THE MUTATION OF VACCINE APARTHEID
The reaction by governments in the Global North to the discovery of the Omicron variant of Covid-19 in South Africa has provided further proof — as if any more were needed — of the deeply inequitable response to the pandemic. The backlash against African countries was swift and severe, as if barring travellers from the region could somehow keep the rest of the world safe.
It hasn’t, and closing borders won’t work when the next frightening variant emerges. Global injustice is very bad for public health.
Although more than half the world’s population has now been vaccinated against Covid-19, only 8% of people living in lower-income countries have received a vaccine dose, compared to 48% in lower-middle-income countries and much higher rates in high-income countries. As of November, the United States had administered more than twice as many doses than had been given in all of Africa.
Given these numbers, it is no surprise that variants of concern continue to emerge and spread rapidly in countries with low vaccination rates. And the disparity is not an accident. It is a direct result of nationalist policies and vaccine hoarding by wealthy countries.
Even before vaccines became available, many experts, including Director-General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus, warned about the consequences of vaccine nationalism.
This summer, it seemed like the tide was turning. In June, members of the G7 pledged to donate their excess doses to low- and lower-middle-income countries either directly or through mechanisms like the Covid-19 Vaccine Global Access (Covax) facility.
But in the past few months it has become clear that vaccine nationalism hasn’t ended. Instead, it has mutated.
Wealthy countries like the US began pushing to administer additional doses of some vaccines even before there was evidence to support the use of booster shots. In fact, shortly before the WHO called for a moratorium on boosters until vaccines had reached those who need them most, the US signed a deal to purchase 200 million doses of the Pfizer-BioNTech vaccine for use as boosters. At the time, the use of third shots as boosters was not even approved by the US Food and Drug Administration.
But booster shots in developed countries are not the only reason low- and middle-income countries lack doses. Canada, Spain and Germany, among others, pledged months ago to donate millions of vaccines directly to low- and middle-income countries as well as to Covax. Yet recent figures show that many governments have failed to deliver on these commitments.
Pharmaceutical companies and wealthy governments have been quick to blame low vaccine uptake in poor countries on vaccine hesitancy and underdeveloped healthcare delivery systems. International Federation of Pharmaceutical Manufacturers and Associations vice president, Pfizer CEO Albert Bourla said the level of vaccine hesitancy in Sub-Saharan Africa is “way, way higher than the percentage of hesitancy in Europe or in the US or Japan”. This is despite evidence that vaccine hesitancy is lower in Africa than in many wealthy countries.
AstraZeneca, a firm that made arrangements for equitable access to its vaccine through a licensing arrangement with the Serum Institute of India, recently announced it would begin increasing the price of doses to make a profit. This decision reflects the worryingly misguided perception that the pandemic is over.
Wealthy countries also have been promoting a narrative that African governments lack the infrastructure and capacity to administer the doses that they have secured, ignoring the conditions under which doses have arrived. Donations often have shown up without advance notice, many close to expiration, without information about the type, quantity and condition of the arriving vaccines. Health officials therefore are unable to make preparations to deliver them in time. Despite these challenges, African countries have been able to administer 62% of the doses they have received.
This scapegoating obscures the reality that low vaccine uptake in Africa is a direct result of wealthy countries’ vaccine hoarding and nationalist policies. And efforts to rectify this inequity have been blocked by the same governments that have an excess of vaccines. It is clear disparities in vaccine access are not an accident of fate, but a result of concerted efforts by wealthy countries to keep supplies within their own borders and by pharmaceutical companies to increase their profits.