Rich nations first ignored the World Health Organisation’s (WHO) call to pause COVID-19 vaccination booster shots to allow the rest of the world to catch up. This week, they brushed aside WHO’s requests to suspend vaccinating children, so that regions like Africa can increase shots to adults. Staff Writer, MBONGENI MGUNI asks who’s listening to WHO?
“Countries with few or no vaccine supply constraints should consider the issues of global equity when making policy decisions about vaccinating children and adolescents,” WHO said in a statement on Wednesday.
“In the context of ongoing global COVID-19 vaccine supply constraints, the focus of immunisation programmes must remain on protecting sub-populations at highest risk of hospitalisations and deaths.”
The global health body added: “While higher-income countries expand their vaccination programmes to adolescents, children, and, in some countries, booster doses to a large proportion of their populations, many lower-income countries still lack sufficient vaccine supply to offer a primary vaccination series to their highest priority-use groups, including older adults and health care workers who comprise only a small proportion of their populations.”
Children usually demonstrate fewer and milder symptoms of COVID-19, WHO says, and carry a lower risk of contracting the disease compared to older adults.
“Although benefit-risk assessments clearly underpin the benefit of vaccinating all age groups, including children and adolescents, the direct health benefit of vaccinating children and adolescents is lower compared with vaccinating older adults due to the lower incidence of severe COVID-19 and deaths in younger persons,” the global health body states.
In addition, the risks of adverse effects after vaccination tend to show up more with children than adults.
WHO’s reasoning for greater vaccine access by poorer countries is backed by data showing that while the rich countries have more or less fully vaccinated their eligible populations or at least those who have come forward for jabs, just four percent of Africans were fully vaccinated as at mid-November.
But who is really listening to WHO?
From the trends throughout the pandemic, richer nations certainly are not. And their proximity to vaccine manufacturers, as well as firm agreements struck in advance for supply, means they can pay lip service to vaccine equity and focus on taking care of their own.
Vaccine inequity, or the trend by wealthier nations who also house the vaccine manufacturers to hoard the life-saving jabs for their own populations, has been a touchy subject throughout the pandemic.
WHO has been like the Biblical prophets “rising early and being sent,” but the nations with their hands-on supply have not “hearkened”.
The lip service was underlined by a research report this week indicating that rich nations and COVID-19 vaccine manufacturers are undersupplying WHO’s COVAX facility, which is a vaccine sharing agreement for about 181 mainly poorer nations. Instead, rich nations prefer to make pledges of donations to the poorer nations and even then they have fallen far short of fulfilling their promises.
Entitled ‘How the Vaccine Rich Get Richer’, the report by the Access to Medicines Programme, a Washington DC-based NGO, underlines the behind-the-scenes politics that perpetuate vaccine inequity.
Botswana, in particular, is cited as a victim of these tactics because, despite the fact that the country has been able to independently secure total coverage outside of COVAX, vaccine deliveries are still being prioritised to rich nations that are pursuing booster and child vaccination drives.
The prioritisation is deliberate says Zain Rizvi, the report’s lead author who used Johnson & Johnson as a case study.
“According to a 2020 contract, if a member state wants to donate vaccines outside the EU, J&J controls who gets access,” Rizvi says.
“The corporation and member state must ‘mutually agree’ on the terms and conditions for donations. “One of the required conditions is that donation recipients, like COVAX, cannot send the vaccines to upper-middle-income countries.”
The result has been that Botswana, as an upper-middle-income country, has paid for vaccines under COVAX and the African Union’s AVATT facilities, but has had to fight for the trickle that has come in.
The allegation that Johnson & Johnson controls who rich nations donate to appears to hold water for Botswana. The country paid for 1.1 million doses of the Johnson & Johnson vaccine before February this year, and to date has only received just over 300,000 doses.
The United States, which has donated 200 million vaccines to more than 100 countries, has so far given Botswana 182,160 doses of Pfizer. The only Johnson & Johnson donation Botswana has received so far has been of 50,400 doses from neighbouring South Africa.
The distinction, analysts say, is that Johnson & Johnson is a single-shot vaccine that has less rigorous cold storage requirements, making it ideal for Africa and its rural populations in particular.
The issue of vaccine equity has become a continental rallying call, with Presidents, Cyril Ramaphosa and Mokgweetsi Masisi, frequently raising the issue at international fora. At the UN General Assembly held in New York in September, Masisi took the issue to the world.
“Botswana shares the frustration by many and strongly supports the call for vaccines to be treated as a global public good, as this is key to recovery and rebuilding better from the COVID-19 pandemic,” Masisi said.
“A more equitable global vaccination roll-out programme is urgently needed if we are to win the race against new variants.
“Let us be mindful of the fact that a variant somewhere is a variant everywhere.”
The African Union’s specially appointed vaccine lobbyist, Zimbabwean billionaire Strive Masiyiwa, has been unequivocal in the causes of vaccine inequity.
“This was a deliberate global architecture of unfairness,” Masiyiwa said on June 23, 2021, at a summit on vaccine equity.
“Imagine we live in a village, and there is a drought.
“There is not going to be enough bread, and the richest guys grab the baker and they take control of the production of bread and we all have to go to those guys and have to ask them for a loaf of bread: That is the architecture that is in place.”
Calculations by COVAX, UNICEF and the International Monetary Fund suggest that only 13% and seven percent of COVAX and AVATT contracted vaccines respectively, have been delivered thus far, leaving countries such as Botswana dependent on donations and the slow-drip bilateral deals.
The worst culprit in this is Moderna, which by November 11 had delivered just seven million doses of the 267 million doses contractually agreed with COVAX. Botswana inked a bilateral deal for 500,000 doses with Moderna in June and received 49,200 in October, with government saying the balance would arrive in the “following months”.
Pfizer has delivered just 112 million doses of the more than one billion contracted to COVAX, while the vaccines manufactured by Indian and Chinese labs have performed much better.
Even within COVAX, Botswana has faced challenges securing its fair share of supply, with the distribution system largely allocating doses proportionally amongst its members according to population size, but regardless of their vaccination coverage.
The system, according to a Reuters report, meant that wealthy nations with healthy vaccine coverage rates received far more doses than poorer, under-covered nations.
COVAX has since revamped its distribution system so that vaccine deliveries are prioritised to countries with the least coverage.
Rizvi says the US and the EU can also change the situation by requiring manufacturers like Johnson & Johnson (J&J) to prioritise deliveries to COVAX and other developing country purchasers.
“To support lagging global production, the US can use the Defence Production Act to require J&J to work with producers around the world,” he says.
The leaders of rich countries can also lean more on manufacturers to share the vaccine formulas to allow production to kick off in more countries in Africa, to better protect not only the continent but the world.
WHO has called for this as early as March this year, with senior officials there urging rich nations to open up vaccine patents to the developing world.
Will the rich nations and manufacturers listen to WHO?