THE coronavirus pandemic has brought a lot of problems – an unprecedented challenge to public health, travel and trade restrictions, food crisis, social and economic disruptions, insecurity, confinement and depression, etc., but the major challenge of the moment is ensuring that no one is left behind in the covax programme, as rich countries buy up every available vaccine, leaving poorer countries stranded.

A week ago, the European Medicines Agency (EMA) approved Johnson & Johnson’s one-dose coronavirus vaccine for use in all adults over 18 after finding that the vaccine met the criteria for efficacy, safety and quality.

EMA has previously recommended COVID-19 vaccines made by Pfizer-BioNTech, Moderna and AstraZeneca, requiring two doses to be taken several weeks apart. All vaccines’ clinical trials must first show they are safe and effective before any vaccine can be authorized or approved for use. However, the agency is yet to approve Russia’s Sputnik V coronavirus vaccine, developed in August 2020, for public use, even though it is said to give around 99 percent protection against covid-19.

Russia was indeed the first country to register a vaccine against the deadly coronavirus that had killed more than 2.6 million people globally since January 9, 2020, when the first death was recorded in Wuhan, China. Since early December, more than two million Russians have been vaccinated with at least the first dose of Sputnik V, according to Health Minister Mikhail Murashko.

Meanwhile, the UK has vaccinated more than 21 million people in its first four out of 10 priority groups with at least one dose of the Pfizer-BioNTech coronavirus vaccine since it began a mass vaccination programme on December 8. The government has rolled out a coverage expansion plan to give at least one jab of the vaccine to everyone in priority groups five to nine by April 15.

In the United States, public coronavirus vaccination began on December 14, and more than 95.7 million doses have been administered according to data obtained by The ICIR from the U.S. Centers for Disease Control and Prevention. Administering an average of 2.1 million shots per day, the country has now vaccinated 18.8 percent of its total population. More than 62.4 million persons have received at least one dose of the vaccine. In contrast, 32.9 million have been fully vaccinated.

Dubai’s Supreme Committee of Crisis and Disaster Management started an extensive vaccination campaign against Covid-19 in late December 2020, giving more priority to the elderly and those with chronic disease. Over 5million people and 58 percent of elderly residents in the UAE have been vaccinated. The government says it aims to vaccinate 50 per cent of the population against infectious disease by March 31, 2021.

Covid-19 Vaccination in Africa

The COVID-19 pandemic has caused great devastation on the African continent, with more than 3.4 million confirmed cases and nearly 87,000 COVID-19 deaths to date. It has also severely impacted the continental economy, education, health programmes and other elements critical to Africa’s Agenda 2063. At the start of 2021, Africa faced a second wave, with far more reported cases and deaths than in the early months of the global pandemic.

However, while richer countries take the lead in covid-19 vaccinations, the difference in coverage is starker by ethnicity, with black populations having the lowest coverage. Many poorer countries, especially in Africa, are yet to access the vaccines. The World Health Organization (WHO) has warned that the crisis cannot end unless everyone can inoculate their populations.

Guinea was the first country in Africa to receive Covid-19 vaccines and rolled out vaccination on December 30, 2020. The country used Russia’s Sputnik V vaccine and had vaccinated 55 people out of its more than 12 million population, mostly government officials, as of late January. Guinea is now battling to keep the Ebola virus which has resurfaced in the country, under control.

On February 16, 2021, South Africa began administering the 80, 000 doses of the J&J vaccines, which were approved by the EMA on Thursday, as part of a study that allowed normal regulatory approvals to be bypassed. The country switched to using J&J shots after a study showed shots developed by AstraZeneca Plc and the University of Oxford had little impact on mild infections caused by a variant of the virus first identified in the country last year.

South Africa later received another 220,000 doses of the J&J vaccine and so far has inoculated more than 100,000 healthcare workers who are the immediate priority group. A further nine million doses are expected from the pharmaceutical company by the end of June and an additional 20 million vaccines from Pfizer before the end of the year.

On the other hand, Ivory Coast has received 504,000 doses of the Oxford-AstraZeneca COVID-19 vaccines, which it began administering on March 1. The country’s health minister, Eugène Aka Aouélé, said the first phase of vaccination targets health personnel, defence and security forces and teaching staff in Abidjan, where 95 percent of the country’s cases have been recorded.

With over 580 lives lost to the Covid-19 pandemic, Ghana began mass vaccination of people in about 43 epicentre-districts in the Greater Accra, Ashanti and Central regions on March 2 after the country received 600,000 AstraZeneca-Oxford vaccines, which is said to provide about 66 percent protection against the virus, as part of an initial tranche of deliveries.

In Nigeria, Africa’s most populous country with an estimated 200 million people, 3.94 million Oxford/AstraZeneca coronavirus jabs arrived on March 2, same day 624,000 of the same vaccine brand arrived Angola and Kenya received 1.02 million doses. In all three countries, priority is given to frontline health workers and government officials to administer the vaccines.

Race towards the Vaccines

With 44 bilateral deals between governments and pharmaceutical companies (dominated by rich countries) signed last year, and at least 12 more already signed this year for the production and distribution of the covid vaccines, there is no doubt a stiff competition of who gets the vaccines first. In an interim report on the global response to the covid-19 pandemic released on Thursday by INET’s Commission on Global Economic Transformation, the institute accused richer countries of hoarding vaccines, thereby denying poorer countries access them.

“We have witnessed unseemly and unfair vaccine grabs by the governments of some of the advanced countries, sometimes (as in the case of Canada) they have ordered vaccine shots for more than ten times their current population and are appropriating for their country 1.5m doses via COVAX as per its technical right,” the report said in part, noting that that the equitable distribution of vaccines is not just a moral imperative, but a strategic and economic imperative.

Similarly, the African Vaccine Delivery Alliance (AVDA) co-chair, Ayoade Alakija, pointed in a recent interview with CNN’s Christiane Amanpour that. In contrast, some countries in Europe and America were vaccinating about three million people in a single day. Many countries in Africa have not received a single dose of the vaccine.

“We’re in a race against time, we’re in a race against the virus and there’s no way that we can win this race unless we have equity unless everybody has a chance to get a vaccine. The issue is the western nations and, in fact, the global north, have bought up every available vaccine,” she stated.

On his part, Tedros Ghebreyesus, Director-General of the World Health Organisation, admitted during the 148^th session of the Executive Board in January that “we now face the real danger that even as vaccines bring hope to some, they become another brick in the wall of inequality between the world’s haves and have-nots”.

“It’s right that all governments want to prioritize vaccinating their own health workers and older people first, but it’s not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries,” Ghebreyesus added.

While it is encouraging to see more countries in Africa receive doses of the vaccines, it is sad to note that this comes almost three months after some of the wealthiest countries started their vaccination campaigns.

Production Delays

Another reason for the slow coronavirus vaccine rollouts in Africa is the delay in production caused by shortages of some raw materials, the invention of new technologies and equipment, expertise and the need to keep up production of vaccines against polio, measles, meningitis and other diseases that still pose a threat in the midst of the pandemic.

As demand for the vaccines outpaces the supply, the world’s largest vaccine maker, the Serum Institute of India, has pledged to manufacture a billion doses of the AstraZeneca vaccine, but the growing list of countries suspending the use of this brand of vaccine might throw a spanner in the wheel of efforts aimed at increasing production. Bulgaria, Thailand, Denmark, Iceland, Norway and at least 14 other countries have all halted their use of the vaccine over reports of people getting blood clots after receiving a dose.

Manufacturers of Moderna, another approved vaccine, announced in January that they are targeting a minimum of 600 million doses before the end of the year, even as the recently approved Johnson & Johnson aims to supply more than one billion doses globally through the course of 2021.

While halting the AstraZeneca vaccine’s use might be a setback in the race against the virus, manufacturers of Novavax, another vaccine awaiting approval, plans to push out 100 million doses of its Covid-19 vaccine by the end of June as soon as it gets a nod. Health experts say more approvals are required to guarantee faster rollouts.

Vaccine Patency

A patent is a form of competitive advantage that gives its owner the legal right to exclude others from making, using, or selling an invention for a limited period of years (minimum of 20 years) in exchange for publishing an enabling public disclosure of the invention.

However, there are instances, especially in the health context, which allow patent waivers to be granted to promote competition and increase the affordability of drugs while ensuring that the patent owner is compensated for the use of the invention.

Given the coronavirus pandemic’s emergency, activists and drug groups are in a waiver war over COVID-19 shot patents. While South Africa and India, largely backed by dozens of developing countries at the WTO, renewed their bid to waive rules of the World Trade Organisation’s Trade-Related Aspects of Intellectual Property (TRIPS) agreement that could allow generic or other manufacturers to make more vaccines, Western countries, including Britain, Switzerland, EU nations and the United States, which have large domestic pharmaceutical industries are opposed to the waiver.

These Western nations argue that protecting intellectual property rights encouraged to research and innovation and that suspending those rights would not result in a sudden surge of vaccine supply.

Ngozi Okonjo-Iweala, the Director-General of the WTO, has urged vaccine manufacturers to collaborate with bodies such as the World Health Organization and vaccines alliance GAVI, to examine possible options, adding that “we must make sure that in the end, we deliver so that the millions of people who are waiting for us with bated breath know that we are working on concrete solutions”.

“The world has a normal capacity of production of 3.5 billion doses of vaccines, and we now seek to manufacture 10 billion doses. I propose that we ‘walk and chew gum’ by also focusing on the immediate needs of dozens of developing countries that have yet to vaccinate a single person. People are dying in developing countries,” she said in a speech on March 1, after the WTO General Council meeting.

The waiver proposal needs backing by a consensus of the WTO’s 164 members to pass, and the council is expected to meet twice in April to discuss the matter before the next scheduled TRIPS Council meeting on June 8-9.

Vaccine Hesitancy

Vaccine hesitancy refers to those who are undecided, unlikely to accept a vaccine or have declined a COVID-19 vaccine offer. Slow vaccination rates in Africa and black communities have also been attributed to vaccine hesitancy, characterized by uncertainty about the vaccines’ safety and efficacy, and insufficient engagement and sensitization campaigns. There are also access barriers in some cases and mistrust caused by centuries of systemic racism, discrimination and exploitation. America has had a long history of using black bodies for experimentation since the days of slavery.

Among adults with ethnic minority backgrounds in the UK, Black or Black British adults were most likely to report vaccine hesitancy, with 44percent of Black or Black British adults reporting hesitancy compared with 8 percent of white adults.

President of Tanzania, John Magufuli, said in January that God had eliminated coronavirus in his country and expressed doubt about vaccination which he termed “inappropriate”.

“If the white man was able to come up with vaccinations, then vaccinations for AIDS would have been brought, tuberculosis would be a thing of the past, vaccines for malaria and cancer would have been found,” he was quoted as saying.

In the same vein, Burundi’s health minister, Thaddee Ndikumana, has said that his country was more interested in preventing the virus than in rolling out vaccination plans. “Since more than 95% of patients are recovering, we estimate that the vaccines are not yet necessary,” he said.

There are calls for more effective public health message and sensitization campaigns in Africa and black communities to encourage increased voluntary participation in the ongoing vaccination exercise.

Efforts towards Vaccine Equity

COVAX was launched by the World Health Organization, the European Commission, and France as a global response strategy to the COVID-19 pandemic that seeks to ensure equitable and swift access to the COVID-19 vaccine in 190 countries across the globe, irrespective of their developmental phase or level of income.

This initiative provides a lifeline for low-income countries that are not self-sufficient to purchase the COVID-19 vaccine for their populace and hopes to bridge the inequality gap between richer and poorer countries.

Most of the inoculations received in Africa have come under this programme to supply vaccines to dozens of countries in the first 100 days of 2021 and two billion doses by the end of the year.

To complement COVAX efforts, the African Union has secured 670 million vaccine doses for the continent which will be distributed in 2021 and 2022. The African Export-Import Bank will facilitate payments by providing advance procurement commitment guarantees of up to US$2 billion to the manufacturers on behalf of countries.

As production capacity increases and more vaccines become available, the AU aims to vaccinate at least 60% of Africa’s 1.3 billion population with at least a single dose. At the same time, WHO has earmarked 600 million doses for Africa.

Delayed vaccination of people across the world increases the possibilities of virus mutation. It reduces the ability to control the pandemic even in rich countries that have secured access to the vaccines. Also, an extended fear of infection caused by the vaccines’ inequitable distribution can slow down trade and hurt the world economy, thereby delaying global recovery from the pandemic.