Africa’s HIV Experts Break Down Global COVID-19 Vaccine Inequity

Written By BLK HLTH

By Akilah Wise, PhD

The COVID-19 pandemic exposed inequities in global health, particularly regarding when it comes to access to the life-saving vaccine. The World Health Organization projects less than 10 percent of Africa’s 54 nations to hit their year-end goal of fully vaccinating 40% of residents. Even more, only 1 in 4 health workers in Africa (27 percent) received vaccinations against COVID-19. In November 2021, the South African National Institute for Communicable Diseases first detected the Omicron variant, which the World Health Organization declared a “variant of concern.” The emerging variant signals what many African scientists had warned about the failure of wealthy nations to facilitate efficient access to vaccines for developing countries and engage with developing nations to launch an equitable global response.

At the pandemic’s start, African countries defied predictions about the coronavirus impact. Equipped with experience of infectious disease outbreaks, many implemented a quick and “unified strategy” to combat the pandemic early in 2020. Many took the lead in many areas of the COVID-19 disease response: Kenya, South African, Egypt, Morocco, and other countries launched e-learning platforms with public and private partnership; Nigeria and Senegal made innovations in testing and diagnostic technology.

These efforts and more kept Africa’s COVID-19 death rate much lower than in the US or Europe in 2020. By the start of Africa’s second wave in December 2020, African countries reported 62,000 deaths out of more than 2.6 million cases, compared to 19 million cases and 334,000 deaths in the United States. Africa entered its second wave in December 2020. At the time of writing, African nations have had 224,000 deaths out of 8.7 million cases, according to Africa Centres for Disease Control.

BLKHLTH spoke with global health experts from the International Treatment Preparedness Coalition (ITPC), a South Africa-based organization of HIV activists and community members who work to increase access to HIV treatment, about the COVID-19 pandemic’s impact on developing African nations. They touched on global vaccine inequity, the importance of community engagement in decision-making, and how institutional mistrust is linked to misinformation and disinformation about COVID-19.

 

What are some COVID-19 challenges African countries face?

Testing Limitations and Underreporting of COVID-19 cases

Solange Baptiste, ITPC’s Executive Director

Solange Baptiste: I'm not sure if I believe all the statistics claiming Africa is doing super well in COVID. To get a clearer picture, we have to look deeper into [COVID-19]  testing. In Africa, only one test has been done for every 20 people, whereas two tests have been done for every person in the US. This is staggering! So if you take this kind of scenario mixed with low surveillance, poor contact tracing, and the overburdened healthcare system, you're not quite sure what's happening on the ground.

COVID-19 and Other Urgent Needs

Solange Baptiste: Many of our partners across the globe say their concerns are not about COVID-19 and the vaccine. But instead, they ask for food; they ask for rice? Because now they have lost their jobs and can't feed their children. What about sanitary napkins? Some women explain that they are being beaten up because their husbands are now home and drinking excessively.

Mistrust of Institutions and Hesitancy

Solange Baptiste: The other part of this is the deeply-rooted mistrust between governments and people, especially brown people and people of color. And it's a rational distrust. Most of the COVID hesitancy that we are working through with communities is not necessarily based on a lack of understanding but a lack of trust in the establishments pushing these vaccines.

 

Why do we have global vaccine inequity amidst the COVID-19 pandemic?

Global Market Monopoly of Wealthy Nations

Othoman Mellouk: It is a question of markets. Vaccines have been developed by Big Pharma companies with a limited production capacity. They protect their products with intellectual property rights, such as patents, trade secrets, et cetera, and they keep the little production to the most offering countries. So, if you have a number of available vaccines, you'd better supply the United States, Canada, the EU, Australia, Japan, the rich countries who have money to pay, and then the others will come later. Unfortunately, we don't have time to wait too long in Africa in this pandemic.

Othoman Mellouk, ITPC’s Access to Diagnostics and Medicines Lead

Health Nationalism

Othoman Mellouk: You have health nationalism, and you have these companies that are aware from the beginning that they cannot supply the work because the demand is huge. [These companies] could have offered licenses to other producers in South Africa - the most important pharmaceutical industries in Africa are in South Africa and Morocco - so, there would have been plans to transfer to technology and produce. They didn't want to do that.

Colonialism Defense of Global Vaccine Inequity

Othoman Mellouk: We are hearing almost the same colonialist arguments, the same logic. Companies claim that it's not an issue of patents; it’s an issue of capacity because these are sophisticated vaccines with complicated mRNA technology. But it's not complicated. If we are looking at all other vaccines developed for children, like Hepatitis B, most vaccines in the world are produced in China and India. It's super easy to transfer capacity [to non-Western nations] and to invest if you want to do it, and they didn't do that. So we hear these colonialists' arguments about our capacities in the global south and their supposedly magical capacities in the north.

 

What are important issues or challenges as we move forward in the pandemic?

Investment in Rural Vaccine Hesitancy

Wame Jallow: There hasn't been enough investment beyond the urban lens…[W]e keep talking about vaccine hesitancy in the urban setting. Still, we don't talk about vaccine hesitancy beyond that, and that's because there's a lack of education, there's a lack of access. I can get access to vaccines, but what about people beyond the city? Here's a lot of work to do outside the city. How much information is going out to the rural areas? How are we getting information out? Do you have people who have data restrictions? That's real right now, especially in the context where we don't have economies of scale in the same, in the same way, like for countries like Botswana. In a country like Botswana, we don't have the population and economies of scale.

Community Agency in Decision-Making

Wame Jallow, ITPC’s Director of Global Programs and Advocacy

Wame Jallow: I think that the most important thing is to allow communities to tell their story, right? We don't hear enough, so there is no strong community voice at the table. And I think this is the first time we've seen community-centered approaches like during COVID, all of a sudden, everything that communities have been doing over the last decade-plus mattered, you know. Communities are now actively finding out the problems, trying to be responsive to the issues, etc. But that needs an empowered community. That means education. That means giving them the right tools to collect information. And then to act, ultimately we need to get communities on the ground, to then do the delivery of the work.

To learn more about ITPC, please visit: https://itpcglobal.org/

Akilah Wise (@awisephd) is a public health researcher and journalist based in Atlanta. She covers topics in public health, medicine, and inequity in the U.S. and has written about health inequities for The Nation, Rewire, The Boston Globe, Texas Hospitals Magazine, and The Appeal.

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