More Equitable COVID-19 Vaccination Needed to Help Africa

In the early days of the COVID-19 pandemic, there was a fear that Africa would be especially hard hit, given its endemic poverty and under-resourced national health systems. But for more than a year, it has defied those expectations. The continent avoided the coronavirus spikes seen elsewhere in the world, although its populations suffered deeply from the economic disruption that accompanied the outbreak.

But the virus, fueled by the emergence of the delta variant, is now gaining ground across Africa. Many of its health systems responded well to the pandemic with planning and initiative but are now being overwhelmed. During the past month, death rates have risen by more than 80%. More than 1 million new cases were reported in July alone. Another mutation of the coronavirus — beta — was first identified in South Africa and has also been labeled a “variant of concern.”

Now contending with more than 6 million cases of COVID-19, only 1.5% of Africa’s 1 billion people have been fully vaccinated.

Meanwhile, approximately 80% of the 4 billion COVID-19 vaccine doses administered so far have gone to higher income countries, which account for less than half of the world’s population. This means we are nowhere close to achieving herd immunity on a global scale, threatening the emergence of new variants and putting at risk highly vulnerable populations.

[MORE: Comparing COVID-19 Vaccination Rates by Country]

In this context, the World Health Organization’s recent call to postpone booster shots reminds us that as an international community we have fallen far short of our duty, both morally in accelerating help to the rest of the world, and practically because the longer COVID-19 variants multiply among unvaccinated populations, the more we undermine our own recovery in the United States.

The international humanitarian and medical communities are coming to a consensus on what needs to happen to address this inequity and provide vaccine access for the world’s most vulnerable people. Wealthier nations must share their vaccine supplies, and the group of seven leading industrial nations must accelerate its pledge to send 870 million doses to COVAX, the international organization coordinating distribution to low-income countries.

The administration of U.S. President Joe Biden has taken important steps to help address COVID-19 in low-income countries, including many in Africa, shipping 110 million vaccine doses abroad (with a pledge of 500 million doses of the Pfizer vaccine, to begin distribution in coming weeks), most through the U.N.-supported COVAX effort. The U.S. has invested more than $4 billion for additional vaccine purchases, but also hundreds of millions to support critically needed health commodities and activities including to prevent COVID spreading in humanitarian settings.

[GLOBAL SURVEY: Countries Seen to Have the Best Public Health Care Systems]

One measure being proposed would be to authorize a temporary World Trade Organization waiver of intellectual property rights that would facilitate the transfer of vaccine manufacturing technology, a measure that is supported by President Biden. This would need to be accompanied by a mobilization of resources to create global manufacturing hubs so that the vaccine could be produced locally, simplifying the logistics of transporting it to the far-flung corners of Africa, Asia and Latin America, where it is most urgently needed. This is unlikely to impact this COVID pandemic due to the time required to scale up, but it will be essential in addressing the next one.

The good news in getting shots into arms in Africa and other low-resource places is that there is a lot of experience in getting medicines from the port or factory to the last mile of the local clinic in some of the most isolated rural communities. The response to the epidemics of AIDS and Ebola has resulted in a new generation of African health care workers who know how to fight a pandemic and how to engender the trust of suspicious local communities buffeted by waves of rumor and misinformation. Many are affiliated with faith-based networks, like the many national Christian Health Associations that my organization, IMA World Health, has collaborated with for decades.

Experience has shown these local organizations and networks can manage the vaccine rollout, but must be supported by local leaders, resources and complementary efforts to educate both the general public and health care workers to reduce vaccine hesitancy, which predates COVID-19. Developing an effective COVID-19 response — from vaccine uptake to economic resilience to investing in health systems — is going to depend far more on national institutions than it will on externally driven strategy and execution.

In a number of countries, past support from international initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and GAVI the Vaccine Alliance, or U.S. programs such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) have helped strengthen these health delivery platforms across local government and private clinics, hospitals and health systems. While many of these have pivoted to address COVID-19 in part, lockdowns and other issues have forced skipped vaccinations for childhood diseases and interruptions to their health interventions. Now they will be tested as never before and we must better support the local leaders who manage these facilities and make sure they are consulted every step of the way.

We have the global resources to end this global pandemic. They are just not being shared equitably, an injustice that will prolong the suffering and death.

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