African Countries Were Denied Access to Having Their Own Vaccine by Western Countries
Policies from the colonial period and global health gatekeepers have made it almost impossible for African doctors and scientists to get their vaccines into clinical trials.
Professor Christian Happi, the director of African Centre of Excellence for Genomics of Infectious Diseases (ACEGID). Photo: PIUS UTOMI EKPEI/AFP via Getty Image
Cameroonian, Dr. Christian Happi who runs The African Centre of Excellence for Genomics of Infectious Diseases (ACEGID) in southwestern Nigeria has produced a DNA-based vaccine candidate against COVID-19.
The Harvard-trained geneticist with international acclaim, Happi was the first to sequence coronavirus samples in Sub-Saharan Africa, before later identifying the arrival of the so-called "South African variant" in Nigeria. He played a key role in containing an Ebola outbreak in Nigeria in 2014.
The Harvard-trained geneticist with international acclaim, Happi was the first to sequence coronavirus samples in Sub-Saharan Africa, before later identifying the arrival of the so-called "South African variant" in Nigeria. He played a key role in containing an Ebola outbreak in Nigeria in 2014.
Happi reported that the vaccine ACEGID produced showed 90 percent efficacy in treating multiple strains of COVID-19 circulating on the continent during pre-clinical evaluation and animal testing, but that despite those findings, it has been unable to obtain public or private funding to move the vaccine into human clinical trials.
Happi told Newsmen,
“We’ve submitted proposals and we still don’t have a response,â€â€œIf we were able to produce a vaccine on the continent, the issue of access would have been far less overwhelming, but African countries don’t want to invest and who else is going to come in and invest?â€
Africa has the lowest vaccination rate of any continent, accounting for less than 2% of all COVID-19 vaccines distributed globally. To date, 42 African countries have signed up for the COVAX vaccine-sharing program, which aims to provide doses to low- and middle-income countries.
Scientists agreed that if a vaccine had been developed on the continent, the severe access problems that African countries are facing could have been avoided.
Instead, the new programme is reliant on international donors, and projections show that mass COVID-19 immunisation will not be achieved in most of Sub-Saharan Africa until at least 2024. Some public health experts believe this fact amounts to "vaccine apartheid."
“I know donors have committed money to vaccines further along, but it doesn’t make sense to ignore [ACEGID’s vaccine] because it denies Africa the opportunity to set up the infrastructure for future vaccine development on other diseases,†Happi said.
Microbiologist Christian Happi works in the lab at the African Centre of Excellence for Genomics of Infectious Diseases in Ede, Nigeria.Credit: ACEGID
Despite the fact that Africa is home to over 16 percent of the world's population and 70 percent of pathogens with pandemic potential, the continent has just 0.1 percent of vaccine production facilities.
The lack of government support for medical research and development is a recurring issue for scientists on the continent, with research spending remaining about 0.5 percent of GDP, well below the global average of 2.2 percent.
The lack of government support for medical research and development is a recurring issue for scientists on the continent, with research spending remaining about 0.5 percent of GDP, well below the global average of 2.2 percent.
Healthcare investment is also lacking in Sub-Saharan Africa, with 25 governments spending less than 5% of total GDP on healthcare, compared to 9% in OECD countries.
As a result, the majority of African healthcare systems depend almost
exclusively on foreign donors to provide access to drugs and vaccines, a
paradigm that Karsten Noko, a Zimbabwean lawyer who works in the health
and humanitarian sectors across Sub-Saharan Africa, claims is rooted in
the continent's colonial history and was deliberately placed in place.
“Any place that isn’t able to produce its own medications and supplies is relegated to always carrying a begging bowl, but to understand the healthcare systems and funding models in African nations you have to examine the role of development institutions like the IMF and World Bank,†Noko said in a Zoom interview.
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Newly founded African states like Tanzania, Ghana, Zimbabwe, and Mozambique were dramatically improving healthcare outcomes for their people in the early days of independence by prioritizing public health spending. The International Monetary Fund (IMF) and the World Bank, on the other hand, started introducing financing models in the 1980s that would radically reshape economic policy on the continent.
The IMF and World Bank provided conditional loans to over 40 African countries through their Structural Adjustment Programmes (SAPs), which allowed governments to introduce financial reforms focused on free-market growth strategies. The net result was a reduction in spending on social services such as healthcare and education, while policies aimed at liberalizing trade, privatizing industry, and encouraging foreign investment were implemented.
Dr. Eugene Richardson, who has worked as a physician in the Democratic Republic of Congo, South Africa, and Sudan, is an advisor to the African Centre for Disease Control. He characterized SAPs as "neoliberal and extractive philosophies disguised as economic "science," according to him.
“SAPs eviscerated safety nets and public health infrastructures across the Global South,†Richardson said via email.
“They privatised public assets, cut spending on healthcare, food and farm subsidies, and deregulated trade rules, such that illicit financial flows to the Global North currently dwarf what is sent to the Global South in ‘aid.’â€
Richardson added:
“The [IMF and World Bank] have abetted this continued postcolonial extraction of wealth, leaving countries that are rich in natural resources bereft and impoverished, which leads to situations where countries become dependent on foreign actors for services like healthcare.â€
The other side of the global health divide, if dependence is one, is superiority.
For more than a century, the global health system has been dominated by organizations and non-governmental organizations (NGOs) based in wealthy Western countries, which set the global research agenda, make investment decisions, and act as gatekeepers to life-saving medicines and technology.
For more than a century, the global health system has been dominated by organizations and non-governmental organizations (NGOs) based in wealthy Western countries, which set the global research agenda, make investment decisions, and act as gatekeepers to life-saving medicines and technology.
Catherine Kyobutungi is a renowned Ugandan epidemiologist and the Executive Director of the African Population and Health Research Centre, a think tank dedicated to developing the continent's healthcare systems. As a public health specialist, she appears to be "on the receiving end of such imbalances," she told Newsmen.
“We are stuck in a system we can’t get out of which has Western roots, where we have no control over power and resources,†Kyobutungi said. “It’s the same system the entire world operates on, so how do you extricate yourself from that?â€.
Professor Dicky Akanmori, WHO’s Regional Adviser for Vaccine Research and Regulation, agreed.
“We’re attached to the same old funding mechanisms, whereby grants come into Africa from international agencies or foreign governments like the EU or Bill & Melinda Gates Foundation,†Akanmori said. “Funding from within is still woefully inadequate, and if you don’t bring the money, you don’t set the agenda, so our research is driven by the Global North.â€
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As a result, medical R&D takes place in high-income countries, resulting in goods that are unaffordable in low- and middle-income countries from the start. Years of lobbying, patent disputes, and the formation of global drug and vaccine alliances are needed to make these innovations accessible to people in developing countries. The decades of lobbying needed to make antiretroviral HIV treatments available are a good example.
“It’s designed to create a benefactor and a beneficiary, so that one party always has the ability to manufacture and produce medications and diagnostics, and the other doesn’t,†Noko said.
“You can almost call it a patronage system. It’s the ability to decide who gets what, when.â€
“GAVI,
the World Bank and the IMF shouldn’t be surprised by the COVID-19
vaccine inequity and lack of access we’re seeing, and if they are, they
need to be much more aware of their own role,†he added.
In
late 2020, an article went viral called “How (not) to write about
Global Health.†Its author was Desmond Jumbam, a Cameroonian health
policy consultant who uses satire to highlight structural inequalities
embedded in the current system and gives talks to university students
around the world on how to engage in responsible research practices when
visiting countries in the Global South.
“We
have researchers who come and study our people, who take specimens and
then go study in the North to tell us about ourselves and our diseases,â€
he told Newsmen.
“Global health is still practiced in colonial ways, particularly through resource allocation. A student at Harvard or Johns Hopkins will have better access to research funding than an expert in Cameroon ever will. So it’s a self-perpetuating system where, because research capacity isn’t built on the continent, the expertise here isn’t acknowledged. We’re still not seen as partners, instead it’s quite exploitative,†Jumbam said.
Kyobutungi and Jumbam are part of a global campaign to “decolonize global health,†which seeks to decolonize medical research and development by dismantling long-standing racially discriminatory systems. Both accept that in order to achieve greater medical autonomy, African governments must recognize the importance of self-sufficiency and make investments in healthcare and science a top priority.
“We need to get our governments to see value in investing in African resources,†Kyobutungi said.
“The missing link here is sustained engagement between the research community and those who hold the purse strings.â€
“People in this movement say those in the Global North ‘need to be willing to give up power,’†Jumbam said.
“People don’t just give up power, it goes back to the African independence movements in the 50s and 60s, the British and French didn’t just ‘give up power’, we had to demand it. It’s similar for the global health movement, we need leaders and intellectuals to rise up.â€
The need for greater self-sufficiency in vaccine production has sparked calls for a manufacturing revolution once again.
The African Union (AU) and Africa CDC held a virtual conference with member states in April to discuss the need to extend vaccine manufacturing capabilities across Africa. By the end of the two-day summit, AU governments had committed to increasing the proportion of vaccines produced on the continent from less than 1% to 60% by 2040.
“If governments really commit to this, they’ll be putting a very important brick in the wall to prevent and deal with the next pandemic,†Patrick Tippoo, a founding member of the African Vaccine Manufacturing Initiative (AVMI), told newsmen.
Africa has been importing vaccines for decades, the majority of which are provided by UNICEF and procured by The Vaccine Alliance (GAVI) through collaborations with foreign donors and pharmaceutical firms.
GAVI developed a business model for selling vaccines in Africa after arriving in the early 2000s, collaborating with foreign donors and pharmaceutical companies to purchase vaccines at cheaper rates, ensure a demand for purchases, secure supply, and address issues of consistency, cost, and fairness.
GAVI developed a business model for selling vaccines in Africa after arriving in the early 2000s, collaborating with foreign donors and pharmaceutical companies to purchase vaccines at cheaper rates, ensure a demand for purchases, secure supply, and address issues of consistency, cost, and fairness.
With an eye to the future, scientists around the continent are now questioning whether GAVI's mandate should be rethought and the market opened up.
“GAVI has done a great job, but it has also hampered development in recipient countries,†Professor Oyewale Tomori, an eminent Nigerian virologist and former GAVI board member told Newsmen.
“The last question I asked at a GAVI meeting was ‘Is GAVI forever?’ And my reason for asking was that so many African governments - even when their economies are developed enough - revert to GAVI-assistance instead of taking care of their own people.â€
This sentiment is shared by Tippoo.
“There's no debate over the remarkable role GAVI has played, but it hasn’t helped to encourage the kind of competition that would drive research and development on the continent. The evolving landscape requires introspection.... and now is the time for GAVI to reflect on a broader contribution it can make to incentivise and free up the markets in Africa," he explained.
Happi, who is still seeking support for his COVID-19 vaccine candidate, believes that the most important missing piece of the puzzle is government transparency and "political will."
“We have Africans that can develop vaccines,†he said.
“We’ve proven that we have Africans that can develop therapies and diagnostics. We’ve proven that, so if our governments were supporting those initiatives, we wouldn’t have to wait for the global community to come in and make decisions for us.â€
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Michael V Bolgent
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