Who is to blame for vaccine inequality?

Who is to blame for the vaccine inequality that has pushed Africa to the back of the queue? The answers are not so obvious as they first seem, says Moky Makura.

When I was little growing up in Lagos, I remember queuing up at school to get vaccinated. I was scared of needles then and still am, so I remember it all rather vividly. Back then, we all understood the important role vaccines played in protecting us from diseases that could kill us.

Fast-forward 40 years or so, and today only five countries on the continent – Egypt, Morocco, Senegal, South Africa and Tunisia – have the ability to manufacture life-saving vaccines. And even then, most of the 10 local companies that do vaccines mainly package and label them.

For decades Africans have happily accepted vaccines made and paid for by rich countries. Today we mainly get vaccines through UNICEF, supported by GAVI, and funded by large donors to the tune of $8.8bn. 

The US, UK and the Gates Foundation were the top three funders, and only one African country – South Africa – appeared to have contributed to the last replenishment. According to the WHO there are fewer than 10 countries in Africa that can pay for their own vaccine requirements. 

I am not a vaccine or a global health expert, but I am concerned about how the current vaccine inequality narrative is playing out. It is portraying us as a broken continent in need of fixing, and one at the mercy of rich countries. It is undoing the progress we have been making to reframe Africa as a partner – not a beneficiary – in its own development.

A few weeks ago, Strive Masiyiwa, the Zimbabwean billionaire philanthropist, founder of Econet Global, AU Special Envoy and head of the African Vaccine Acquisition Task Team, accused rich nations of deliberately excluding Africa from securing vaccines. During a panel discussion, Masiyiwa used this simplistic but powerful analogy to explain how COVAX had failed to deliver on its commitments to Africa:

“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,” he said. The question Masiyiwa failed to ask of his African leader colleagues is why didn’t we build our own bakeries back then; why didn’t we invest in drought-resistant seeds and why didn’t we stockpile during the bumper years when we started enjoying the bread?

The blame game

And then there was this emotive opinion piece by CNN’s Larry Madowo, who shared a heart-breaking story about the impact of vaccine inequality on his family. In it he says; “Even at 96, my Kenyan grandmother was among hundreds of millions in the developing world who were not vaccinated until recently because rich nations have hoarded most of the available shots.” 

Don’t get me wrong, both Masiyiwa and Madowo are highlighting very real issues that need addressing; there are simply not enough vaccines on the continent to meet the needs, but is attributing blame the solution, especially when it is damaging years of rebalancing the inequality inherent in the donor, beneficiary dynamic?

In any case, when you point one finger, three are pointing back at you. 

Both Masiyiwa and Madowo have taken us right back to the dark ages of development, to a time when Africans had no agency and when it was perceived that we couldn’t come up with our own solutions. 

By focusing the discussion away from our complicity and omitting the progress, albeit baby steps that African governments are making to increase vaccine manufacturing on the continent, we are in danger of dredging up the old stereotypes that have dogged the way rich nations view poor nations. 

It takes me back to the days of Sir Bob Geldof and the Live Aid concert in the 80s which sealed Africa’s fate as the broken continent. It triggered memories of the Michael Jackson, Stevie Wonder, chart busting song, ‘We Are The World’, and the iconic image of The Economist’s ‘The Hopeless Continent’ cover of 2000. 

Vaccine manufacturing is complex and requires massive financial investments by African governments who, incidentally, have pledged to increase capacity from 1% to 60% by 2040. Till then, thousands of African children will continue to receive free vaccines, but rather than point the finger, a more helpful framing would be to discuss how and when these vaccines will bear the stamp, ‘Made in Africa’.