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SUB-SAHARAN AFRICA: First COVAX vaccines arrive, but equity debate intensifies

Table of Contents

  • The first COVAX vaccines have now been delivered in 17 African states, enabling a few more countries to finally kick off Covid-19 vaccination campaigns.
  • However, such headlines should not distract from the slow vaccine rollout across the region and a vaccine supply pipeline for 2021 that still looks vastly insufficient.
  • Amid the widening gulf between vaccination progress in most rich and poor countries, the global vaccine equity debate is intensifying on fronts ranging from COVAX funding to IP rights.

A drop in the ocean?

Since 24 February, 17 countries in sub-Saharan Africa (SSA) received their first batches of the AstraZeneca (AZ) vaccine supplied via the COVAX initiative (see table below). According to a 2 March COVAX allocation update, 41 SSA countries have so far been allocated around 67mn vaccine doses for the period from February to May. The initiative's target is to reach at least 3% population coverage in all eligible countries in 2021-H1, enough to inoculate local health care workers, and 20% by year-end.

Under the separate African Vaccine Acquisition Task Team (AVATT) set up by the African Union (AU), some 50mn vaccines are expected throughout Q2, with a total of 270mn doses from manufacturers AZ, Pfizer, and Johnson & Johnson (J&J) in the pipeline in 2021. In addition, Russia has offered AVATT 300mn doses of the Sputnik V vaccine, along with financing packages – which would be Russia's biggest ‘vaccine diplomacy' play so far.

To date, few countries have secured additional direct contracts with vaccine suppliers. For example, Senegal, Seychelles, Sierra Leone, Ghana, Guinea, Equatorial Guinea, Mozambique, Mauritius, Uganda and Zimbabwe have received Sinopharm and/or AZ vaccines, in some cases in the form of donations from China or India. For its part, Guinea is reportedly also in talks to secure 400,000 doses of the Sputnik V vaccine, which has already received regulatory approval in six SSA countries (Angola, Republic of Congo, Djibouti, Gabon, Ghana, and Guinea).

After major delays, South Africa's supply pipeline has begun to improve on the back of direct deals with manufacturers. The country commenced a limited, trial-based vaccination campaign on 17 February, after the government pivoted from the AZ to the J&J vaccine over concerns that the AZ vaccine – 1mn doses of which had already been imported – may be less effective against the B.1.351 variant now predominant in South Africa. About 160,000 doses of the J&J vaccine have been delivered to date and are being administered as part of an ‘implementation study' pending regulatory approval. The government expects a total of 2.8mn J&J doses throughout Q2. While its public remains skeptical, South Africa is comparatively better placed than many SSA countries to make vaccination progress during 2021; it now expects 11mn vaccine doses of J&J's single-shot vaccine (with talks for a further 20mn doses reported), about 20mn from Pfizer, and 12mn via COVAX. However, it remains to be seen whether the government will take up the AZ vaccines allocated under COVAX.

One stand-out success story in the vaccine race is the Seychelles. The government this week stated that it expects to complete inoculating 70,000 residents (70% of its population of around 100,000) by mid-March. The country benefited from early donations of the Sinopharm and AZ vaccines from the UAE and India, respectively, and purchased additional doses of the AZ vaccine. Its small population renders the vaccine rollout more manageable, though failure is hardly an option given the heavily tourism-dependent economy.

In total, as of 8 March, 24 SSA countries have received a cumulative 16.95mn doses of various provenance:

SUB-SAHARAN AFRICA: First COVAX vaccines arrive, but equity debate intensifies 1

Yet overall, the current vaccine pipeline for a continent with a population size of 1.3bn is hardly sufficient. If COVAX aims to supply sufficient vaccines for 20% of the population and additional supply contracts (direct or via AVATT) remain limited, the vaccine pipeline could be but a drop in the ocean of what is required to achieve ‘herd immunity' anytime soon. This is particularly concerning in the context of new variants, as well as the region's recovery prospects.

Vaccine equity debate intensifying

As a result, the debate around global vaccine equity appears to be intensifying. The need for a bigger and better COVAX facility is all too obvious, given that many countries are heavily reliant on COVAX but that the facility – to date – is only expected to cover 20% of the beneficiaries' population. While vaccine nationalism continues to dominate the posture of many rich countries, the recognition of the need for multilateral commitments to the global vaccine fight appears to be strengthening. At the G7 summit on 19 February, the US, Germany, European Commission, Japan, and Canada pledged an additional USD 4.3bn to the WHO's Access to Covid-19 Tools (ACT) Accelerator to fund the development and rollout of the tests, treatments, and vaccines. Despite total commitments now at USD 10.3bn, the ACT Accelerator still faces a currently estimated funding gap at USD 22.9bn. However, The Economist estimates that the COVAX scheme is only USD 800mn short of this year's target. Another proposal is that rich countries pledge surplus vaccines, though a timeline is missing, and will probably depend on the supply picture and the progress of vaccination campaigns in Western countries.

Separately, the World Bank is readying emergency vaccine financing for some 30 countries in the region. Loan sizes are still uncertain but could be small judging by a first International Development Association (IDA) financing deal for Cabo Verde worth USD 5mn. A more significant upside – not only in terms of vaccine acquisition but also broader economic recovery and debt issues – could be proposals to advance the International Monetary Fund (IMF) ‘s issuance of Special Drawing Rights (SDRs) which is gaining traction under the new US administration.

Yet unless global vaccine access (and issues around transparency and pricing) are addressed at the multilateral level, the debate around intellectual property (IP) rights may not abate. Talks are ongoing at the World Trade Organization (WTO) regarding South Africa and India's proposal for a waiver of IP protections for Covid-19 treatments, including vaccines. Resistance from European countries and the US remains strong; a recent interview with Emmanuel Macron suggests that he sees bolstering global vaccine funding and distribution as a way out of IP debates.

Ahead of a WTO meeting this week, WHO chief Tedros Adhanom Ghebreyesus, calling for sustainable vaccine manufacturing and production across the globe, has indicated his support for a temporary waiver on patents for Covid-19 vaccines. The WTO's newly minted secretary-general, Ngozi Okonjo-Iweala, shares his concerns, though she has alluded to a “third way.” As a first step, she has called on WTO member countries to end export restrictions to improve global vaccine availability. She has further suggested that licensing agreements by major vaccine manufacturers like AZ, rather than more common contract manufacturing agreements, could facilitate technology transfer while still protecting IP rights.

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SUB-SAHARAN AFRICA: First COVAX vaccines arrive, but equity debate intensifies

The first COVAX vaccines have now been delivered in 17 African states, enabling a few more countries to finally kick off Covid-19 vaccination campaigns.