By Dr. Githinji Gitahi, Group CEO, AMREF Health Africa
Solidarity is not new to African communities. It refers to notions of unity, mutual aid and sharing, locally expressed in words such as ‘Ubuntu’, ‘Turihamwe’ and ‘Umoja’.
We are defined throughout our history by this concept of ‘solidarity’ and it is something we should never abandon nor let it run out of steam, particularly in times of a global pandemic. Pandemics have affected civilisations throughout human history and we have seen their impact on society, both in devastating populations and changing the course of history.
The COVID-19 pandemic has manifested itself on an unprecedented scale. So far over 4.8 million deaths have been reported around the world, pushed millions into extreme poverty, shrunk governments fiscal capacities and strained nations health systems. For the past year, countries and their governments have put in a lot of effort to fight the virus and roll out massive vaccination campaigns. Vaccines are one of the most successful developments in modern medicine, backed by significant amounts of real-world evidence and clinical trial data, that we must believe in to protect our populations.
In a globalised and interdependent world, there is no secret: we must come together to save lives. In this regard, we rightly saw an upsurge of global solidarity. COVAX, a unique and ambitious global initiative was created to procure and distribute vaccines to low and middle-income countries. COVAX is the largest, most rapid and complex roll out of vaccines in history with more than 190 countries and territories participating. Since the first delivery of 600,000 AstraZeneca vaccine to Ghana back in February, over 435 million COVID-19 vaccines distributed to 144 participants by the time I was writing this. This is the first global vaccine initiative of its kind, with multiple manufactures contributing to its efforts. Realizing the COVAX ambition, was never going to be easy; is not going to be easy.
Despite over $10 Billion dollars raised through multilateral solidarity, 4.5 Billion vaccines doses booked and financially guaranteed, COVAX remains holding empty promises!
Global vaccination equity remains a challenge. Only 1.8% of people in low-income countries have received their first doses of COVID-19 vaccines, compared to 82% in high and upper-middle-income countries. Africa still has the lowest vaccination rate, and we must improve it through COVAX and working collaboratively with initiatives like AVAT (Africa Vaccines Acquisition Trust) by Africa Union. To quote WHO’s guidance, no one is safe, unless everyone is safe.
That said, we must not overlook the important strides made over the past few weeks. It has required a high level of collaboration among many partners – governments, development organisations, UN agencies and vaccine manufacturers, as well as healthcare workers tirelessly managing the vaccination programmes across the continent that has now fully vaccinated slightly below 5% of its population up from 1% in July. Given the export restrictions in India and despite the magnitude of this supply operation, COVAX is currently the best scalable and viable and solution to fight the pandemic and it has given hope to millions of people that they will be able to return to a new normal. This hope is built on the knowledge that global, equitable access is the only way out.
Such globally collaborative initiatives must continue to be supported by our African governments and should not be perceived as just another aid project targeted at poor countries and must work closely with the African Vaccine Acquisition Trust (AVAT) initiative to deliver for all of Africa while avoiding the debt trap that may arise from direct purchases. Its estimated that without multilateral support. Low income countries would need to increase their health budget by almost 60% in order to vaccinate 70% of their populations – not tenable!
We understand that COVAX has had shortcomings making it far from perfect and so is every other national, regional and global mechanism and response during this pandemic. The call here is to address wider global policy and governance challenges that already existed before the pandemic and which must be addressed if the world is to end this pandemic faster and prepare itself for the next pandemic. This includes but is not limited to other problems such as vaccine nationalism, and which can be addressed by global treaties that result in timely increased contributions from G7 countries. In addition, national governments must address vaccine skepticism and healthcare infrastructures weaknesses that are also slowing down vaccination programmes, contributing to the shortfall in vaccination targets.
We must trust the science behind the vaccine and the innovation behind the COVAX initiative, which was inspired by mechanisms that enabled universal and equitable access to pneumococcal, measles and HPV vaccines. COVAX is built on the lessons learnt about equity as a driver of a more just and healthy future. We recognise that the global picture of COVID-19 vaccine access and roll out is still unacceptable, and we must continue working together to stop the growing vaccine inequity and prevent the virus continuing to destroy lives – we must act now! We welcome the calls for vaccine manufacturers to prioritise COVAX, along with firm commitments to provide transparency on pricing and timelines for availability, to allow countries to plan in advance.
We are confident that COVAX can make a greater impact in Africa and other low-income communities vulnerable to COVID-19. To support the initiative, it is imperative that governments recognise the importance of COVAX and increase doses to African countries via this route, realizing that it currently represents the most viable option for supply and distribution at scale built on its many years of experience and capacity distributing childhood vaccines. However, on its own it will not eradicate the virus and we need continued joint collaborations and initiatives to tackle all the issues at hand, end stockpiles to share more doses, limit boosters, increase manufacturing through knowledge sharing as seen between AstraZeneca and Serum Institute of India and invest in national and local health systems – do this today rather than tomorrow to vaccinate the whole world.