Global health authorities are looking with alarm at the Covid catastrophe in India, fearing that a similar alignment of circumstances — a stalled vaccine rollout, emerging variants, and a largely poor population — could be replicated in Africa.
John Nkengasong, director of the Africa Centres for Disease Control and Prevention, recently warned that the Indian catastrophe should put Africa’s health ministers “on high alert” to prepare oxygen supplies, hospital beds and medical staff. India’s health system, especially its ratio of doctors to patients, is far more robust than what exists in much of Africa. Yet India is in crisis, with patients unable to access hospitals and oxygen supplies running out.
According to the official tally, Africa has recorded about 125,000 Covid deaths, fewer than 4 per cent of the global total. However, the true figure is likely to be much higher: South Africa, for example, has 55,000 official deaths, but its excess mortality figures hint at a true total two or three times that.
Fearing a potential crisis ahead, Matshidiso Moeti, the World Health Organisation’s Africa Director, has called for vaccine equity and for Africa to “knuckle down and make the best of what we have,” yet, across Africa, nervousness over the use of vaccines is rife, where stocks of jabs have been routinely dumped, to the frustration of senior health officials across the continent.
While Africa represents 16% of the world’s population, it possesses less than 0.1% in the world’s vaccine production capacity. According to the World Health Organization, fewer than 10 vaccine manufacturers are based in Africa. Moreover, the majority of those located on the continent focus on packaging and labelling rather than manufacturing. As a result, Africa is ill-equipped to produce, source and supply doses in the midst of this pandemic. As described by Rwanda President Paul Kagame: “So long as Africa remains dependent on other regions for vaccines, we will always be at the back of the queue whenever there is scarcity.”
Most of the vaccines shipped so far to Africa have been AstraZeneca shots via the global vaccine-sharing scheme Covax and manufactured by the Serum Institute of India. With India suspending exports to meet its own needs, supply has come to an abrupt halt.
While Ghana, Rwanda and Senegal have sped through their Covax supplies, many countries have only managed to administer only a fraction of what is needed. Malawi has said it plans to destroy more than 16,000 doses of AstraZeneca’s vaccine manufactured by the Serum Institute of India because the shots were not administered before the April 13 expiry date on the packaging. Meanwhile, South Sudan has set aside 59,000 doses supplied by the African Union and is not using them because of the same expiry issue.
Rather than sitting on the side-lines, public health bodies like the WHO should be on the ground educating, supporting, and encouraging people to take up the vaccine. Any delays now could have serious ramifications for public health in the future and the economic wellbeing of the continent. A recent study by the World Bank indicates that for every month that vaccines are delayed in reaching the African continent, 13.8 billion US dollars are lost in GDP.
The higher the number of Covid cases a country has, the more likely it is that new variants will emerge. That is because every single infection gives the virus a chance to evolve, and a major concern is that mutations could arise that render vaccines ineffective.
What this whole demonstrates is that public health bodies like the World Health Organisation have yet again fallen asleep at the wheel, just like they did in their response to the Ebola outbreak in West Africa from 2014-16, which was the largest and most complex Ebola outbreak since the virus was first discovered in 1976.
Even an independent panel set up by the WHO recently reported that the pandemic was preventable, and that the combined response of the WHO and global governments was a “toxic cocktail”.
Covid-19: Make it the Last Pandemic, was compiled by the Independent Panel for Pandemic Preparedness and Response. The panel argued that the WHO’s Emergency Committee should have declared the outbreak in China an international emergency a week earlier than it did. Seemingly pushing the blame, the panel said the month following the WHO’s declaration was “lost” as countries failed to take appropriate measures to halt the spread of the virus.
In recent decades, the WHO has expanded its remit far beyond communicable diseases and health emergencies. It now recommends legislative and regulatory interventions designed to combat non-communicable ‘lifestyle’ diseases.
Some of this work is easily justifiable, such as improving childbirth outcomes in poor societies. Much of it, however, is rooted in the desire to legislate health.
Despite owing its existence to the charitable largesse of benefactor member countries, what this demonstrates is that by no longer sticking to communicable diseases and health emergencies, the WHO has become overly political. A global organisation that can help the less fortunate is not in itself a bad idea, but we must question whether this is what we have got right now. More crucially, has the WHO lost sight of its original mandate? The spread of Ebola in West Africa should have been the wakeup call for the WHO, but its refusal to divert its focus from diets, smoking, drinking and the speed of electronic scooters, means that Covid will possibly kill more people than booze and burgers combined.
The WHO must return to the successes of the past, focusing on the near eradication of diseases like measles and polio, as well as investing in healthcare capacity. We will all be better served if the public health work of the WHO is free of politicization. Africa, now more than ever, deserves better.