged in June to donate 870 million additional doses to countries in need, with the aim of delivering at least half that number by the end of this year.

But public health experts say the donations so far will not be enough to inoculate Africa’s more than 1.3 billion people.

Until this week, no coronavirus vaccines had been manufactured in Africa. Public health authorities and some pharmaceutical companies have been working to change that.

“The pandemic has also shown that in a crisis, Africa cannot rely on imports from the rest of the world,” Tedros said. “One of our priorities must be to invest in local production of medicines, vaccines and other health technologies in Africa.”

Johnson & Johnson has contracted Aspen Pharmacare to manufacture vaccines in South Africa with ingredients sourced from Europe. Aspen released the first batch of vaccine from its South Africa facility on Monday for distribution in the country.

Pfizer-BioNTech last week announced a similar deal with the Cape Town-based Biovac Institute to carry out the “finish and fill” process for doses using drug substance produced in Europe.

Candice Sehoma of Doctors Without Borders South Africa called the deal “a step in the right direction” but urged Pfizer-BioNTech to make technology and know-how available so that African countries can produce doses on their own and have greater control over their distribution.

The WHO is working with Covax partners to establish a hub in South Africa to transfer mRNA technology — the basis of some coronavirus vaccines — to Africa. Public health leaders are also calling for the waiver of intellectual-property protections for coronavirus vaccines. The Biden administration supports a waiver, but European countries and pharmaceutical companies remain opposed. World Trade Organization delegates debating the proposal are planning to take an August holiday break, Bloomberg News reported.

Even if a waiver comes through, getting vaccine production in Africa up and running will take time. For now, public health leaders on the continent are imploring wealthy countries to send more doses.

“A vaccine delayed is a vaccine denied,” Gitahi said. “Speed is of the essence.”

This report has been updated.