It cannot be said enough that Africa has been pushed behind the rest of the world when it comes to COVID-19 vaccine acquisition and administration. The vaccine has been in our lives for over a year and yet, just over 15% of Africa’s 1.3 billion population has been fully vaccinated. Vaccine nationalism, or “vaccine apartheid” as Kenyan and South African officials have referred to it, is an ongoing issue that needs to be taken seriously.

In response, leaders and organisations from around the world have stepped up to help the continent secure doses. The question of whether enough doses have been secured for all of the continent’s people is a conversation on its own (the short answer is no), however the question we need to ask right now is whether the current initiatives and commitments are helpful or harmful in today’s health landscape.

Yes, there have been pledges made and commitments declared to make sure that Africa has her people protected from the pandemic, but words are not actions — and if there is action, there’s no guarantee that the action will be meaningful and collaborative. Dose sharing and vaccine donations require more than just a commitment to them. Dose sharing is not about charity, it’s about equity.

You can’t just close your eyes and throw vaccines in Africa’s direction, expecting that they will be well received. Important logistics need to be considered: things like whether the receiving countries are ready to accept doses, and whether they have the tools — such as syringes and gloves — to administer jabs, or even whether enough time has been given for each country to prepare a vaccine drive to begin with. 

At the end of 2021, the Africa CDC, the World Health Organisation (WHO), and the Africa Vaccine Acquisition Trust (AVAT) released a statement concerning meaningful donations of vaccines.

“Countries need predictable and reliable supply,” the statement said. “Having to plan at short notice and ensure uptake of doses with short shelf lives exponentially magnifies the logistical burden on health systems that are already stretched.”

The statement continued: “Donations to COVAX, AVAT, and African countries must be made in a way that allows countries to effectively mobilise domestic resources in support of rollout and enables long-term planning to increase coverage rates.” 

There is no use in donating or sharing jabs if they cannot be received in a way that ensures they will reach the regular population. 

This World Immunisation Week, Global Citizen is taking a look at initiatives that aim to supply Africa with doses of the COVID-19 vaccine — and diving in to see whether or not they’re truly helping the continent.

1. Donations From Wealthy Countries

Rich countries that have hoarded vaccines and are the main culprits of vaccine nationalism — namely the G7 and EU member states — subsequently made commitments to donate vaccines to Africa. Has this been helpful? 

Yes and no.

The pledges themselves have been important, but the lack of actual donations being received (and doses making it into people’s arms) is troubling. While some countries, like France and the United States, have partnered or communicated with receiving countries to make sure that doses are administered and that donations are well received, others have donated doses that are either near expiry dates (such as the United Kingdom, which donated 1 million soon-to-expire vaccines to Nigeria), or have yet to make a decent dent in their vaccine donations to begin with.

While the US has donated the most of all the wealthy countries, it’s still falling short of 76% of its commitment to countries in need. The country that has least kept to its pledge to low-income countries is the UK, having fulfilled just 10% of its commitment to share 1 billion vaccines.

More than this, the aforementioned statement from the Africa CDC, the WHO, and AVAT, was a result of wealthy countries inadequately donating doses.

2. USAID’s Global VAX Initiative 

At the beginning of 2022, the US announced that it would be ramping up its vaccine support for Africa through its Global VAX initiative. This support includes assisting 11 sub-Saharan African countries with access to doses, vaccine rollout, and vaccine tools.

The initiative pledged US $250 million to assist with vaccine drives, and an additional US $510 million to make sure that vaccine campaigns are sustainable, which includes investments into cold-chain storage and mobile centres for administering doses.

So, is this a helpful initiative?

For starters, it’s a step in the right direction. The initiative kicked off by working with three sub-Saharan African countries, Côte d'Ivoire, Uganda, and Zambia, in an aim to see how it can help, by studying what is needed and considering where the countries need support. To date, this is already more involvement in the process of donating vaccines than other country initiatives have had. 

After scoping out the situation, the initiative found that concentrated efforts to support vaccine campaigns and rollouts, above simply donating doses, resulted in a steady increase of vaccine uptake. The initiative’s most recent plan involves a stronger partnership with Zambia, announcing a commitment of US $28 million, which, according to an official statement, “will support Global VAX activities that make it easier for Zambians to get vaccinated: increasing the accessibility of vaccination sites, bolstering cold chain supply and logistics, and addressing vaccine confidence and demand.”

Working with receiving countries and investing in the rollout — and not just in the vaccines themselves — is a consideration that is likely to increase the rate of doses being successfully administered, and therefore, the initiative is proving to be helpful.

3. South Africa’s Donations to Its Neighbours

South Africa is in a unique position in the fight against COVID-19 as compared to most of the African continent. As a middle-income country with vaccine manufacturing capabilities, and as the country’s president has played a crucial role in setting up the AVAT in his tenure as the president of the African Union, South Africa has stayed ahead when it comes to vaccine rollouts. 

In fact, it has been able to donate doses to neighbouring countries, in an effort to make sure that nobody gets left behind. The country has pledged over 2 million doses to its neighbours through AVAT, amounting to a financial commitment of US $18 million. 

South Africa made this pledge even when the country had not yet vaccinated at least half of its own population. 

“This donation embodies South Africa’s solidarity with our brothers and sisters on the continent with whom we are united in fighting an unprecedented threat to public health and economic prosperity,” President Cyril Ramaphosa said in a statement. “The only way in which we can prevent COVID-19 transmission and protect economies and societies on our continent, is to successfully immunise a critical mass of the African population with safe and effective vaccines.”

Is South Africa’s donation helpful? This is not clear yet as the donations will be rolled out throughout 2022, but the idea is that it will be, as the country will be working closely with AVAT and the African Medical Supplies Platform to distribute doses.

As Johnson & Johnson doses are being filled to finish in South Africa — meaning that they are manufactured elsewhere, and packaged for administration in South Africa — transport and distribution should be easier to coordinate with neighbouring countries than it will be for doses being received from outside the continent.

4. Promises From Pharmaceutical Companies

Johnson & Johnson

After sending Africa-produced vaccines to wealthy countries in August 2021, Johnson & Johnson pledged to provide 17 million vaccine doses to African Union nations. The commitment was announced towards the end of 2021, and the one-shot doses are planned to be administered through COVAX and AVAT.

“From the beginning of our COVID-19 response, we’ve understood that no one is safe until everyone is safe,” Dr. Paul Stoffels, chief scientific officer and vice chairman of the executive committee at the company, said in a statement. “We recognise that a single-shot vaccine compatible with standard distribution channels has the potential to be a crucial tool to help vaccinate the world during a pandemic.”

The initiative is helpful as doses will be shared through a partnership with the African Union, however, it’s crucial to note that the Johnson & Johnson donation is not solely from the pharmaceutical company itself — it is actually through the initiative of the US, which purchased the vaccines for sharing.

Moderna

The mRNA vaccine producer agreed to supply 110 million doses to African countries. Rather than a donation, this is an agreement that Moderna will sell doses to African countries. 

This is somewhat of a breakthrough, but a drop in the ocean in comparison to the larger issue at hand.

The African Union has faced difficulty bagging deals to acquire vaccines directly from pharmaceutical companies — this despite the fact that it has the funds to do so. This is mainly because in their efforts to hoard vaccines for their populations, high-income countries pre-purchased most of the available vaccines well in advance. 

On this, Strive Masiyiwa, special envoy to the African Union, said at a press briefing: “In almost all instances, without exception, we were told there would be no vaccines available for us to purchase in 2021.”