Vaccinating everybody may not help Africa
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”.
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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.
As sad loss of a loved one can be though covid 19, the reality is that it only serioulsy affects people close to the end of life and with co-morbitities. The avarage life expectancy due to covid is higher that general life expectancy. Africa has a young popoulation and better immunity, so there is no reason why Africa will follow India since it has a different demographic, and has its own separate health challenges that are far more affecting.
In this world of human overpopulation with all the affects on life and the planet, Corona virus could be viewed like Pnemonia, as an ‘old man s friend’. People are undable to make hard decisions about prolonging life in people with significant health problems.
All the evidence about the disease having far less affect on fit and healthy people has been ignored in all the helath campaigns, by encouraging people to lose weight, improve their diet and take exercise in the outdoors as a priority. Some scientists also are concerned that vacinating people against air bourne virus will have a negative affect on peoples’ immune systems to stave off future viruses, that could be more deadly for far more people.
You seem to have a very black and white view of what constitutes fit and healthy, Frank. There are several million people in this country who are clinically extremely vulnerable but who can expect many years, decades even, of happy and fulfilling life provided they avoid catching Covid. They don’t appreciate being written off as expendable because of their “co-morbidities”.
Sorry, Toby, you are like so many journalists caught in the web of the narrative that has sprung up (or was constructed…?). The vaccine is only the answer to get out of the narrative not to make the world population healthier. Covid does not kill people (well it does but very very few), it is the response of patients to covid that makes them very ill and possibly die. This reponse is for a large part based on the health status of the patient (health s in the WHO definition of health).
Lockdown was the best breeding ground for making all things worse….
Am I allowed to be cynical and say well done Pharma for developing such a good business model. I do not blame them. I will be much more critical towards the scientists who speak the loudest in the press an the many journalists who only produce stories that fit in with the current narrative.
…. many people now agree that lockdown was the result of the pressure of the press… time for journalism to look itself in the mirror… hard thing to do… and start asking questions why people did not receive any treatments when they were ill with covid at home and why there was no MASSIVE campaign by the governments to increase the resilience of the population to viral infections…
It is time we evolve from a health policy based on an industry of illness to a policy of promotion of health.
“The pressure of the press” is the big issue here. The politicians knew full well what a disaster the lockdowns would be. But it was based on one number: the number of deaths. And that is because that is the only datum the press would cover. The politicians were covering themselves. By taking the most extreme actions they could say “I did everything I could,” thereby protecting themselves from the press, who are the only citizens they care about.
They also created the BLM program, and the resulting breaking up of America.
Generally a great and depressing article, one that gives more figures to various points made a year ago. Even in rich countrries the Covid response has hit the poor and young very hard. We’re also coercing the young to be vaccinated, but not particularly for their benefit.
“Rich countries outbid poor ones when the first doses were auctioned off” is very misleading. Certainly the UK gov paid almost all the cost of the Oxford AZ development, and put in advance orders for other vaccines – which helped their development and production capacity. AZ is also sold at cost, and yet they get slated.
Also the UK has suffered more Covid deaths than all of Africa. So if we had a globally controlled ‘fair’ vaccine program then the UK would still be in the high priority group for receiving the vaccines first.
US and the UK have too many fatties and they are classifying as many things as possible as Covid deaths.
Can someone clarify something for me? From what I have read, the current jab was not designed to stop Covid spread, it was designed to lessen the severe symptoms of the disease. If you go on the CDC, W.H.O., John Hopkins sites, they all state “we currently do not know if these vaccines confer immunity.” So why is everyone saying you need to get the jab to protect others? If there is any science to support this I would love to see it.
You are right Angela and people keep repeating this fallacy because the experts are quite ambiguous about it. For example, Prof. Tim Spector says “the Zoe app shows that the vaccine provides 70% protection”, but what he means is 70% of developing symptoms, as in Zoe they only test people with symptoms. Then people say, look at Israel and the UK where there are almost no cases now, but there are other countries where there are almost no cases now (or are dropping fast) where there is almost no one vaccinated.
So yes, people keep repeating this “convenient” fallacy to justify everyone getting the vaccine but there is no real evidence that it will curb the spread or if it does for how long it will do it.
I agree with the writer’s position that the Covid vaccine in Africa doesn’t make sense but I’ve been saying the same about a few other vaccines that have been pushed in Africa (and India) when public health dollars could be more effectively used to insure clean water, modern sanitation, better nutrition, etc. Vaccines have become an industry that benefit corporations far more than the people they purport to serve. Brave people at the WHO have been complaining about Bill Gates’ oversized influence to push vaccines to the exclusion of better public health measures for years and this Covid vaccine is just the latest ill-conceived one these poor nations are being cajoled into purchasing.
indeed Jack: all the improvement in health and reduced deaths from the 18th to mid 20th century were obtained though sanitisation. the advent of vaccines and antibiotics and others has brought only another 10% improvement….
2023 until everyone is vaccinated?
Every previous pandemic resolved itself in less time without vaccinations. Absolute nonsense idea.
Agreed. Life expectancy in Africa is 65 years. Average (mean) age of persons in UK dying with Covid-19 is 80.3 years. Yet the calls in the West to vaccinate everyone in the Third World continue with no justification.
As usual, rich countries export their solutions/problems to developing ones without even considering the different realities in developing countries.
The biggest killers in Africa are hunger, malaria, and other issues for which the developed world has provided no solutions.
It’s sad how in the name of “helping” the developed world always screws the developing world. War on drugs, war on terror, and now war on covid …
And TB, HIV…. on it goes
How “developed” Europe would be in your opinion if the European population had quadrupled over the last few decades, like Africa did?
As it happens, it is the undeveloping world which exports its ticking population problem to the ‘developed’ one.
hunger, malaria, and other issues for which the developed world has provided no solutions.
Where did the “developed world” got its solutions for its own hunger, diseases and other issues? Did the solutions fall out from the sky? Brought by the Easterbunny? Martians? Nope. They were developed along the continuum of civilisation. Africa had just as much time to develop their own – and it’s not that they lacked natural resources / climatic conditions -, yet somehow they never happened to do so.
This makes me think of another aspect of Western priorities: we defeated smallpox because it killed everywhere on the planet, but don’t worry about malaria for instance because it doesn’t affect us in the same way. We are proud of flying a helicopter on Mars costing $81 million and this is a priority somehow over defeating malaria, or dysentery or lack of education in the world! Why do we need Bitcoin which uses more energy than is needed to power most African countries? We find it very hard to distinguish need from greed.
Thank goodness someone else is pointing this out.
The idea that Africa must be vaccinated to save the developed world has multiple flaws. Taking Nigeria as an example
- Basic bioethics says treating A to help B is generally disallowed, if A does not benefit materially
- The risks to Africans from COVID appear extremely low. There are 2000 deaths reported in Nigeria with 200m people. Even is this is out by a factor of 10-20 it is a non event in a country facing the health problems of Nigeria.
- There are 100k deaths from malaria in Nigeria each year. It is thus not ethical to spend a dollar on COVID which could have been spent on malaria there.
- No thought is given to consent on the part of Africans. Only 50% of the French were intending to get vaccinated last year during a pandemic featuring lockdown and curfews. What overriding factor should drive a Nigerian consent to vaccination when it is at the bottom of their list of risks?
Those in the public health bubble obsess over the “developing world must be vaccinated to save the developed world” mantra, without paying the least attention to the ethics of actually carrying it out.
This is a classic example of groupthink in which one idee fixe overrides every other concern.
When is someone with clout going to address the elephant in the room?
That is, questioning the Bill & Melinda Gates Foundation’s domination of global vaccination policy.
It’s Bill Gates who has led the race for Covid-19 vaccines, to vaccinate the global population against a virus which isn’t a serious threat for most people, see for example his article on GatesNotes: What you need to know about the COVID-19 vaccine, 30 April 2020.
It’s way past time that ‘philanthropists’ such as Gates were subject to investigation for the enormous power they are wielding over global policy.
For instance, the Bill & Melinda Gates Foundation is the top funder of the WHO, along with the BMGF-founded Gavi Alliance, and vaccine producing countries such as the UK, US and Germany and the European Commission.
In other words, the WHO is a front for the vaccine industry.
And according to this September 2020 report, the Bill & Melinda Gates Foundation is a major investor in vaccine companies, i.e. Pfizer, BioNTech, CureVac and Vir Biotechnology.
People such as myself and others have been trying to raise the alarm about the influence of Gates for years, but we have been ridiculed and marginalised by the mainstream media, and on comments forums such as UnHerd. And now here we are, with the Gates running the show, and buying the unquestioning support of media such as the Telegraph, BBC and the Guardian and others.
We are in a really bad situation, and with no effective fourth estate to blow the whistle…
So many are on the Gates’ gravy train…
For example, Neil Ferguson, the architect of society and economy destroying lockdowns around the world, with his Imperial College Report 9, is funded by the Bill & Melinda Gates Foundation, as noted in the SAGE COVID-19 Register of Participants’ Interests.
There’s a massive web of influence to investigate…
The disproportionate and ill-targeted response to SARS-CoV2/COVID-19, and it being used as a Trojan Horse to destroy liberal democracies, is the biggest scandal in history!
When is the lid going to blow off this thing?!
“… and the response to it have devastated Europe and the Americas, but the situation is very different elsewhere. Mortality figures in Africa are low….”
I thought the same about India, wondering for months and months why the disease did not rip through India. Well, it is now. And it’s now very likely I would say, it will do so in Africa too sooner or later. There is it appears something very “chain reaction” about the way Covid19 spreads, clearly *still* not fully understood or modelled, where the answer lies. It’s some variety of exponential order effect, where the spread is much lower than you would anticipate, until a critical mass is reached, after which it is much faster than you would expect – a flashpoint. And vaccines, ever faster and cheaper are absolutely an answer. So is letting the virus rip, and it will burn out in a couple of years (probably), but at a terrible cost. Which is what would have happened if this virus had arrived even a decade ago: there would have been no lockdowns because vaccines could not have been produced as quickly as now, and not even people in the global north could have afforded the loss of livelihoods. As it is, the year long lockdowns will cost the rich north, likely an order of magnitude more deaths due to knock on destitution over the next few years. It looks like a full one percent of Mexico City is dead as a result of the virus. That could easily translate to ten million dead in Africa if it rips through there, because Africa is younger but also poorer. But the economic devestation of the lockdowns will very likely cause even significantly more deaths than that over a few years in Africa.
It must be very frightening in India right now, I understand your fears.
However I think the point is that in Africa (where I live), as the OP mentioned, other diseases are already killing multitudes more than COVID is & the governments in the two countries where I work have certainly diverted resources away from these higher killers, by aping western approaches to combating the virus and focusing only on it.
Furthermore, the closure of schools has had a catastrophic effect on the life chances of young Africans already at a disadvantage in the global market.
There is also still no evidence that I have seen that this virus will kill ‘ten million in Africa,’ as there simply isn’t that number of high risk people there – yes people are poorer, but they are younger, thinner and have better diets. In my countries, those dying match the profiles of those in the west – i.e. mostly the very old and those with pre-existing conditions. The much-feared devastation of the continent that even the WHO warned of just hasn’t materialised (yet, and I sincerely hope it doesn’t). The devastating effects of lockdown, on the other hand, are being felt almost across the board here.
Very worried about India. I wouldn’t make any predictions but a source of hope is that, while they’ve currently had approximately 4 times as many cases as the UK, even though that’s rises extremely fast, they’ve only had approximately 1.5 times as many deaths. This is likely due to the young demographic.
Ordered Green’s book straight after reading this. I’ve a feeling it will be of the utmost importance for understanding what we have done this last year.
Really excellent information to have. Thank you to Dr. Green and Unherd for this article.
Thank you, Prof. Green. This is a very interesting and thought-provoking piece. He warns about seeing Africa through a Western prism, and that is wise advice. However, does his specific point, that Covid-19 vaccination will divert resources from dealing with more virulent diseases, stack up?
Can he show that the vaccination programme in the West is doing this? Certainly, the palliative care of the sick disrupted our health systems drastically (and we have yet to count the cost). But can you say the same about the rate-of-knots vaccination programmes in the UK and US?
Well, OK, the West is rich, it has resources to spare. In that case, how about Morocco or Turkey? They have vaccination programmes which are at least on a par with Germany, but without German wealth.
BBC world service reporting ad infinitum that the West is racist for hogging all the vaccines etc
and yet also that Africa is ace continent for not catching COVID etc.
typical BBC – wants it both ways…
Africa is perfectly well-equipped to weather out a pandemic even much worse than this. They stuck with nature’s way of producing large numbers of offspring to mitigate any occurring mass loss, as opposed to developing other measures such as medicine, sanitation etc. Africa may be vaccine-poor, but it’s immensely child-rich.
Since the mortality from COVID is extremely dependent upon age (in conjunction with pre-existing co-morbidities), and as those primarily dying are those in excess of 65, it would seem to me that there is almost no point in vaccinating large swathes of the African population given that the vast majority are under 65. If one is going to do anything in Africa, just vaccinate those over 65 with co-morbidities.
This article epitomises exactly everything that has troubled me with the West’s response to Sara Cov2 and it’s consequent disease Covid 19. Either it fits perfectly with my own biases or history will reflect on this time in a wholly unsympathetic manner.
Thank you Toby! I am an African of one of the white tribes in South Africa. I can say with confidence that Africa certainly does not need Covid19 vaccinations.South Africa with by far the most Covid19 deaths is, I believe, because South Africa use the most Statins, HBP and Diabetes than all of the rest of Africa together and the result many death by covid19 in comparison – about 50,000 in 2020.Western attitudes and ideas have often enslaved Africans telling them they are poor and need handouts that end up in corrupt and greedy politicians. .
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