Obstacles to COVID-19 Vaccine Equity in Africa
By Kaiwen (Coco) Zhang
This post is part of a series in diverse mediums focusing on the theme “How do we envision equity in global health?”. These submissions are by McGill students who were part of the course, Fundamentals of Global Health, in Fall 2023.
The COVID-19 pandemic has ravaged the world, causing over 6 million deaths globally and triggering an unprecedented global economic crisis (Our World in Data, 2022). Vaccination became the key eradication strategy that could bring the world back to normalcy. Despite the rapid development of safe and effective vaccines, vaccine inequity is significant especially in low-income countries (LICs), many of which are in Africa. Although 75% of people in high-income countries (HICs) were fully vaccinated, African countries have persistently experienced the lowest vaccination coverage with only 28% of their population fully vaccinated, as of December 2022 (Our World in Data, 2022). In Africa, 15 countries were under 10% full vaccination of their population; 21 countries had reached between 10 and 19% of their population; five countries had reached between 40 and 69% of their population; and only Mauritius, Rwanda, and Seychelles had surpassed 70% vaccination coverage (World Health Organization, 2022). Although it is essential for COVID-19 vaccines to be equitably distributed among countries to allow adequate global protection and ensure the world returns to normalcy, the achievement of COVID-19 vaccine equity is significantly hindered by various barriers.
Low government funding
Limited government funds allocated for COVID-19 vaccines can lead to unaffordability and inaccessibility of the vaccines in Africa (Figueroa et al., 2021). This would put African countries in dilemmas of either waiting for COVID-19 Vaccine Global Access Facility (COVAX) to increase its allocation; transferring funds that were originally allocated for the rest of the national health system; or leaving the rest of the population unvaccinated.
Intellectual property rights issues
African countries suggested vaccine developers in HICs relinquish intellectual property rights associated with COVID-19 vaccines, diagnostics, and therapeutics to increase COVID-19 vaccine production and access in Africa (Pilkington et al., 2022). However, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS agreement) waiver faced strong opposition from HICs that host large domestic pharmaceutic industries, such as the European Union and UK (Sariola, 2021).
Vaccine nationalism
The HICs prioritized their own vaccine needs and strived to get first access to vaccines’ supply during the COVID-19 outbreak (Bhutto, 2021). By August 2020, the USA had secured 800 million doses of various vaccines; the UK had purchased 340 million doses; and Canada had ordered hundreds of millions of doses that could cover more than the entire population (Basak et al., 2022). On the contrary, African countries only started purchasing vaccines in January 2021 through the African Union’s pooled procurement approach (Duke Global Health Innovation Center, 2022). This approach left African countries with few vaccines to cover the entire population, thereby reducing these countries’ access to the much-needed COVID-19 vaccines. An open letter appeal to G20 summit leaders highlighted the disparity in access to vaccines between HICs and LICs. It was stated that there were only four doses of COVID-19 vaccine administered for every hundred people in LICs while 133 doses were administered per hundred people in HICs (Grandi et al., 2021).
Weak health systems
Most African countries have weak health systems characterized by the lack of cold storage facilities to store COVID-19 vaccines at the recommended temperature, such as 2-8°C for Oxford-AstraZeneca and -70°C for Pfizer (Acharya et al., 2021). Additionally, the geographical landscape of various African countries requires the vaccines to be transported over long distances to static vaccination sites, which poses a significant challenge to distribute vaccines (Acharya et al., 2021). Therefore, COVID-19 vaccines are delayed and sometimes arrive close to their expiration dates, leaving little time for usage. This consequently affects both the availability and uptake of vaccines.
Vaccine hesitancy
While the primary reason for COVID-19 vaccine hesitancy in HICs was the rapid pace of vaccine development, the common reasons for hesitancy in African countries included fear of adverse effects after vaccination, vaccine misinformation, and lack of trust in the government (Ackah et al., 2022). Studies revealed that numerous misleading myths and faith-related rumors led to the spread of false information regarding COVID-19 vaccines, causing fears and mistrust of the healthcare system across Africa (Ackah et al., 2022).
Overall, there have been huge disparities in the coverage of COVID-19 vaccines in Africa, primarily due to vaccine nationalism, low government funding, low vaccine production, weak health systems, and high vaccine hesitancy. Potential solutions have been proposed to improve vaccine distribution, access, and uptake across Africa. These solutions include expanding the COVAX facility to increase allocation of COVID-19 vaccine in Africa; waiving the control of IP rights associated with COVID-19 vaccines, diagnostics, and therapeutics; increasing COVID-19 vaccine manufacturing capacity in Africa; strengthening the healthcare system in Africa; and implementing mass COVID-19 vaccination campaigns across Africa to promote COVID-19 vaccine acceptance and uptake. These measures are crucial in achieving global vaccine equity and global health security.
References
Acharya, K. P., Ghimire, T. R., & Subramanya, S. H. (2021). Access to and equitable distribution of COVID-19 vaccine in low-income countries. Npj Vaccines, 6(1), 2–4. https://doi.org/10.1038/s41541-021-00323-6
Ackah, B. B., Woo, M., Ukah, U. V., Fazal, Z. A., Stallwood, L., Okpani, A., & Adu, P. A. (2022). Covid-19 Vaccine Hesitancy in Africa: A Scoping Review, 7, 21. https://doi.org/10.21203/rs.3.rs-759005/v1
Basak, P., Abir, T., Mamun, A. A., Zainol, N. R., Khanam, M., Haque, Md. R., Milton, A. H., & Agho, K. E. (2022). Global Perspective of COVID-19 Vaccine Nationalism, 2021, 21268580. https://doi.org/10.1101/2021.12.31.21268580
Bhutto, F. (2021, March 17). The world’s richest countries are hoarding vaccines. this is morally indefensible | Fatima Bhutto. The Guardian. https://www.theguardian.com/commentisfree/2021/mar/17/rich-countries-hoarding-vaccines-us-eu-africa
Duke Global Health Innovation Center. (2022). Vaccine purchases: Tracking COVID-19 vaccine purchases across the globe. Launch and Scale Speedometer. https://launchandscalefaster.org/covid-19/vaccinepurchases
Figueroa, J. P., Hotez, P. J., Batista, C., Ben Amor, Y., Ergonul, O., Gilbert, S., Gursel, M., Hassanain, M., Kang, G., Kaslow, D. C., Kim, J. H., Lall, B., Larson, H., Naniche, D., Sheahan, T., Shoham, S., Wilder-Smith, A., Sow, S. O., Strub-Wourgaft, N., … Bottazzi, M. E. (2021). Achieving global equity for covid-19 vaccines: Stronger International Partnerships and Greater Advocacy and solidarity are needed. PLOS Medicine, 18(9). https://doi.org/10.1371/journal.pmed.1003772
Grandi, F., Vitorino, A., & Ghebreyesus, T. A. (2021). An appeal to G20 leaders to make vaccines accessible to people on the move. World Health Organization. https://www.who.int/news/item/29-10-2021-an-appeal-to-g20-leaders-to-make-vaccines-accessible-to-people-on-the-move
Our World in Data. (2022). Coronavirus (COVID-19) vaccinations. Our World in Data. https://ourworldindata.org/covid-vaccinations
Pilkington, V., Keestra, S. M., & Hill, A. (2022). Global covid-19 vaccine inequity: Failures in the first year of distribution and potential solutions for the future. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.821117
Sariola, S. (2021). Intellectual property rights need to be subverted to ensure global vaccine access. BMJ Global Health, 6(4). https://doi.org/10.1136/bmjgh-2021-005656
World Health Organization. (2022). Africa’s COVID-19 vaccine uptake increases by 15%. https://www.afro.who.int/news/africas-covid-19-vaccine-uptake-increases-15