"Vaccine Apartheid" Unfair Distribution Hampers Global Vaccination Drive

Only 2 percent of the 1.3 billion people who live in Africa have been vaccinated. Yet there are plenty of surplus doses in wealthy countries. Fair distribution has been little more than an illusion so far.
Vaccination in Kenya: Africa will need lots of international help to catch up

Vaccination in Kenya: Africa will need lots of international help to catch up


Brian Inganga / AP

The battle against the coronavirus is proving to be a tough one. Three quarters of a year since the introduction of the vaccine, more than 5 billion doses have been administered and at least 2 billion people have received two jabs. And the pace of the largest and most complex vaccination campaign the world has ever seen continues to increase: Just last week, 39 million injections were administered. Per day. Before October gets here, another billion doses may have been dispensed.

Aus: DER SPIEGEL 36/2021

The article you are reading originally appeared in German in issue 36/2021 (September 4th, 2021) of DER SPIEGEL.

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By the end of the year, a dozen pharmaceutical companies will have produced another 5 billion doses, according to the estimates. And next year, global production will rise even further. The producers of the particularly effective mRNA vaccines – BioNTech/Pfizer and Moderna – are expected to almost double their output from around 4 billion to 7 billion doses. On top of that, several more vaccines will be hitting the market, including one from the U.S. company Novavax, which can be stored at normal refrigerator temperatures, making it far easier to use for many countries. The French pharma giant Sanofi could also soon introduce its long-delayed vaccine.

By the end of this year, enough vaccine will have been produced that, in theory, more than 70 percent of humanity could be protected against serious illness or death should they contract the virus. At the beginning of 2021, not even optimists thought we would have come so far. But are we reaching the end?

Unfortunately, it’s not quite that easy.

Many countries in Africa have far too little vaccine to make much of a dent in the pandemic. But that could soon be changing.

Many countries in Africa have far too little vaccine to make much of a dent in the pandemic. But that could soon be changing.

Foto: Brian Ongoro / AFP

The total number of people who have been vaccinated is rather impressive, to be sure, but it’s still not enough. There is a lack of a master plan for all of humanity. The world must proceed with far greater prudence and coordination if we want to begin approaching the end of this pandemic and ensure a return to normal life for as many people as possible – and to finally find a way out of the deepest health crisis we have seen in a century.

Even now, after so many doses have been administered, the global vaccination campaign continues to mirror our world’s inequalities. Rich countries are already vaccinating adolescents and are planning third, or even annual, doses for adults of all ages. They are buying up all the vaccine on the market and hording it while numerous poor countries still haven’t had the opportunity to even protect frontline medical workers and the most at-risk groups from COVID-19.

Around 40 percent of the global population have received at least one dose of vaccine, but the national differences are shocking. Eighty-four percent of those qualified for vaccination in Portugal have received at least one dose and 61 percent of Argentinians – and even 29 percent of people in Albania.

"Vaccine Apartheid"

In Africa, though, the numbers are far, far worse. Only 3.5 percent of eligible Kenyans have received a jab, 1.3 percent of Nigerians and just 0.09 percent of people in the Democratic Republic of Congo. More than 1.3 billion people live on the continent, and less than 2 percent of them have been completely vaccinated. Critics are furious about the "vaccine apartheid" and condemn the "vaccine nationalism" of wealthy industrialized countries.

The situation isn’t just unacceptable from an ethical point of view. Medically, the inequality is dangerous for the entire world. Places where the virus can circulate freely among largely unvaccinated populations are ideal for mutations, the result of which could be a pathogen that is resistant to the vaccines thus far produced.

Just last week, medical professionals in South Africa reported that they have identified a new variant. Since May, the C.1.2 variant has been identified frequently in South Africa and has also been found in China, England and Switzerland.

It’s not yet clear how dangerous this new variant might be. Researchers, though, are concerned by the fact that C.1.2 features numerous mutations to the spike protein, which the virus uses to force its way into the human body. Changes to this key protein could be decisive because they have the potential to limit the effectiveness of existing vaccines.

The new mutation is a clear reminder that the world must be far more vigilant and do all it can to avoid vaccine black holes such as the one that has developed in Africa. This is not a new realization. Since the very beginning of the pandemic, epidemiologists have been warning that a situation like that has be avoided.

A delivery of Moderna vaccine in Kenya via COVAX on August 23

A delivery of Moderna vaccine in Kenya via COVAX on August 23

Foto: Daniel Irungu / EPA

It’s not like nothing has been done. The World Health Organization (WHO) launched the COVAX program  in April 2020 together with partners around the world in an effort to ensure the fair distribution of vaccine around the world. The idea was that COVAX, financed primarily by prosperous countries, would be able to cheaply buy large amounts of vaccine for participating countries and then distribute it to poorer countries based on their population size and need. Recipients would only have to pay very little or nothing at all.

The COVAX program got off to a good start. So far, 192 countries have joined the program and it has gradually collected around 10 billion euros. Germany has contributed several hundred million euros, and when Joe Biden became president, the United States became a supporter as well, with a donation of $4 billion.

Beyond that, though, the news hasn’t been so good . The COVAX program had aspired to distribute 2 billion doses of vaccine this year, hoping that it would be sufficient to at least partially stem the pandemic in poorer countries. But that goal has not been met.

A Shining Example?

Thus far, COVAX has only delivered around 230 million doses to a total of 139 countries – far too little to make much of an impact. Furthermore, wealthy countries like Britain, Canada and Saudi Arabia have been among the countries that have received vaccine from the program. Despite having plenty of vaccine of their own, they weren’t prepared to renounce their rights under the COVAX program.

COVAX was conceived as a shining example of global solidarity in times of collective need. But the idea has failed for the time being. By the time COVAX finally had sufficient capital to place large orders, says a spokesperson from the vaccine alliance Gavi, which is a participant in the initiative, "the wealthier governments had already reserved the entire 2021 supply."

The result is that COVAX has been forced to depend almost exclusively on a single supplier: The Serum Institute of India. The largest vaccine producer in the world, the institute is to supply COVAX with large quantities of the AstraZeneca vaccine produced under a licensing agreement. Initial deliveries were made, but then, when India was hit hard by the second wave of the pandemic, New Delhi applied an export ban on vaccines, and it has yet to be lifted.

COVAX has proven unable to compensate for the loss of is most important supplier. As a result, Africa fell hopelessly behind on its vaccination campaign, just as the Delta variant began spreading on the continent and killing tens of thousands of people.

The lack of vaccine, though, isn't the whole story. Some African countries have also proven to be hopelessly overwhelmed by the challenge of organizing an effective vaccination campaign. This spring, for example, a plane delivered 144,000 doses of AstraZeneca to the West African country of Benin – only for 110,000 of those doses to be thrown away because the country was unable to administer them before their expiration date. Part of the problem was that the delivery arrived too late in the first place and the country had only had about four weeks to administer all the doses, which proved to be too little time.

The launch of vaccinations in the Central African Republic, Cameroon, Gambia, Sierra Leone and South Sudan was similarly catastrophic. More than 450,000 doses of vaccine went unused. In some instances, there was a lack of trained medical personnel, in others there was a lack of refrigerators, electricity or fuel for trucks. Sometimes, not enough people could be rounded up who were interested in receiving the vaccine.

Niger, Liberia and Senegal are all bastions of religiously motivated anti-vaxxers. Surveys show that a huge majority of the population in these countries have far more faith in God than they do in vaccine.

Some African Countries Are Well Prepared

Furthermore, the long discussion of the potential side effects associated with the AstraZeneca vaccine has also boosted skepticism in Africa. Malawi was unable to find willing recipients for 17,000 doses, which the country’s health minister blamed on "the propaganda against the AstraZeneca vaccine." The minister threw the expired doses into a hospital’s incinerator herself. Many in Africa see the vaccine – which has been severely criticized in numerous social media channels – as being second rate, even though it has proven to provide reliable protection against the Delta variant.

Other African countries, by contrast, were able to prepare well for mass vaccinations – in part because some of them only just recently carried out vaccination campaigns against Ebola or yellow fever and were thus well practiced.

The arrival of a vaccine delivery at the airport in Entebbe, Uganda, on March 5

The arrival of a vaccine delivery at the airport in Entebbe, Uganda, on March 5

Foto: Hajarah Nalwadda / Xinhua / imago images

Rwanda, for example, is able to manage the end-to-end cooling necessary for the BioNTech/Pfizer vaccine and it is also a likely site of a planned BioNTech production facility. Botswana, for its part, has carried out an intensive informational campaign, resulting in 76 percent of the population expressing a willingness to be vaccinated.

Ghana has sent teams to remote areas of the country to vaccinate the elderly, and Mauritius simulated the entire campaign in order to prepare. Angola has developed mobile vaccine stations that will be able to administer the elixir to 5,000 people each day – at least once sufficient supplies show up.

Overcoming the Shortage

There is much to indicate that the shortage of vaccine could soon be overcome. Many rich nations possess more vaccine than they could ever use and the U.S., the Netherlands, Britain and Germany have had to destroy thousands of expired doses. In the future, they are hoping to eliminate such waste by donating the doses to COVAX in a timely manner.

Germany is also planning on relinquishing 30 million doses of AstraZeneca and Johnson & Johnson vaccines, which have proven unpopular in the country, with Japan planning to follow a similar approach. France has promised more than 60 million doses to poorer countries and Britain has pledged 100 million doses. The U.S. is even planning on financing 500 million doses of BioNTech/Pfizer, which will then be distributed via COVAX this year and next to 92 developing nations. U.S. President Joe Biden has ensured that no political strings will be attached to the vaccine donations. China, meanwhile, has promised to distribute 2 billion doses of vaccine, although it has not provided a specific timeline. Only 100 million doses of that total will be distributed via COVAX.

Since the beginning of August, meanwhile, some countries in Africa have begun receiving deliveries from a unique joint order placed by the African Union. It includes 400 million doses of Johnson & Johnson produced in Europe and packaged in South Africa. The order is to have been completely filled by the middle of next year.

All in all, it seems as though the vaccination campaign in Africa could, in fact, begin gaining momentum soon. The continent could then have plenty of vaccine available in just a short time from now. But mass vaccination campaigns can only be successful if the vaccine can be effectively administered. A number of African countries must rapidly expand their capabilities in this regard, and also prepare for a future in which their citizens, too, might ultimately need more than two doses for lasting immunity.

Is it ethically viable for the West to declare booster shots a medical necessity when many parts of the world haven’t even received their first doses yet? Will the wealthy countries again ensure that the vast majority of the available vaccine ends up in the West? Such concerns are fully justified. And there is only one real path out of the dilemma.

The world must produce significantly more vaccine for everyone. Experts with UNICEF, a COVAX partner, have calculated that under optimal conditions, the global production of vaccine could make a huge jump next year – from around 13 billion doses to more than 42 billion.

If that were to happen, if the best-case scenario was to become reality, if the number of anti-vaxxers was to go down and if no super-mutant appears, then the world could conceivably approach that mythical goal of herd immunity. If not, though, then health expert Andrea Taylor of Duke University could prove to be right. She fears that the campaign to vaccinate the poorer parts of the world will still take quite some time. Until 2023.

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