If 2020 was the year of the coronavirus pandemic, then 2021 is shaping up to be the year of the vaccine. Yet rightful optimism about the arrival of coronavirus vaccines belies significant barriers to vaccine availability and access in large parts of the world. Familiar patterns of global inequities are resurfacing as the global vaccination drive gathers momentum. Moreover, intensifying geopolitical competition, especially between China and the United States, is impeding multilateral cooperation on critical issues including public health.
Poorer and less influential countries, especially those in Africa, are caught in the middle—facing obstacles to accessing vaccines, with likely negative effects on their prospects for a smooth post-pandemic recovery.
Surveying the Economic Damage
African countries need access to large-scale vaccinations to move to a post-pandemic normal. As in other regions, the pandemic has severely disrupted economic activity across Africa (see figure 1 below). For oil exporters like Angola, Gabon, Nigeria, and South Africa, the pandemic’s economic impacts exacerbated a crisis that began with the collapse of commodity prices in 2015. Not only did Africa’s largest economies, Nigeria and South Africa, slip back into recession in 2020, hopes of a rebound will languish well into 2022. Countries with relatively more diversified economies such as Côte d’Ivoire, Ethiopia, and Rwanda—which had some of the world’s fastest pre-pandemic growth rates—have seen a slowdown but not a reversal of their strong economic trajectories. Dampened demand in advanced economies has reduced exports. Travel restrictions have disrupted tourism and hospitality industries in the small island nations of Cabo Verde, Mauritius, São Tomé and Príncipe, and Seychelles. And strict lockdowns since early on in the pandemic have affected small businesses. Migrant remittances for African countries, which are now larger than flows of aid and foreign direct investment, fell by 9 percent—a significant drop, though not as steep as earlier forecasts suggested.
Most African economies will continue to experience pandemic-related hardship for the foreseeable future. The IMF projects aggregate growth of 3.2 percent in 2021 for sub-Saharan Africa, a better performance than the Middle East but a worse outlook than those of other emerging markets. Real GDP will not return to precrisis levels until at least 2022 and as late as 2024 for oil exporters. There could also be devastating longer-term reverberations. According to the World Bank, between 26 million and 40 million Africans could fall into extreme poverty amid the pandemic. Nearly half of African students lack access to remote learning, even as the region still lags on global enrollment and completion rates.
Other problems abound as well. Like in other parts of the world, debt servicing hampers the capacity of even the most well-meaning African governments to provide social assistance, inject economic stimulus, and procure medical supplies. And while much attention has rightly focused on Angolan and Zambian bilateral debt to China, several African countries including Ethiopia, Ghana, Kenya, and Nigeria are also heavily indebted to both private creditors and multilateral lenders such as the African Development Bank and the World Bank. Against this backdrop, the cumulative impact of the pandemic could be devastating enough to result in yet another “lost development decade” for Africa, according to Ghana’s finance minister. For African countries to ease restrictions safely, reach herd immunity, and revert to a sustainable trajectory of economic recovery, they will need to immunize a critical mass of people.
Lagging in Access to COVID-19 Vaccines
When will African countries access enough vaccines to begin the long road back to economic recovery? According to the Economist Intelligence Unit, Africa, like much of the developing world, will not have vaccine access before 2023 at the earliest for healthcare workers, the elderly, and other vulnerable groups. This timeline could extend up to mid-decade for universal coverage. Thus, a continent from which COVID-19 did not originate and which effectively deployed limited resources to keep infections and deaths below global averages may suffer greatly from the pandemic’s socioeconomic impacts due to challenges around vaccine access (see figure 2).
Africa lags in access to vaccines due to insufficient global supplies. The continent needs 1.5 billion doses to vaccinate 60 percent of the population, the African Union’s current targeted threshold. So far, the African Union has secured 270 million vaccine doses from a mix of sources including Pfizer and BioNTech, Oxford University and AstraZeneca, and Johnson & Johnson. By the author’s estimates, no more than twenty countries or less than half the continent have placed or are planning to place orders for the six major vaccines available.1 The COVID-19 Vaccine Global Access (COVAX) Facility, which aims to help poor countries inoculate up to 20 percent of their populations, is one of the main sources of vaccine supplies for the continent. But COVAX has yet to deliver a single dose to any country, and its heavy reliance on the Oxford-AstraZeneca vaccine (which is less effective against new strains of the virus) could limit its objectives. According to the Africa Centres for Disease Control and Prevention, excluding any vaccines supplied by COVAX, most African countries have only secured enough immunizations for between 5 and 10 percent of their populations. Altogether, there is a shortfall of about 1.3 billion doses needed for Africa to reach its goal of immunizing 60 percent of the population.
The cost of procuring and delivering these vaccines is another major problem. The 1.5 billion doses needed will cost about $9 billion for procurement and delivery, according to the African Union’s vaccine strategy. While the African Export-Import Bank has guaranteed a $2 billion loan, the 270 million jabs the African Union has secured will cost $3–$10 per dose, imposing an additional financial burden on countries with growing public debt exposure. Although the World Bank is providing $12 billion to “help poor countries purchase and distribute vaccines, tests, and treatments,” this lending, albeit at concessional rates, could add to their debt burden. Thus, it is no surprise that just about twenty African countries have adequate plans for financing and distributing the vaccines.
Even when vaccine supplies are secured, other challenges around infrastructure and logistics will affect COVID-19 vaccine delivery in Africa. Only twenty-two countries have “a working cold-chain [storage] system” for keeping vaccines at the proper temperatures, not to mention the extremely advanced storage requirements for the Pfizer and Moderna vaccines. Other challenges include limited healthcare worker capacity and widespread disinformation about COVID-19 vaccination.
Squeezed by Vaccine Geopolitics
Africa’s challenges accessing COVID-19 vaccines are compounded by a fraying multilateral order marked by heightened great power rivalries. As Nigerian analyst Nwachukwu Egbunike has observed, African countries, like much of the developing world, are caught “between China’s soft power diplomacy and the West’s vaccine nationalism.”
In the push for vaccine diplomacy, China has branded itself as a benign power helping other developing countries to overcome a pandemic whose earliest cases, it is worth remembering, were found within its borders. Thus, in May 2020, China’s President Xi Jinping pledged to make the country’s COVID-19 vaccines a “global public good.”
Unsurprisingly, the details on vaccine delivery are unclear. For instance, the Chinese government had initially suggested it would provide these vaccines to African countries free of charge, but later said it would provide low-cost access. Like concerns around the quality of some medical supplies donated by Chinese entities in the early days of the pandemic, there are questions around these vaccines’ efficacy. The reported efficacy of Coronavac, a leading Chinese candidate, is between 50.4 percent and 78 percent, for instance. Nevertheless, China has already set up logistics networks to prepare for delivery of vaccines to Africa and other parts of the world through the Cainiao–Ethiopian Airlines cold chain vaccine storage air bridge between Shenzhen and Addis Ababa.
Other non-Western powers are also ramping up their vaccine diplomacy. Russia has offered the African Union 300 million doses of its Sputnik V vaccine along with a financing package for countries wanting to secure the shots. A handful of countries including Algeria, Egypt, and Guinea have already secured some supplies of Sputnik V. India is also leveraging its vast pharmaceutical industry to extend its soft power. Afghanistan, Bangladesh, Myanmar, the Maldives, Nepal, Sri Lanka, and the Seychelles have received free Oxford-AstraZeneca vaccine doses produced by the Serum Institute of India, the world’s largest vaccine factory.
This soft power diplomacy by rising powers is occurring alongside vaccine nationalism by wealthy countries. Prominent global public health leaders have drawn attention to a trend of hoarding limited medical supplies to the detriment of the vast majority of countries around the world. The director general of the World Health Organization, for instance, has described as “morally indefensible” the fact that “rich countries with just 16 percent of the world’s population have bought up 60 percent of the world’s vaccine supply.” Canada notably has purchased more than nine times the supply of vaccines it needs to cover its entire population. Similarly, the EU has bought up more than three times the vaccine needs of its population, as have the UK and the United States.
Of course, it is understandable on one level that countries that invested billions of dollars of taxpayer funds in the research and development of these vaccines should be first in line. What is inexcusable, though, is that vaccine nationalism in rich countries is creating insurmountable barriers to access for developing countries. Specifically, African countries’ ability to trial and cheaply manufacture COVID-19 vaccines is encumbered by rigid intellectual property rules. As a case in point, an October 2020 proposal by India and South Africa to the World Trade Organization (WTO) to waive intellectual property protections to scale up vaccine production in poor countries was blocked by high-income members including Canada, the EU, Norway, the United States, and the UK. The waiver proposal, backed by several developing countries, argues that market-based approaches are not working as intended to make diagnostics, therapeutics, and vaccines for COVID-19 available promptly in sufficient quantities and at affordable price to meet global demand. Even the COVAX Facility, funded through donations from wealthy countries, is insufficient for ensuring timely, equitable, and universal access.
Wealthy countries rejected this proposal on the grounds that the intellectual property system incentivizes innovation and that equitable access can be achieved through COVAX and technology transfers on a case-by-case basis. At a time when newspapers, magazines, journals, and other publications are granting open access to knowledge about COVID-19, it is astonishing that vaccine nationalism is erecting barriers to knowledge sharing. Consequently (and shockingly), when some low- and middle-income African countries secure vaccine supplies, they are paying more than their counterparts in wealthy countries. South Africa purchased the Oxford-AstraZeneca jab from the Serum Institute of India at $5.25 a dose, more than double the $2.16 paid by EU countries.
Identifying Needed Next Steps
What can be done to alleviate this deeply troubling situation? Some steps can be taken within Africa. Taking the cue from countries like Morocco, the Seychelles, and South Africa, more countries should secure supplementary deals with individual manufacturers to protect healthcare workers, policymakers, military personnel, and other sectors vital to national security. These deals can be negotiated through the African Union’s Africa Medical Supplies Platform, which (since 2020) has proven effective in pooling bulk purchases of scarce but critical medical supplies. The exceptional efforts of the Africa Centres for Disease Control and Prevention in regionwide coordination, timely information sharing, and quality control of supplies from China should be sustained. However, relying mainly on COVAX and other charitable donations to combat a raging pandemic cannot be the central plank of Africans’ long-term public health strategy. Thus, the African Union should be more pragmatic in coordinating its member states toward strategies for coexisting with COVID-19 in the medium term, while limiting infections and deaths. There should also be investments in African R&D and production of pharmaceuticals, as India has successfully done.
Wealthy countries also need to take further action. They have a moral obligation to not willfully prevent developing countries from accessing the medical supplies and treatments necessary to save billions of lives. Beyond moral appeals, there are the optics of vaccine nationalism at an unprecedented juncture when history is being documented in real time. Heeding French President Emmanuel Macron’s call to reject vaccine nationalism, the leaders of the G7 countries have now announced a doubling of funding to COVAX to secure more vaccine doses and strive to roll out at least 1.3 billion vaccine doses in world’s poorest economies in 2021. This is commendable.
The WTO under the new leadership of Director General Ngozi Okonjo-Iweala should make it a priority to coordinate the relaxation of intellectual property protections for COVID-19 pharmaceutical technology to allow for timely and more affordable universal access, while strengthening manufacturing capacity in developing countries. The United States in particular can provide African countries with timely and affordable access to the Johnson & Johnson COVID-19 vaccine, which is well-suited to Africa with its less stringent storage and transportation requirements. The United States should use its long history of effective public health programs in Africa as a springboard for resetting relations with the continent.
1 These figures are taken from a data set the author compiled with Juliette Ovadia’s assistance from announcements in a variety of news media sources.