ANALYSIS | An inconvenient truth: The real reason why Africa is not getting vaccinated

ANALYSIS | An inconvenient truth: The real reason why Africa is not getting vaccinated

Pharmaceutical companies like Pfizer have said low vaccine uptake in
Africa is due to increasing hesitancy on the continent. But the truth is
inequitable distribution of Covid vaccines have left Africa as a vaccine
desert, write Tian Johnson, Tom
Moultrie, Gregg Gonsalves
and Fatima Hassan.

Albert Bourla, the CEO of the US-based pharma
giant Pfizer, recently claimed the slow uptake of Covid jabs in Africa is
because of vaccine hesitancy, which, he said, would be “way, way higher than the percentage of hesitancy in
Europe or in the US or Japan”

But he conveniently misses the truth. It’s not
because people in Africa are hesitant that they’re not getting their shots;
it’s because they’re simply not getting stock.

Of the approximately 6.4-billion vaccine doses administered globally so far, only about 2.5% have been in Africa. If we consider that Africa has
close to 1.4-billion people, this ratio
translates to only a country the size of Ghana being vaccinated on the entire

A ‘grotesque’ gap: How rich countries are controlling Covid vaccine

Bourla’s statements about vaccine hesitancy
perpetuates a far too common narrative, grounded in racism and which paints
people in Africa as being science shy and resistant towards vaccines and other
medical advances. Quite to the contrary, a team of leading researchers reported
in Nature Medicine in July this year that Covid vaccine acceptance is higher in several
low- and middle-income countries, including a number in Africa, than in richer
countries such as the United States (US) and Russia. The
results were remarkably consistent across countries, suggesting that
people in poorer countries are willing to get their
shots – if only vaccines were available to them.

While many African countries are still waiting
for supplies, richer countries have in effect 
bought up the lot for 2021. The situation is so unequal that the World Health Organisation’s (WHO)
director general, Tedros Ghebreyesus, warned already in March this year that
the vaccination gap between rich and poor countries would become “more grotesque every day“.

The world was not fooled by a media briefing of some of the
big pharmaceutical companies on 7 September –
the same one where Bourla aired his views –
proclaiming they are confident of having enough vaccines for everyone.

The next day, COVAX – the international
initiative set up to ensure global access to Covid vaccines – announced a
sobering outlook: it had to cut its forecast of deliveries to low-income
countries by 25% for 2021–2022  because of a constrained supply chain. This
comes on the back of many countries in the North starting to consider rolling
out third shots, despite the WHO repeatedly having called for a moratorium on booster shots to first get healthcare workers and the elderly in low-income countries

A call which has thus far been ignored.

The WHO was not impressed either. “[B]ecause manufacturers have
prioritised or been legally obliged to fulfil bilateral deals with rich
countries willing to pay top dollar, low-income countries have been deprived of
the tools to protect their people,” Ghebreyesus
said at a media briefing the same day.

“I will not stay silent when the companies and countries that control the global supply of vaccines think the world’s poor should be satisfied with leftovers.”

A vaccine glut vs a desert: Why we need redistribution
of the doses

Although vaccine hesitancy is real, it is shaped
by a history of medical research not always having the best interest of
participants – especially from minority communities – at heart.

There has been the notorious Tuskegee
Syphilis Study
, in which infected black men in the US were
observed but not treated over four decades. During apartheid, we saw medical
experimentation leading to chemical and biological weapon programmes being set
up by the South African government to develop substances that could poison, sterilise
or kill black people
. The roll-out of injectable contraception
between the 1950s and the 1970s by then minority, undemocratic governments in South Africa and Zimbabwe raised concerns about these programmes being a mechanism to curb
fertility rates among black communities.

And it’s reared its head again recently. Reports
that Covid-19 patients at an Arkansas jail were given Ivermectin  – approved for treating parasitic worms, not
Covid, and which the US Food and Drug Administration specifically advised against – sparked outrage.

Contrary to Bourla’s “evidence-free” view, the
WHO recognises that almost every low-income country
has “extensive experience in large-scale vaccination
“. Every
country in Africa has successfully eradicated smallpox, all but a few have effectively
immunised their populations against polio
and most
are making steady progress in immunising their children against
vaccine-preventable childhood diseases

Many countries in the North are also struggling
with vaccine uptake, despite having started their programmes in the first
quarter of 2021 already and having ample supplies – because they were allowed
to buy them all up and continue to be “priority customers”. Pharmaceutical companies
do not hesitate to continue to prioritise supplying vaccines to wealthy
countries, despite their glut possibly leading to many more than 100-million doses destined to go to waste by the end of 2021 if they are not urgently and equitably

Bourla and his ilk clearly do not understand the
broader context of how public health is realised in Africa, with their desire
to profit driving supply decisions while Africa faces multiple waves of
Covid-19 in a vaccine “desert”.

A complex history: What’s behind vaccine hesitancy in Africa

We’ve been here before.

During the early years of the Aids crisis, the
tardiness in giving Africa affordable and equitable access to antiretroviral
(ARV) drugs was laid – unfairly – at Africa’s door.

Scores of people died prematurely, yet then
USAID administrator, Andrew Natsios, declared that the agency was opposed to
giving Africans ARVs as people “do not know what watches and clocks are” and would not be able to take their medicines at the right time each

As a consequence of neocolonial economic and
social policies in Africa, fragile health systems impact communities’ access to
health services in much of the continent. In this context, African civil
society, the private sector and governments grapple daily with the complexity
of vaccine hesitancy and work diligently to build vaccine confidence.

But it is more convenient for a fully vaccinated
Bourla to glibly cite “hesitancy” as the reason for the low number of
vaccinations in Africa than to engage with the ongoing supply crisis and the
complexity of historical mistrust, exclusion and inequitable access.

Greed and glut: How rich countries are helping sustain Covid in Africa

Africa will become known as the continent of
Covid-19 – not because of vaccine hesitancy but because of the inequity, greed
and inaction of pharmaceutical companies and political leaders of the North.

Far from Bourla’s self-serving narrative, Pfizer
has not materially contributed to vaccine equity. Instead, for the past year
both Pfizer and its German partner BioNTech have refused to share vaccine
know-how with other manufacturers around the world.

And not by coincidence, the German government publicly declared their opposition to  a proposal, initially raised
by the South African and Indian governments in October 2020, that the World
Trade Organisation waive certain conditions of intellectual property rights
with regard to Covid technologies

So far, Pfizer has also not been willing to partner
with the WHO’s mRNA hubs being set up
around the world – including South Africa – and which could help to supply
much-needed additional vaccine doses rapidly.

Rather, the company alone decides which
countries it wishes to supply, with how much, by when and at what price – all
factors that contribute to a sizeable and lucrative revenue stream for Bourla and his shareholders. But contracts are not transparent and
reports of disconcerting indemnity terms and pricing negotiations in supplying
vaccines have again highlighted concerns about contractual
agreements contributing to “vaccine nationalism

Bourla cunningly side-stepped the issue of
knowledge sharing at the manufacturers’ joint press conference. Instead he
referred to a recent “deal” with South African biotech firm Biovac, but which –
incredulously – is not in any way linked to the first WHO mRNA hub established
in South Africa, of which Biovac is a partner.

The “deal” is in fact not a full manufacturing
licence, but rather just a “fill and finish” arrangement – the final stages of production during which the product is put into
vials, sealed and packaged for shipping. This means the process of mRNA
production will remain in Europe and keep Africa dependent, unless a radical
shift is seen in holding pharmaceutical companies accountable.

“I’m not sure what the point of transferring
technology is … it is going to take years to transfer,” he continued. Yet several
medicine access advocacy groups, and even the
WHO, have laid out realistic plans to establish technology transfer efforts, with far more ambitious timelines than Bourla will admit.

Turning ‘hesitancy’ into a scapegoat: The moral crime of vaccine

Bourla’s opinions on (not) sharing knowledge
highlight larger structural issues. Rather than big pharma confronting their
own complicity in blocking reasonable access to vaccines, “hesitancy” is
increasingly made the scapegoat.

And while African countries are waiting for
vaccines, which have not been delivered on time or not at all, wealthy
countries continue to hoard supplies, some to the point of expiry. Little has come of their promises to donate vaccines to Africa, with
the WHO stating that less than
15% of the one billion pledged doses have materialised.

By refusing to treat Covid-19 vaccines and other
essential technologies as products for the public good – especially when those
technologies were funded by public money – big
pharma are sustaining the pandemic in low- and middle-income countries.

It might be naive to expect consciousness,
courage or even shame from an industry that has a long history of putting
profits before people. But we will not stand by in silence; instead, we will
remind them at every opportunity that they will, for generations, be known as
those who stood in the way of an end to Covid-19.

The current situation of vaccine inequity and
racist tropes being flung about to justify knowledge hoarding and a dire lack
of vaccine supplies is sadly shameful. It is also a moral

– This story was produced by theBhekisisa
Centre for Health Journalism
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