Rich countries bulldoze poorer ones into submitting to their public health goals
It’s become a truism that the novel coronavirus can’t be defeated until everyone in the world is vaccinated. And truisms, in this pandemic, have wrought havoc. Here’s another: the vaccination programme must be carried out as quickly as possible, everywhere. This, policymakers agree, is the only way to keep the virus from mutating indefinitely to lethal effect. The WHO Director-General Tedros Adhanom Ghebreyesus has said, “we cannot rest until everyone has access” to the vaccine.
There’s a long way to go, if it’s true. In Africa, less than 1% of the population has been vaccinated. In dialogue with the United Nations, the continent’s political leaders have promised to vaccinate 60% of citizens, but at the current rate, herd immunity won’t be reached until at least 2023. Partly, this is a problem of supply. Rich countries outbid poor ones when the first doses were auctioned off, and the COVAX mechanism — a global initiative led by UNICEF and others to provide equitable vaccine access — will offer only 27% of the doses Africa needs. Earlier this month, Gordon Brown called for a global effort to foot the $30 billion-a-year bill for a mass vaccination programme on the continent. Failure to do this, Brown said, “will leave Covid-19 spreading, mutating and threatening the lives and livelihoods of us all for years to come”.
This plan seems to serve the world as a whole, then. But does it serve Africa? Covid-19 and the response to it have devastated Europe and the Americas, but the situation is very different elsewhere. Mortality figures in Africa are low. As of mid-April, around 30,000 lives have been recorded lost to Covid-19 between the Sahara and South Africa (a figure rising to roughly 85,000 if you include South Africa and Botswana). Annual mortality on the continent was 9.05 million in 2019.
Many analysts suggest under-recording of Covid deaths, but even if this figure were just a third of the real number, the risk would still only be moderate for the vast majority of Africans. The population is much younger (the UN estimated the median age in Africa to be 19.8 in 2020) and lives predominantly outdoors, while immune systems are generally stronger. After a year of data, it is clear that malaria (400,000 deaths a year), HIV (300,000) and bilharzia (nearly 200,000) are much greater threats. And whereas Covid-19 predominantly targets the elderly, all these diseases mainly affect the young.
Medical scientists often analyse mortality by age, through what is known as the Disability-Adjusted Life Year (DALY). A child dying of malaria or malnutrition loses many more life years than an older person who dies of the same disease; DALYs allow the measurement of comparative loss of life years from different diseases. A recent study by David Bell and Kristen Schulz suggested that the recorded Covid-19 DALYs lost in 2020 in sub-Saharan Africa (north of South Africa) were 2.0%, 1.2% and 1.3% of those estimated for tuberculosis, HIV/AIDS and malaria respectively. Yet these diseases seem to have dropped off the radar of global public health. Focusing aid efforts on a mass vaccination programme for a disease that’s hardly a health priority in Africa seems at best self-serving.
But it could be worse than that. What could overwhelm the medical infrastructure is doing what it takes to vaccinate 60% of the continent’s population in the next two years. Meeting this target would require the majority of the continent’s already scant public health resources to be diverted, at the expense of those suffering from endemic diseases.
Some countries, like Ghana, have used existing medical infrastructure to begin the vaccine rollout already, but in other nations the picture is bleak. Some middle-income countries, like Senegal, have seen resources diverted from neonatal care. Medical staff in Angola — who, living in a dictatorship, must remain anonymous — are seeing an almost total lack of the medicines required to treat HIV, malaria, tuberculosis and typhoid.
The director of a medical centre in central Angola reports that there is a nationwide shortage of routine vaccines, like those for yellow fever and tetanus — something that has never happened before, even in the nation’s most difficult moments. She attributes this to the laser-focus on the fight against Covid-19.
For those suffering from HIV/AIDS, the situation is just as bad. The production and distribution of anti-retroviral drugs (ARVs) has already been documented as plummeting in Nigeria owing to Covid-19 impacts. And research published in The Lancet suggested half a year’s interruption to normal ARV treatments would lead to an estimated 296,000 excess deaths. Modelling conducted for UNAIDS and the WHO came to an even bleaker conclusion: disruption to medical supplies could result in an additional half a million AIDS-related deaths in sub-Saharan Africa by December 2021.
A mass global vaccine effort, then – rather than one targeted at older African citizens at risk from Covid-19 — will not necessarily benefit “all of us”. Dependent on overseas aid, health ministries in many countries have little option but to bow to a one-size-fits-all globalism. It is a classic case of medical colonialism, where rich countries bulldoze poorer ones into submitting to their public health goals.
All the while, diseases devastating Africa’s population, but not the rest of the world, move out of the global public health spotlight. Is a substantial increase in deaths from malaria and AIDS in Africa in order to defeat Covid a price “worth paying” to protect “all of us”? This, rather than the $30 billion annual price tag mooted by Gordon Brown, may be the true cost of this ambition.
Toby Green’s book The Covid Consensus: The New Politics of Global Inequality is published on April 22 by Hurst. He is Professor of Precolonial and Lusophone African History and Culture at King’s College, London.