I began my global health career as a surveillance officer with Nigeria's National Programme on Immunization.
So of course I've been following the vaccine news with a close eye.
I was elated when the first COVID-19 vaccine was shown to be effective late last year. Knowing how effective vaccines can be in ending epidemics, I was hopeful that the end of the pandemic was in sight.
However, my joy was cut short when richer Western nations began buying up the vaccine doses. As a result, COVID-19 vaccines will not likely be widely available in Africa until 2022 or 2023.
I am shocked that these wealthier nations think this is the best way to protect their people from a global pandemic that does not respect borders. The Igbo people of Nigeria — my ethnic group — are always practical. An Igbo proverb comes to mind, as popularized by the late author Chinua Achebe: Onye ji onye n'ani ji onwe ya. "He who will hold another down in the mud must stay in the mud to keep him down."
I am angry at African leaders who have let this happen again — always depending on richer Western nations to fund vaccinations on the continent. For instance, Norway has promised to eventually donate extra vaccines to less-well-off countries. As commendable as this action is, it perpetuates the narrative that Africa is the poor relation, waiting for crumbs from the tables of wealthier nations.
I agree with Liberia's former president, Ellen Johnson Sirleaf, who co-chairs the World Health Organization's pandemic review panel. This month, she expressed her disappointment with the West's handling of COVID-19 vaccines. The WHO pandemic review panel "is discouraged and frankly disappointed by the unequal plans for vaccine rollout," she said.
WHO's director-general, Tedros Adhanom Ghebreyesus, echoed the same sentiment. In remarks on Jan. 18, he called the world's vaccine effort a "catastrophic moral failure." At that time, he said, there had been 39 million vaccine doses administered in wealthier countries, while in the world's lowest-income countries, there had been only 25 doses of COVID-19 vaccine officially administered — all in the nation of Guinea.
Tedros wanted to make sure he would not be misunderstood, stating: "Not 25 million, not 25,000 — just 25."
In epidemiological terms, this self-interested action by richer nations means that it would likely take until 2023 for Africa to achieve herd immunity. In global health security terms, it means richer Western nations will still be at risk of being reinfected if Africa is left behind.
As far as COVID-19 is concerned, the global community is as strong as its weakest link. Unfairly, vaccine nationalism is making Africa the weakest link despite the continent deploying better a public health response to the pandemic than many of these richer Western nations.
I'm not completely pessimistic.
Last week, the chairperson of the African Union, President Cyril Ramaphosa of South Africa, announced that the African Union has secured 270 million doses for the continent. However, the rollout is slow. Fifty million doses are expected to arrive between April and June 2021 and the balance later in the year.
But I'm not optimistic either. Even once the doses arrive and are administered, what is 270 million doses for a continent of 1.2 billion people? At best, it would vaccinate just a little more than 1 in 10 Africans.
Other possible vaccine sources include COVAX, a coalition of global health groups (including the WHO) that aims to provide equitable access to COVID-19 treatments, including vaccines. COVAX promises to deliver vaccines to cover 20% of Africans by the end of 2021. President Biden has just signed an executive order that directs the U.S. to join COVAX. I wish vaccines from COVAX were being distributed and administered at the same time with Western nations. Sadly, despite this great attempt to ensure vaccine equity, many African countries may not be able to administer vaccines until early 2022.
But all this is still too little. Combined with the other doses, it helps cover about 30% of the population.
And in my homeland of Nigeria, Africa's most populous country, we're getting ready to receive the first 100,000 doses of the Pfizer-BioNTech vaccine. To reiterate: 100,000 doses for a country of more than 200 million people! It's like attempting to drain the ocean using a tablespoon. Indeed, the situation is so dire that the governor of Oyo state in southwest Nigeria is attempting to buy vaccines directly from manufacturers, bypassing national and continental efforts.
What can be done to ensure vaccine equity?
We must allocate the vaccines to those who are most vulnerable, not by country. First, vaccinate all front-line health workers globally. There are about 59 million health workers globally, according to the WHO global health workforce report. More than 7,000 health workers worldwide have died from COVID-19 while in the line of duty. Protect them so they can protect us.
Next, vaccinate those who are age 65 and above. About 703 million people are in that age group globally. This is almost the population of Europe. Indeed, Tedros of the WHO said, "It's not right that younger healthier adults in rich countries are vaccinated before health workers and older people in poorer countries."
Once these demographics are vaccinated, then other demographics that provide core social services to large segments of populations, such as teachers, city cleaners, garbage collectors and workers on city water systems, should be prioritized.
If all nations would join together, they would be stronger. I'm reminded of an Igbo word, igwebuike, which means "there is strength in community." However, to work as a stronger global community, the well-off Western world must stop behaving as if poorer countries are invisible. And they must acknowledge how their plunder of these poor nations contributed to those countries' poverty.
As it now stands, the selfish behavior by richer countries makes me wonder about the kind of future that my two daughters, now ages 11 and 8, would inherit as Africans. As a dad, I want my daughters to inherit a more equitable world — one that lifts and empowers the weak.
If my daughters were to ask me what is happening with the vaccine, I would have to tell them that richer Western nations are acting like ostriches, burying their heads in the sand.
And I would add that life can be unfair sometimes. So they must ensure that no one silences their voices. And they must keep demanding a fairer world.
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