Julia Mwangaza* is a 41-year-old health practitioner at a hospital in Dar es Salaam, Tanzania’s largest city. When I spoke to her recently, she expressed fear that, given the rising number of COVID-19 cases in the region, the health workforce would soon be overwhelmed and unable to care for their patients. Ms. Mwangaza was also worried that there seemed to be no end in sight for COVID-19 and its impact on the community.
“I doubt we, the poor, will ever be vaccinated,” she said. “Unless they are too scared that we will contaminate them, Western countries will never be that generous.” As countries like the United States and the United Kingdom have pre-booked huge numbers of vaccine doses, many Africans wonder if there will be equity and fairness in their production and distribution. “If rich countries continue to increase their share of the deal, it will be a long way until the average African gets vaccinated,” says Daniel Ncube*, a doctor from Zimbabwe.
Ms. Mwangaza, Dr. Ncube and the other African health workers and experts I interviewed over the past few weeks have reasons to be concerned. In October, Human Rights Watch published a report addressing the troubling prospect that rich governments, with the resources to pre-book hundreds of millions of doses of the limited amounts of COVID-19 vaccines currently available, means low and middle-income countries will be forced to wait for whatever is left over.
Oxfam International reported in September 2020 that high-income countries had already reserved 51 per cent of the doses of several leading vaccine candidates, even though those countries represent only 13 per cent of the world’s population. Global Justice Now reported in November 2020 that more than 80 per cent of Pfizer and BioNTech’s vaccine doses have already been bought by a handful of countries – all of them developed countries outside of Africa.
On 7 November 2020, the Chairperson of the African Union, President Cyril Ramaphosa of South Africa, convened a meeting with other African leaders to strategize on options for acquiring and financing COVID-19 vaccines in Africa, which he estimated would cost at least $12 billion. Dr. John Nkengasong, the director of the Africa Centers for Disease Control and Prevention (Africa CDC) estimates that it would take 1.5 billion doses to vaccinate 60 per cent of the Africa’s 1.3 billion people, at two doses each.
While vaccination is already underway in the US and the UK, vaccines likely won’t reach African countries until mid-2021, Dr. Nkengasong warned. WHO estimates that it might take until 2024 to vaccinate the whole world against COVID-19.
Yet, African governments and the AU could support three major initiatives that would help ensure that the continent is not left behind in the global fight to end the pandemic: The first initiative is the COVAX Facility, a global initiative that brings together governments and manufacturers to ensure that COVID-19 vaccines reach those in greatest need. This initiative has the potential to benefit African countries if it succeeds in getting sufficient vaccine supplies at affordable prices that minimize debt.
But even with this help, the continent would not have nearly enough doses to vaccinate 60 per cent of the population. That’s why two other global initiatives are essential to address vaccine scarcity and ensure universal and equitable access can be a reality. In May 2020, the Costa Rican government spearheaded a call to action for the WHO to create the COVID-19 Technology Access Pool (C-TAP), a common shared pool of rights to technologies, data and know-how that everyone around the world could use to manufacture any medical products needed to tackle COVID-19, including vaccines.
As of December 2020, only six countries in Africa – Egypt, Mozambique, South Africa, Sudan, Tunisia, and Zimbabwe – had endorsed the C-TAP Solidarity Call to Action, the second initiative. The third initiative is a waiver, proposed in October 2020 by India and South Africa, to some provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), an international legal agreement between all members of the World Trade Organization (WTO).
The proposed waiver would allow all countries globally to collaborate on the COVID-19 response, including vaccine development and distribution, without being unduly hampered by the complexity of laws and restrictions governing intellectual property. Countries like Kenya, Eswatini, and Mozambique have joined to co-sponsor the proposal. Dr. Solomon Ayele Dersso, the chairperson of the African Commission on Human and Peoples’ Rights (ACHPR) recently called on the AU to lead this initiative for Africa. Other international organizations’ experts have also welcomed the waiver proposal.
These different calls reveal the urgency for African governments and the AU to ensure that their citizens have access to COVID-19 vaccines. The remaining 48 African countries should join Egypt, Mozambique, South Africa, Sudan, Tunisia, and Zimbabwe to endorse and implement the WHO's C-TAP requiring global, open and non-exclusive licensing of intellectual property to maximize the benefits of scientific research. Also, more AU member States should co-sponsor and support India and South Africa’s proposal at the WTO and use TRIPS flexibilities at the country level. The AU could convene a pro-TRIPS waiver proposal meeting of AU heads of State and Government to send a strong and united message of solidarity.
AU member States should also call for concrete conditions on all funding for COVID-19 vaccine research, development, manufacturing, or distribution requiring technology transfer. These would ensure the sharing of all intellectual property, data and other know-how to enable mass manufacturing of successful vaccine candidates. The AU and its member States can take these few concrete steps to help ensure equity, transparency and fairness around the manufacturing and distribution of COVID-19 vaccines. The lives and health of Ms. Mwangaza, Dr. Ncube, and millions of other Africans may depend on it.
*Not their real name.
Ms. Nantulya is the Africa advocacy director at Human Rights Watch.