Dr. Chinwe Obuaku-Igwe : “African countries need to own local productions of generic vaccines ”

How to promote access to the covid 19 vaccine in Africa? According to Chinwe Obuaku-Igwe, lecturer and researcher in sociology of health at the University of the Western Cape in South Africa, the solution lies in the local production by African countries of generic vaccines and partnerships with large corporations. 

What is the current status of Covid 19 vaccination in Africa?

Globally, over 50million doses of the vaccine has been administered in various settings, with 235 331 045 people, (about 3%) fully vaccinated. There are some vaccines that require two doses; hence the number of doses are different from vaccination cases. The vaccination stats for African countries, as of the latest data, are: Morocco (11,8%), Rwanda (2,8%), Zimbabwe (0,31%), Tunisia (0.46%), South Africa (0.5%), Guinea (0.3%), Seychelles (69%), Equatorial Guinea (0.62%), Gabon (0.02%), Djibouti (0.5%). 

There are countries that do not have publicly available data on their vaccination status but most civil servants, front line workers, members of the armed forces, the elderly and other ‘high risk’ demographics are getting vaccinated. They include Nigeria, Ghana, Kenya, Egypt, Ethiopia, Senegal, Angola, Uganda, Malawi, Togo, Sudan, Mauritius, Côte d’Ivoire, Algeria, Eswatini, Botswana, Mali, Gambia, Lesotho, Republic of the Congo, Cape Verde, Papua New Guinea, South Sudan and Cameroon.  Countries like Liberia, Somalia have been able to acquire vaccines from the COVAX Facility to vaccinate specific populations in multiple phases. 

Burkina Faso seems to be the only country that has not started vaccinations nor declared its intentions publicly. Madagascar has not started vaccinations yet but they are promoting the Covid Organics (CVO) plant-based tonic cure. Just like Madagascar, in February, Tanzania rejected the covid-19 vaccines and even though the President later started advocating for precautionary measures, it appears the country is yet to reverse that decision. Based on available data, it is quite surprising to note that Cameroon and South Sudan have administered the lowest doses. In terms of perceptions and behavioral patterns, while Nigerians are hesitant to get vaccinated, Kenyans are keen to get the vaccinations. 

I think one pattern that really stands out is the fact that a good number of African countries are heavily dependent on AstraZeneca vaccine which is received pro bono from the COVAX facility, a global initiative focused on giving access to vaccines to low-income countries.

What is preventing the Covid 19 vaccine from being accessible in Africa?

There are a lot of reasons why most African countries are unable to procure vaccines for their citizens. Interestingly, these are strikingly similar to the wider challenges of access to essential medicines – Accessibility, Affordability, Availability, Acceptability and quality. 

The first reason is the issue of affordability. Most national governments in Africa cannot afford covid-19 vaccines at the moment. As a result, most of them are depending on donations from Western countries and from China. When the pandemic started, a lot of high-income countries which have access to R&D sped up the process of vaccine production and some had their clinical trials in Africa. But what happened was that rich countries who have the means bought the first batch of vaccines at ridiculously low prices. The challenge now is that poor countries, particularly those in Africa, now have to pay a lot of money or wait for the vaccines to be donated by the wealthier countries. Most vaccines are supplied on a first-come, first served basis and any country that wants to get it has to speed up negotiations and payment.In March 2021, China produced, donated and exported about 48% of its locally manufactured covid-19 vaccines to low-income countries. Russia and Cuba are also supporting low-income countries. 

The second reason is the issue of accessibility. There are reports of vaccine companies bullying countries and making outrageous demands from national governments in the form of payments. In some instances, some vaccine manufacturing companies are demanding collateral for future legal costs, a form of exemption from legal liabilities. Others requested guarantees and other forms of payment for potential costs of civil cases that might come up due to their own malice, fraud or negligence.

As a result of these outrageous demands, it took over three months before vaccine companies and national governments could reach a deal. This further contributed to the delay in vaccination in most African countries. The implication of offering exemption from legal liability to vaccines manufacturers is that in the event that people suffer any side effects from the vaccinations and decide to sue the companies, the government will pay out, instead of the companies being held liable. 

The politics of procuring covid-19 vaccines says a lot about global inequality and the political economy of global health. However, poverty and poor capacity in relation to R&D seems to be working against African countries. For instance, the first 723,000 (about 7 million) of COVID-19 vaccines that got to African countries were donated by a South African telecoms company. At the moment, most African countries are depending on the COVAX facility and supplies from donors. The current trend suggests that African countries are only receiving what is left after the big countries scrambled for the vaccines. Based on these, it is apparent that most African countries will only access vaccines when the higher income countries are fully vaccinated. 

How to promote access to the Covid 19 vaccine in Africa?

Before I answer this question, I would like to begin by stating that right from 1930, African countries have been hosting pharmaceutical manufacturing companies and have supported a lot of them in assembling production facilities and in the production of medicines in the continent. From 1930 to 1960, African countries like Kenya, Nigeria, South Africa and Zimbabwe had started manufacturing medicines. For instance, May and Baker was established in 1944 in Nigeria, etc. One might ask, if African countries have the capacity to produce vaccines and have been doing so since the 1930, then what is the problem? Why is it that Egypt, Liberia, Nigeria and other African countries are mostly acquiring vaccines under the COVAX agreement for low-income countries? Apart from politics, poverty and poor capacity seem to be working against African countries. 

One of the ways African countries can promote access to vaccines is through the production of generic vaccines. If African countries can unite and advocate for the right to produce generic vaccines, by 2025, vaccines will be cheaper and easily accessible.When vaccines or medications are produced locally, it lowers cost and increases accessibility. At the moment, China is making plans to set up production plants for Sinovac locally in SA, Indonesia, Brazil, countries. Russia is equally supporting low-income countries with Sputnik. 

Egypt, Thailand, Malaysia and the United Arab Emirates are entering into partnership with other neighboring countries for Covid-19 vaccines production. In order for African countries to meet current demands for vaccinations in the continent, they need to own local production of generics or partner with large corporations/countries like China, Japan and Russia because donations alone cannot solve the problems.

Finally, the challenge of people who are refusing to take the vaccine, even if it is available, should be challenged ahead of availability. As a continent with deep religious beliefs, there is a risk that large populations of people will refuse to accept the jab even when it becomes available.

Danielle Engolo