The issue of vaccine distribution is well present to the international organizations, not only as it is obvious WHO, that follows specific problems, but also the UN, whose Secretary General, Antonio Guterres, beside stating that “at this critical time, vaccine equity is the greatest moral test facing the global community,” has called for a Global Plan for Vaccines that brings together scientists, vaccine manufacturers, and funders, while the Deputy Secretary General, Rosemary Di Carlo, called attention to the risk of political destabilization that would not be necessarily limited to lower-income countries.
The call of the UN Secretary General possibly had some effect to make concrete the commitments of the richest countries expressed in a number of circumstances, among which the mentioned G20 Summit of last November in Abu Dhabi, and, previously, the extraordinary Summit of March 26.
At Abu Dhabi, the recognition by public health experts of the need for equitable vaccine distribution and of the expected long time that developing countries might have to wait before receiving the low-cost vaccines compatible with their conditions of transport and storage, reflected in verbal commitments by almost all leaders. The President of the European Union asked the G20 leaders to “commit to establishing a fund of 4.5 billion dollars.” Italian Prime Minister Mr. Giuseppe Conte underscored, “We must strengthen collaboration with multilateral institutions, which must be made more effective, including the strengthening of WHO” – a statement of special interest, if one remembers how WHO has been instrumentally criticized by the previous US administration.
In the following months, these statements did not materialize until the London G7 meeting. It followed a meeting held a few days earlier by the UN Security Council, where Mexico, the country where Benito Juarez on July 16, 1867, said “Respect for the rights of others is peace” was the spoke-country of less-income countries.
G7 countries confirmed their Abu Dhabi positions with some important variations: the predictable one of the US whose president committed to a 2-year, $4 billion plan to support the COVAX program, and that of the UK, that opened up about shipping vaccines to poor countries. However, these changes are not enough. The main problem is not money, but the availability of vaccines, and this makes interesting, and hopefully important, the British change and President Macron’s proposal of donating some of the vaccines purchased by rich countries.
In any case, the issue of vaccine liberalization was not touched upon, and in their absence, intermediate-resource countries will continue to receive vaccines with irregular rhythms, with possible uncertainties on the application of second doses.
This discussion with some long-term promising perspective should not hide the current problems which needs immediate action.
On March 2, almost 270 million vaccinations have been carried out in 126 administrative units, 10 of which are not independent countries. The countries without vaccines are still 40%. This is not the most shocking inequality. In the 10 countries with the highest number of vaccines, vaccinations are 79% of the total, a percentage that reaches 86.8% if the first 15 are considered, while the last 10 countries, having at least 1,000 vaccinations and 1 million inhabitants, have only been able to carry out 45,000 vaccinations. Their total population is of about 285 million, 85% of that of the US.
The majority of the countries where vaccines have not yet arrived are in Africa – a continent with 1.2 billion inhabitants, which, while waiting for 670 million doses from AstraZeneca, has only been able to carry out slightly more than 4 million vaccinations, 93% of which concentrated in Morocco. And the rest are limited to less than 10 countries. The first arrivals of COVAX doses were an indication that this situation will change, but at a velocity definitely lower than those observed in advanced countries during the last 3 months.
Sometimes, the lower number of COVID-19 infections and deaths in Africa due to COVID-19 has led to minimize the importance of the pandemic, accepting structural explanations like cross-reactive herd immunity induced by exposure to other coronaviruses, younger age structure, experience acquired during the Ebola crisis, non-specific innate immune responses protective against COVID-19. However, a recent study of the causes of deaths in Lusaka between July and September showed that COVID-19 caused at least 15% of them, and out of them, 70% were at homes of people never tested. This points to a very simple explanation: insufficient data.
This is certainly the case of Tanzania, whose president, Mr. John Migafuli, besides proposing improbable defenses such as vegetable smoothies, declared on June 5 that it was COVID-free. The WHO Director for Africa’s invitation to prepare a vaccination plan has been rejected by the government as detrimental to national autonomy.
Despite official denials, the actual diffusion of the pandemic there is confirmed by the reported deaths of several Catholic priests, and even more by its inclusion in the list of 10 countries for which the Spanish Government has decreed that a quarantine must be required to passengers coming from them.
This situation led to unusual diplomatic behavior. The US ambassador, himself a doctor, sent a message to the Tanzanians with appropriate reminders of reality. Certainly, there aspects of his appeal, like the comparison with the US vaccination campaign success and the call to the Tanzanian government to convene its health experts and review the evidence on vaccines that may justify an eye browse and give an insight into the way rich countries perceive the African situation. It is hard to refrain from asking: Why talk about vaccines if they are not arriving?
There is no way of comparing the Africa with the US situation. In the US with their almost 80 million vaccinations, problems discussed are along the lines of whether it is advisable to use a half dose of Moderna or whether sending Johnson and Johnson single-dose vaccines to certain locations may be counterproductive, if misinterpreted as a signal of ethnic discrimination.
Others are the problems of Africa and also to a minor extent of Latin America. We cannot but agree with Salim Abdool Karim, chairman of the South African Coronavirus Advisory Committee, “To me, it would be inconceivable for a country like the United States or the United Kingdom to start vaccinating low-risk young people, when here in Africa we haven’t even started vaccinating health workers and the elderly.” Inconceivable, perhaps, but this is what is happening.
For what concerns Latin America, it has been able to use 6.4% of the vaccines administered. This figure might even appear satisfactory, considering that its population is 5.6% of the world’s. Of course, this appreciation changes if the data is compared with that of EU and UK jointly. With a total population only slightly greater, their vaccinations are 3.3 times more numerous than in Latin America. The comparison with North America is even more merciless.
