Bridging Africa's Health-Care Divide

For the past 30 years, everyone assumed that developed and developing economies were converging, with higher growth rates in Africa and elsewhere helping those countries to catch up. But African economies are now growing at only half the average global rate. Divergence is becoming the new order of the day. And with growing fiscal pressures, increasing debt, mounting inflation, rising interest rates, and supply-chain disruptions creating new barriers to growth, it is almost certain to get worse in 2022.

This outcome is not inevitable, but the only way to reverse it is to extend the benefits of vaccination and other medical protections from the Global North to the Global South. As we write, only 8.5  per cent of African adults have received one dose of Covid-19 vaccine. Of the 6.9 billion doses that had been administered globally by mid-October 2021, only 176 million (just 2.5 per cent) were in Africa. Under 1 per cent of the population in a dozen African countries has been vaccinated, and the rate for the continent as a whole is just 5  per cent, compared to 62  per cent in high-income countries. Worse, the Access to COVID-19 Tools Accelerator (ACT-A) projects that there will be 200 million more COVID-19 cases in the coming year, three-quarters of which will be in low- and middle-income countries. Without vaccination, these infections could cause another five million deaths in the next year (exceeding the 4.9 million recorded deaths from the virus so far). Africa could become the pandemic’s long-term epicenter.

At their summit in June, G7 leaders committed to vaccinate the entire world by the end of 2022, promising Africa hundreds of millions of doses. But, because the event was run in the manner of a charity fundraiser (with each country simply offering to donate what it could), no operational plan or timetable was established. As a result, the CovidOVID-19 Vaccine Global Access (COVAX) facility, the international bulk-purchasing agency that had initially hoped to allocate two billion vaccines by this December, was forced to cut its delivery projections to 1.4 billion. So far, it has only had enough supplies to release 406 million doses to 144 countries, with 326 million going to the 91 poorest countries. The world thus fell far short (by 200 million doses) of its goal to vaccinate at least 10 per cent of the population in every country by the end of last month. In Africa, 39 of 54 countries missed the target. More donations were announced at a vaccines summit hosted by US President Joe Biden in September, where some progress was made toward setting a new hard target: vaccinating 40 per cent of adults in every country by the end of this year. But, again, there was no agreement on a timetable or delivery plan, and the richest countries’ donations have yet to match their pledges. As a result, COVAX needs 500 million more doses by this December – and five billion more next year to achieve the overall global target of 70 per cent vaccination coverage.

Aware that these promises are not being met, African leaders have taken decisive action. The African Union has formed the African Vaccine Acquisition Trust (AVAT) to coordinate its vaccine-distribution effort, and with a deal to purchase 400 million single-shot vaccines from Johnson & Johnson, shipments have been underway since August (to be completed in September 2022). Moreover, a purchase agreement with Moderna this month should provide another 100 million doses, with 50 million arriving in three batches between December 2021 and February 2022. Owing to its own efforts, Africa will be able to vaccinate up to 100 million people by the end of this year. It has secured enough future supply to vaccinate 35 per cent of its population in 2022 – half the 70 per cent target set by the World Health Organization. The problem it has yet to overcome lies with Western donors, whose unfulfilled promises have left a large shortfall. No one now doubts that, in the long run, Africa will need to create its own manufacturing capacity, just as it is now creating its own medicines agency. When it does, it will need technology-transfer licensing agreements and patent waivers. This is where the G20 comes in. While the International Monetary Fund, the World Bank, and the World Trade Organization are doing their best to coordinate vaccine efforts with the WHO and others, they do not control the flow of vaccines.

Project Syndicate