As opiniões expostas neste artigo vinculam exclusivamente os seus autores.
The Covid-19 pandemic undeniably caught the world off-guard. It was certainly not the first health crisis the human species has dealt with, but the preceding ones were sufficiently far away from memory to be taken as a serious threat. Be that as it may, the world was forced to adapt, and adapt it did. Even though the World Health Organisation (WHO) declared the spread of the COVID-19 virus as a worldly affair, it has been shown that it affects parts of the globe differently. For instance, in Africa, nine of the fifty-five countries accounted for more than 82,6% of reported cases in the continent, coupled by the fact that the Northern and Southern regions were more heavily affected than their counterparts, specifically Morocco, Lybia and South Africa (Salyer et al., 2021). Even though the current pandemic spread at much slower rate in this continent than in the rest of the world, eighteen countries reported a higher case fatality rate than the world average (Salyer et al., 2021).
After a considerable effort made by the main laboratories in the world, assisted by considerable sums of public investment, several vaccines were tested and commercialized. Subsequently, a race for the vaccine swiftly followed, resulting in the wealthiest countries, which account for 16% of the world population, having bought 60% of production, well beyond domestic requirements (Sharun & Dhama, 2021). Conversely, just 1% of 1,3 billion vaccines administered have been directed to Africa (WHO Africa, 2021). In fact, the global dissemination of vaccines is being affected by a phenomenon baptized as vaccine nationalism, which consists of a refusal on the part of HICs to disperse vaccine doses across borders as well as the pursuit of agreements with big pharmas, which, in turn, negatively affects global procurement (Forman et al., 2021).
Yet, leaving the greater part of the world unvaccinated is a mistake, given the fact that it leaves us vulnerable to the arrival of new strains of the virus, that, with time, are more likely to be resistant to existing vaccines’ formulas (Forman et al., 2021). Thus, it is of the utmost importance to build resilient healthcare systems to fight current and future health hazards all around the globe (Musa et al., 2021). In sum, global partnerships and collaborative efforts ought to be a priority in the current world agenda, since a problem of this magnitude affects everyone, in one way or the other. In spite of this fact, what has been observed so far is the West turning its focus inward, leaving the Rest to fend for itself.
So, in order to fully grasp the context in Africa, in what concerns vaccination rollout, it is both important and relevant to investigate the following question: Who are the main actors and what is their role in vaccination rollouts across the African continent?
As mentioned earlier, vaccination rollout in Africa is slow. Besides a barrier in ensuring supply, caused by vaccination hoarding (Sharun & Dhama, 2021), coupled by the fact that countries such as South Africa, Uganda and Saudi Arabia pay €5 per dose of the Oxford/Astra Zeneca vaccine, whilst the EU pays only €3,5 (Forman et al., 2021), there are other factors contributing to a delayed dissemination of vaccines. They are insufficient funds on the part of the countries to store and disseminate the vaccines, lack of trained professionals to administer the doses and hesitancy among the populations to take the vaccines, in light of recent discussions of the risks each one entailed (WHO Africa, 2021).
Even though COVAX partners assure 20% of vaccines needed by each country, dissemination is under the responsibility of African states, entailing transport and administration, which may be difficult to ensure. Furthermore, targeting the most at-risk citizens in the more remote areas proves difficult, meaning that other, perhaps non-priority, citizens are vaccinated beforehand, coupled by the fact that essential health services, for instance, measles immunization, are being disrupted due to the COVID-19 outbreak (WHO Africa, 2021).
In sum, the African continent faces a number of barriers for an effective vaccination rollout, not restricted to supply of doses, but also connected to infrastructure problems and the fact that countries are still fighting the pandemic and experience supply and personnel depletion.
However, the most worrisome factor remains the lack of supply of vaccines doses, resulting in a serious concern over health equity, given the fact that the US has a vaccination rate of 84/100 people (Wolfe et al., 2021), whilst frontline health workers remain un-immunized in many countries across the Global South. In fact, estimates have shown that more than eighty-five countries will not have access to widespread vaccination until 2023 (The Economist, 2021). As such, serious concerns over vaccination equity, or lack thereof, ought to be raised. Especially so, when taking into consideration the fact that unequal distribution of vaccines is not only morally questionable, but also counterproductive in economic and epidemiological terms (UN, 2021).
Thus, in order to better understand the process of vaccination in Africa, a table holding a stakeholder analysis performed on the main actors involved can be found below.
Starting with the bottom-left corner of the scheme, it is possible to observe that African citizens were a largely overlooked group, in the sense that they were described as the victims of the lack of speed in the vaccination rollout, but rather lacking in agency to change their current situation. As such, they can be considered neutral stakeholders, considering that they have a reduced role to playout.
On their part and for the time being, Non-Governmental Organisations (NGOs) seem to be focused on relief and support operations spread across the world, rather than targeting their efforts around vaccination initiatives. Considering that the scope of this essay is solely focused in immunization, NGOs consist of indifferent stakeholders as well.
Taking a closer look at the blockers in vaccination operations, they consist of the main western powers. Even though they are behind considerable amounts of donations directed at both COVID-19 relief and/or vaccination efforts, there are serious gaps in their courses of action, as well as a clear lack of interest in securing herd immunization in Africa, which could have been achieved under the leadership of COVAX and its guidelines. These gaps can be further illustrated, for instance, by the fact that even though the European Union (EU) has pledged €1.1 billion towards COVAX, €600 million consist of loans (ONE, 2021a). Furthermore, estimates have shown that the US, Canada, France, Italy, Germany and the UK may soon have vaccine surplus, meaning they will soon cross the tipping point where supply is greater than demand, whilst only 2/100 people in Africa are currently immunized (ONE, 2021a). Additionally, Australia, Canada, the UK, the US, Japan and the EU, combined, could spare 1 billion doses of the leading vaccines and still immunize their entire population, however they are not showing prone to do so (ONE, 2021b).
Even considering recent efforts on the part of both the EU and the US to donate 100 million vaccines and 20 million doses, respectively (Fortune, 2021), these nations are only shifting their focus outwards after having secured vaccines inwards. Plus, due to the timing of this commitment (President Von Der Leyen spoke on the 21st of May), it may be considered a reaction to the advancements throughout this pandemic in public diplomacy made by China, Russia and India, to a lesser extent, given the alarming situation sweeping the country.
Finally, these countries have taken part in what literature is referring to as vaccine nationalism, coupled by the fact that they bypassed COVAX and conducted direct negotiations with vaccine manufacturers, reserving 60% of overall production for their citizens (Sharun & Dhama, 2021). As such, Middle and Low-income countries are left with reduced procurement of shots, mostly from non-western produced vaccines (Wouters et al., 2021).
So, the African countries have turned to the current drivers of vaccination in Africa: India, China, Russia and the WHO. India, accounting for 60% of the world’s supply and consisting of the main manufacturing hub, has also developed the Vaccine Maitri initiative to provide low-income countries, including multiple African countries, with 10,515,000 doses as grants (Sharun & Dhama, 2021). However, given the recent evolution of the pandemic in India, exportation on doses was heavily conditioned (Chatterjee et al., 2021).
Countries such as Russia and China have invested heavily in vaccine diplomacy, strongly connected with International Development Aid (Kobierecka & Kobierecki, 2021). These countries have provided the Rest with vaccines, whilst the West was focusing inwards. China has donated 6 million doses and has pledged to donate vaccines to 40 African countries (Time, 2021), coupled by the fact that Egypt will produce Sinovac vaccines for domestic and continental dispersal (South China Morning Post, 2021). On their part, Russia has offered 300 million doses to the African Union (Winning & Bavier, 2021). Consequently, the pandemic has become fertile ground for Chinese and Russian public diplomacy and enhanced public image, which, in turn, enhances the nations’ soft power (Kobierecka & Kobierecki, 2021).
In turn, the WHO has been at the centre of vaccination in the African continent, assisting countries through material supply, direction, relief support and helping in the preparatory stages of vaccination rollout (WHO, 2021). As the main multilateral health institution, the WHO has been at the epicentre of the crisis through its regional offices and multiple partners.
COVAX, a global allocation mechanism, established by the WHO itself, aims to achieve vaccine allocation equity, by assisting and providing subsidized dose prices to ninety-two low and middle income countries through official development aid (ODA) (Wouters et al., 2021).
The principle would be to achieve 20% immunization in every country and, from there, progressively increase these numbers (Wouters et al., 2021). However, this initiative faces significant hurdles. For instance, national procurement strategies which surpassed COVAX and directly secured doses, lack of funding, which has led the World Bank to estimate the need for another US$12 billion (WHO Africa, 2021) and uncertainty regarding COVAX supply itself (Wouters et al., 2021), since this mechanism relies on India’s production, meaning only 14,9 million out of 77,6 million doses have been administered so far (ONE, 2021a). As such, COVAX has failed to be the leading force of vaccination rollouts around the globe, when faced with the Western powers’ negotiation capabilities, meaning this mechanism is not influential enough to have its interests prevail.
Finally, the African Union has procured 220 million doses from the Johnson & Johnson vaccine, with the possibility to secure another 180 million in the coming year, which entails the largest communal effort secured after the EU (Reuters, 2021). This feat should be considered for the Drivers category. However, this deal was brokered only for the third quarter of 2021, whilst the US is predicted to achieve herd immunity by the end of May 2021 (ONE, 2021a). As such, they are not lacking in interest, however, they do not yield the influence needed to ensure the fastest deal.
In sum, the main stakeholders and their role in vaccination rollout in the African country have been described above. As such, some considerations regarding this conjecture for the overall paradigm of Development Aid are in order, to better understand the broader implications for the sector.
The COVID-19 pandemic has, undoubtedly, many disastrous effects. Yet, this same catastrophic event can simultaneously foster an opportunity for change. As Ostrom (2010) has argued, a moment of crisis is also an optimal moment for a community to cooperate and strengthen itself by creating collaborative and resilient systems. As such, the International System could profit from this tipping point in history to effectively change how Development and Aid is disbursed and implemented across the world. However, little change from the “business as usual” approach appears likely so far, since development persists to be structured around hierarchies of place (Pailey, 2019).
When considering the power vacuum left by the North, it may be argued that there was a surge in South-South cooperation, a trend increasingly more observed in the Development sector. It may very well be the case, considering that the majority of the drivers of vaccination rollout in the African continent are in the Global South. Since assistance in times of need is rarely forgotten, perhaps in future instances of need, African countries will turn to partners in the Rest. Only the future will tell if this trend is lasting.
In sum, vaccination in the African continent has undoubtedly been slow. This is the result of the above-described phenomena, which is not solely the result of factors outside of Africans’ control. Even so, when looking at the stakeholder analysis above, it is clear that the African countries are not holding the reigns to their vaccination rollouts: both drivers and blockers are outsiders.
As such, it is fair to conclude that the prevailing logic is the status quo, that of the little to no agency afforded to the African peoples and governments and their continued dependency of foreign assistance. Additionally, perpetuating headlines such as: “G20 leaders at Rome summit pledge more vaccines for poorer countries” (Euronews, 2021) does little to alter this narrative, especially when taking into consideration that, if the richest nations had respected the allocation mechanism, “poorer countries” would not be in this dire situation in the first place.
At an important cross-roads moment in History, where prevalent resilient change could be enacted in the Development industry, the opportunity was not seized: Western powers looked out for themselves, with little care over the consequences for anyone else. As such, very old hierarchies prevail, and the Rest is left behind. However, times may be changing in the sense of the rise of South-South cooperation, with Southern Nations being ready to substitute Western countries as main donors. Be that as it may, this feat may be closest to reform than it is to transformation, since the replacement of Western powers for Southern powers is but a change in currency, a reform where the Scramble for Africa became the Scramble for the Vaccine and African populations remained the biggest losers.
Sara Amorim
Mestranda em Conflict and Development Studies
University of Ghent
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