Five things you need to know about vaccine (in)equity in Africa

Many months ago, the UN chief, Antonio Guterres, warned the world that we needed to accelerate the global rollout of vaccines. ‘In an interconnected world, none of us is safe until all of us are safe’ he said. But the world did not listen. And one continent above all is paying the price for this dereliction of global leadership: Africa. We asked Jackie Kiarie and Steve Murigi from Amref, Africa’s leading health NGO, to tell us what has gone wrong.

If the number of COVID-19 vaccines produced in 2021 had been fairly distributed, every country in the world could have reached the WHO’s target of 40% coverage by the end of September. 

Instead, many wealthy nations are well into the delivery of third doses, with some making plans for a fourth, while lower-income countries remain largely unprotected – putting lives at risk and creating the conditions for the emergence of variants such as Omicron.

The disparity is particularly acute when it comes to Africa. At the time of writing (late January 2022), less than 10% of Africa’s population was fully vaccinated. If we consider that definitions of “fully vaccinated” are being rewritten to include booster shots, that number plummets to around 1%.

There are encouraging signs: shipments to Africa – through COVAX (the mechanism set up to ensure equitable access to vaccines globally), AVATT (Africa Vaccine Acquisition Task Team, an initiative of the African Union), and bilateral deals and agreements – are increasing. Supplies are becoming more reliable: but they remain insufficient. And while supply is critical, it’s not the only challenge standing in the way of improved vaccination rates.

As Africa’s leading health NGO, we’d like to see the UK media take a more nuanced approach when reporting on these complex challenges. Here are five key points we’d like to see highlighted more often.

1. COVID-19 is one of many infectious diseases threatening lives and livelihoods across Africa

At the time of writing, the continent is facing outbreaks of dengue, Lassa fever, cholera, and measles. In many contexts, these outbreaks co-exist with humanitarian emergencies, such as conflict and displacement in the DRC and Cameroon, or flooding in South Sudan, putting unbearable pressure on already over-stretched health systems and the people who staff them.

African countries don’t have the luxury of choosing which public health emergency to prioritise. If anything, this makes increasing COVID-19 vaccination coverage in Africa – including among frontline health workers – all the more urgent.

2. Wealthy nations must go beyond increasing the number of doses they are sharing: they must commit to providing doses that are useable

We have seen a lot of examples of wealthy nations – the UK among them – congratulating themselves on the number of doses they have donated to less affluent countries. And while successes should be celebrated, it’s also important carefully and critically to examine these claims.

In reality, wealthy nations have failed to follow through on their commitments. Of the doses that are being shared, especially through mechanisms such as COVAX, many have extremely short lifespans and are due to expire months or even weeks after they arrive in the recipient country. This makes it challenging for governments and health workers to distribute the doses equitably and mobilise communities to receive the jab, increasing the risk of wastage – and resulting in further negative news coverage condemning African countries that destroy unused doses. (Particularly galling when the UK has recently destroyed thousands of booster vaccines due to lack of demand.)

Donor countries must commit to sharing doses with longer lead times to allow adequate time for deployment. Until they do, they are setting recipient countries – many of whose health systems are already over-stretched – up to fail.

3. Media reports should paint a broader, more holistic picture to improve public understanding of what it takes to roll out a vaccination programme in a country whose health system is already under pressure

Remember, too, that COVAX’s responsibility stops at the port. Challenges related to logistics, infrastructure and capacity stand in the way of vaccines “reaching the last mile” and getting into people’s arms. In many African countries, very few health facilities are equipped to administer the vaccine. Myths and misinformation result in vaccine hesitancy; many health workers have not received the training they need to calm people’s fears and increase uptake. It can be hard to ensure that doses are stored safely and in the correct conditions. It is challenging to get doses from entry points to remote regions, especially when time is of the essence and expiry dates fast approaching.

Covid vaccination rollout in Uganda. Photo credit: Amref Health Africa

4. Vaccine hesitancy is a challenge – but it’s not the only, nor the principal, obstacle to increasing coverage

Too many media reports frame vaccine hesitancy as the leading cause of low coverage in Africa. And while hesitancy is a challenge, as it is in other parts of the world – including wealthy nations – it is not the primary reason that people in Africa are not getting vaccinated.

Amref staff working across the continent consistently find that when vaccines are available, people are lining up to receive them. The challenge lies in securing those doses, and then in bringing them closer to communities: getting them to the places where people are doing business and going about their lives.

The best advocate for a vaccine is someone who has received one: so the lack of access to vaccines only feeds hesitancy. A person who has had a positive experience of vaccination can share that experience and encourage others. In a similar way, if someone living in a remote area walks for several hours to the nearest health facility hours – or spends their last shillings on transport – only to find there are no vaccines available, they will share their disappointment and are unlikely to go back. Tackling myths and misinformation is a key component of any vaccination drive, and frontline health workers are an indispensable resource.

5. COVID-19 vaccine inequity shines a light on global health inequity more broadly

In the words of WHO Director-General Dr Tedros Adhanom Ghebreyesus, “If we end inequity, we end the pandemic”. COVID-19 has exposed and exacerbated inequities in access to health care and services, not just between but within countries. These inequities have had a devastating impact on the rollout of the vaccine. Across the African continent (and indeed around the world), there is inequity not only in access to the vaccine, but in access to reliable information about the vaccine. Case management is being hindered by acute shortages of PPE as well as limited oxygen supplies.

On top of this, African countries are experiencing a decline in the provision of other services as resources are diverted to pandemic response and crisis management. Routine, life-saving services like antenatal care, childhood immunisation programmes, HIV testing, and the testing and treatment of tuberculosis have all been affected. The consequences of this disruption will outlast the pandemic. We need to be thinking beyond COVID-19 and strengthening health systems in anticipation of the next public health emergency.

Meanwhile, if large swathes of the world’s population remain unprotected, booster programmes will not keep wealthy nations safe from emerging variants. The longer it takes for wealthy nations to realise this, the more distant the prospect of a return to “normal”. It serves no-one to point fingers at the Global South when wealthy nations are stockpiling, falling short of their commitments to provide more doses, failing to act on the WHO’s recommendations to prioritise global primary vaccinations over national boosters, and ignoring calls for pharma companies to share the technology that would allow these nations to manufacture their own supplies.

Even as COVID-19 slips down the UK news agenda, we – as consumers of news and global citizens – must keep up pressure on those with the power to change the pandemic’s trajectory. We need to move away from the scarcity mindset that sparks fear and fuels unhelpful practices such as stockpiling. If efforts to vaccinate the world are grounded in the principles of equity and fairness, we will find that there is enough for everyone.

What can you do?

• Sign Amref Health Africa’s petition calling for an end to vaccine injustice
• Support Amref Health Africa’s ‘Vaccine Solidarity with Africa’ campaign

Authors: Jackie Kiarie, Regional Programme Manager, Global Health Security, Amref Health Africa HQ and Steve Murigi, Head of Programmes and Strategic Partnerships, Amref Health Africa UK