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Vaccine apartheid is prolonging COVID – not vaccine hesitancy

There’s a colonial tendency to portray people in Africa as anti-science and averse to progress, when the real problem is Big Pharma’s monopoly

Alena Ivanova
2 December 2021, 10.15am
A placard at a protest in South Africa to demand a fair, global rollout of COVID-19 vaccines, June 2021
Siphiwe Sibeko/Reuters/Alamy

Next week will mark the first anniversary of the NHS administering the first COVID-19 vaccine outside of clinical trials in a hospital in Coventry. Almost a year on from 8 December 2020, the Omicron variant threatens to ruin yet another holiday season and raises questions about the UK government’s approach.

But we already knew of the dangers of vaccine inequality. While the UK this morning announced it had ordered an additional 114 million COVID vaccine doses – despite around 85% of its adult population being fully vaccinated – just 6% of Africa’s 1.2 billion people have received two doses. And hastily reimposed travel bans on people from the African continent reveal more than the refusal of governments in the Global North to deal with the crisis at hand. The racist scapegoating of Black people has a history as old as public health itself.

There is no conclusive evidence that the new travel ban imposed by the UK on six countries in southern Africa will be effective. Indeed, there is plenty of evidence to show that the new variant was circulating in Europe much before Omicron was identified in South Africa, thanks to the scientific rigour and openness of South African researchers. Arbitrary travel bans can affect scientific cooperation and knowledge-sharing, as Tulio de Oliveira, director of South Africa’s Centre for Epidemic Response & Innovation, has warned. He tweeted that travel restrictions mean laboratories don’t get essential supplies.

But politicians and CEOs in the Global North have been busy excusing their dreadful track record on cooperation with low- and middle-income countries, blaming the low vaccination levels in southern Africa on hesitancy. Soundbites such as Pfizer CEO Albert Bourla’s claim that vaccine hesitancy in low-income countries is “way, way higher than the percentage of hesitancy in Europe or in the US or Japan”, have angered many, who have accused them of being tropes grounded in racism – akin to those used during the HIV crisis. In reality, research has suggested a higher willingness to take COVID vaccines in lower- and middle-income countries. But portraying people in Africa as anti-science and averse to progress has long been the coloniser’s excuse to dominate and subjugate and we should not be surprised that it keeps rearing its ugly head. What’s worrying is the speed with which such excuses are adopted by the UK government, while being left unchallenged by the media.

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Britain’s Africa minister, Vicky Ford, has repeatedly evaded the issue of vaccine supplies to low- and middle-income countries, focussing instead on their vaccine hesitancy when questioned in Parliament. But research shows no basis for such claims. Africa’s problem is not hesitancy but the fact that many of its healthcare systems are ravaged by privatisation, often imposed by countries such as the UK. Is it any wonder that most African countries are unable to respond quickly and efficiently to the uncertain supply of donated vaccines that arrive with little warning?

We can’t know why pharmaceutical firms keep sending low- and middle-income nations to the back of the vaccine queue

Even the so-called ‘level-playing field’ of the market doesn’t seem to deliver for African countries. Earlier this year, Botswana ordered 500,000 doses of the Moderna vaccine at a higher price than was paid by some richer countries. Delivery was expected in August, but as Zain Rizvi, a drug policy expert at US think tank Public Citizen, has noted, none had appeared by October.

What’s more, vaccine hesitancy exists everywhere. The early stages of the vaccination programme in Europe were marred by controversy around the Oxford-AstraZeneca jab, with several countries suspending the inoculation drive or switching vaccines by age group. Even now, enclaves of vaccine hesitancy and mistrust remain across the continent, yet nobody seems to deny European countries the right to an adequate supply of doses.

So where do we really stand on vaccine inequality? COVAX, the global mechanism that was supposed to facilitate equal sharing of doses through a centralised donation and purchasing scheme, has failed. Its original goal of distributing two billion doses across the world during 2021 won’t be met. Instead, COVAX now has a revised goal of distributing 1.45 billion doses by the end of the year. But at the time of writing, only 589 million doses had been shipped; shockingly half a million of those were delivered to the UK.

Pharmaceutical companies tell us that supply is not the problem. Yet, with rich countries guzzling the existing doses and refusing to share equally, the only just solution is to expand supply. But a waiver on intellectual property rights for COVID-19 vaccines, treatments and tests – a proposal to increase production that is supported by much of the world –is being blocked by the same countries that have hoarded doses and protected the financial interests of big pharma.

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As NGOs, UN agencies and the governments of less affluent states call for the suspension of patents, the stakes could not be higher

We can’t exactly know why pharmaceutical companies keep sending low- and middle-income nations to the back of the vaccine queue. Pharmaceutical companies don’t share the contracts signed with governments. But, using a much-delayed order of the Johnson & Johnson vaccine by COVAX as a case study, research by Public Citizen highlights decision-making by pharmaceutical firms that appears to deprioritise the needs of the poorest regions. Even as the company struggles to expand manufacturing capacity, it refuses to share technology and know-how and, crucially, to prevent its vaccines from being donated to certain countries. And when doses are filled and finished – the final stage of vaccine production – in the Global South, as millions have been in South Africa, they are shipped off to wealthy countries, which don’t need them as desperately on account of higher vaccination rates.

The depressing conclusion is that nobody is a winner in this game, except for the pharma CEOs we helped turn into billionaires. The US government may support a limited waiver of patents on COVID-19 vaccines, but it seems to be doing nothing to exert pressure on those who would block the move at the World Trade Organization. Meanwhile, Moderna is working through the courts to try to erase the role that public money and scientists played in developing its vaccine. The NHS has paid £2.57bn to Pfizer for 100 million doses, with a £1.903bn mark-up on production cost. That’s more than six times the sum ministers allowed NHS England to spend on pay rises for nurses this year.

Despite pumping billions into research, development and manufacturing, governments seem less in control of medical innovation than ever. Global initiatives for sharing knowledge such as COVID-19 Technology Access Pool, launched by the World Health Organization (WHO) last May, are stalling. So is the specialised mRNA vaccine hub that the WHO set up in South Africa. Both initiatives require production to open up to lower- and middle-income countries, but lack the leverage to force pharma into sharing recipes.

The UK is selling its vaccine-manufacturing centre, which was supposed to be key to future pandemic preparedness

And then we learn that the UK government is putting its flagship vaccine-manufacturing centre up for sale, after millions of pounds of public investment. It is patently absurd but unsurprising that this Tory government has concluded, nearly two years into a pandemic, that state investment in a vaccine-manufacturing centre is not needed. The site was supposed to be key to future pandemic preparedness.

Perhaps nothing about the way the world has handled the pandemic so far should surprise us. The intellectual property policy that countries in the Global South are now fighting against was designed by a former chair of Pfizer and imposed on them not so long ago under threat of trade sanctions. In its relatively short lifespan, the 1994 agreement on Trade-Related Aspects of Intellectual Property Rights or TRIPS has proved to be exactly the sort of medical monopoly that ten countries, led by India and Brazil, had resisted.

But unsurprising does not equal inevitable. Signs of resistance are everywhere, and nowhere as bold as in the Global South. From refusing to prioritise supply to rich countries, to reverse-engineering the vaccine recipes themselves, countries are taking matters into their own hands. And, as the pandemic is prolonged by outdated economic doctrines, people are beginning to see vaccine apartheid for what it is – yet another expression of a colonialist mindset.

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