The World Needs More Equity in COVID Vaccine Access | Opinion

The decline in the COVID-19 fatality rate in vaccinated populations is evidence of the efficacy of vaccines. In the U.S., 65 percent of the adult population has received at least one dose and 54 percent is fully vaccinated. The average figure for the European Union's 27 member countries is 70 percent. In Africa, meanwhile, just 3 percent of adults are fully vaccinated.

Africa rightly feels indignant about the unfair global distribution of vaccines. The vast majority of AstraZeneca, Janssen, Pfizer and Moderna COVID-19 vaccines available in 2021 have been reserved by upper-middle- and high-income countries, leaving the African Union's Africa Vaccine Access Trust (AVAT) and the COVAX vaccine sharing scheme empty.

Pfizer expects to produce 3 billion doses this year, but these have overwhelmingly been reserved by high- and upper-middle-income countries. At this rate, supply for others can only be met in February next year. And while Pfizer expects to produce 4 billion doses next year, a large portion has already been allocated to the same buyers who took up most of this year's supply.

This injustice was further exacerbated by the decision of Aspen Pharmacare (the only licensed COVID vaccine manufacturer in Africa) to deliver a significant portion of its first batch of vaccines in July to Europe, while Africa waited. While that position has since changed, Aspen's initial stance was not illogical. It wanted to mitigate its risk by supplying vaccines to governments with the capacity to pay quickly, and at a premium.

But African countries have also made some effort to pay for vaccines. In March of this year, the Africa Export-Import Bank provided a financial guarantee to Johnson and Johnson to assure the supply of 400 million doses to the AVAT program. However, the first batch of those vaccines are only now being received. This delay cannot be justified.

Irrespective of whether booster shots will be required, rich nations' stockpiling of vaccines, well in excess of their demand, is nothing short of hoarding. That COVID is likely to be with us for the long term—meaning we may require intermittent booster vaccines—does not change the fact that the current oversupply to the G20 economies is both economically unsound and socially unsustainable.

Equitable global distribution of vaccines for a disease such as COVID makes both financial and moral sense. Leaving the most populated parts of the globe under-vaccinated will decrease economic growth and increase poverty and social insecurity in such places.

Covid vaccine
A nurse prepares an injection of a dose of the Oxford/AstraZeneca Covid-19 vaccine during the launch of the vaccination campaign for 5000 frontline workers in the tourism and hospitality sector in Nairobi county at the Kenyatta International Convention Centre (KICC) in Nairobi, Kenya, on April 21, 2021. Yasuyoshi CHIBA / AFP/Getty Images

It is also likely to have negative effects for developed economies. As illnesses and economic slowdown take their toll on fiscal receipts and budgets, social—and possibly political—instability will increase. The longer vaccine access is denied to countries, the more likely it is that the situation will worsen.

African governments accept that they bear primary responsibility for delivering vaccines. However, reallocating any efficiencies in their budgets would, while helpful, not be sufficient to meet the extra cost.

According to the World Bank, governments in Sub-Saharan Africa spend about $30 in domestic general health expenditure per capita, compared to $2,600 in the European Union and $5,300 in the United States. This indicates that at $10 per fully vaccinated individual, governments in Sub-Saharan Africa would spend 30 percent of their entire annual health budgets on COVID-19 vaccination. These costs could jeopardize the prospects of meeting the target of full vaccination of 60 percent of the adult population in Africa by 2022. This is both socially and economically untenable.

While COVAX has made significant progress, raising more than $10 billion and securing legally binding vaccine delivery commitments of up to 4.5 billion doses, only 240 million doses have been delivered so far. As of August, just 10 percent of the doses allocated to Africa from COVAX had been delivered. More needs to be done.

The first, best approach would be for the G20 to treat the situation in Africa and poor parts of Asia and South America as they have done for their own societies. Immediate assessment and allocation of the full grant funding required to supply and roll out vaccines should be provided. To save time, this could be done through existing multilateral channels.

For the African adult population of 700 million, we estimate the amount required to manufacture and deliver 2 doses per person would be less than $14 billion. As a second best option, an increase in volume and procurement guarantees to support price discounts and supply to Africa is also likely to be helpful. The longer-term solution—developing licensed regional manufacturing sites—should not cloud the immediate need.

A vaccine delayed is a vaccine denied. The present injustice should be replaced by genuine action to save lives—all lives. We should be willing to examine any solution that could help the world's poorest countries get a fair chance of beating the COVID pandemic.​

Dr. Githinji Gitahi is Group CEO of Amref Health Africa. Charles Okeahalam is Chairman of Amref Health Africa's international board of directors.

The views expressed in this article are the writers' own.