COVAX or bust? Accessing coronavirus vaccines in Africa

On March 8th, global vaccine leader Israel had administered 102 vaccine doses per 100 people. The UK had administered 35 per 100, the US 28. Up until that point, Africa had managed to give out 0.38 doses per 100 people. This is because vaccination campaigns only started in the first week of March in many African countries, after receiving their first doses of vaccines through the global vaccination initiative COVAX. This poses the question of whether COVAX is the continent’s best bet for achieving vaccine success – and if it isn’t, what alternatives are there?

After a slow start, COVAX recently hit its stride. On February 24th COVAX delivered its first doses globally to Ghana. Since then, COVAX has distributed over 10m doses to 14 African countries. The initiative also received a funding boost. During the recent G7 early summit, leaders doubled their commitments to $6.3 bn. However, despite this, COVAX faces a familiar issue: the global shortage of vaccines. While it has enough funds to deliver about 600m doses to Africa this year – enough to vaccinate 20% of the population in a two-dose vaccine regime - COVAX currently only has enough supply for about 3% of Africa’s population. This might be enough to inoculate health care workers, but casts doubt over the achievability of delivering 600m doses by the end of 2021.

Against this backdrop, it is unsurprising that the continent’s political leaders and public health professionals are keen to take matters into their own hands. The African Union created a central vaccine procurement taskforce to complement COVAX and help reach the 60% vaccination threshold usually considered a minimum requirement for herd immunity. In a remarkable success, the AU secured 670m doses, which countries can access at reduced prices. However, here too, only 50m doses will be available by June. Given these constraints, John Nkengasong, head of the Africa Centres for Disease Control and Prevention, believes a more realistic target might be vaccinating 35% of the population this year.

This leaves those African countries that can afford it to explore bilateral deals with vaccine manufacturers. While some, such as South Africa and Rwanda, have managed to secure deals with Pfizer or Johnson & Johnson, the US, UK and EU are currently looking inward, embroiled in their own arguments over vaccine deliveries and exports. This focus on vaccine nationalism in the West has now created an opening for vaccine diplomacy by Russia and China. 

Russia is offering its Sputnik V vaccine to key partners in Africa, such as Guinea, where Russia has significant mining interests. Russia has also offered the African Union 300m doses of Sputnik for the joint task force. For China, positioning itself as a trusted source of vaccines to the continent has been a priority since before any vaccines were developed. President Xi Jinping assured Africa they would be first in line for Chinese vaccines during a summit in June. Chinese vaccines have already arrived in Zimbabwe, Equatorial Guinea and Sierra Leone. And more than a dozen additional countries are in talks to receive vaccines from China this year.

However, while COVAX vaccines may have been slow to arrive, at least they come with no strings attached. In a recent call with Ethiopia about vaccine deliveries, China’s foreign minister, Wang Yi, was quoted as saying that China would expect Addis Ababa to “continue supporting China on issues related to China’s core interests.” 

If the West does not want to cede the field to Russia and China, financial support for COVAX needs to be followed by a more outward-looking approach to vaccine distribution. France and the UK recently floated the idea of donating surplus vaccines to COVAX. This could be a solution. However, looking further ahead, boosting vaccine production will be crucial. Waiving intellectual property rights to allow more manufacturing of vaccines as currently demanded by South Africa might be an option. 

This shift in behaviour may require a broader embrace of the idea that ensuring equitable vaccination around the world is not a question of altruism. If the virus is permitted to continue spreading among unvaccinated populations in poorer countries, further mutations are likely. Equitable access to vaccines will be key to the global recovery – and a multilateral effort like COVAX, with the right support, is a key tool to achieving it.