COVID-19 vaccine inequity in African low-income countries

Abstract

Equitable access and utilization of the COVID-19 vaccine is the main exit strategy from the pandemic. This paper used proceedings from the Second Extraordinary Think-Tank conference, which was held by the Health Economics and Policy Unit at the Kamuzu University of Health Sciences in collaboration with the Malawi Ministry of Health, complemented by a review of literature. We found disparities in COVID-19 vaccine coverage among low-income countries. This is also the case among high income countries. The disparities are driven mainly by insufficient supply, inequitable distribution, limited production of the vaccine in low-income countries, weak health systems, high vaccine hesitancy, and vaccine misconceptions. COVID-19 vaccine inequity continues to affect the entire world with the ongoing risks of emergence of new COVID-19 variants, increased morbidity and mortality and social and economic disruptions. In order to reduce the COVID-19 vaccination inequality in low-income countries, there is need to expand COVAX facility, waive intellectual property rights, transform knowledge and technology acquired into vaccines, and conduct mass COVID-19 vaccination campaigns.

Which roads lead to access? A global landscape of six COVID-19 vaccine business models.

“…There is a substantial literature that seeks to explain why access was so globally unequal. For example, a significant body of scholarship has focused on advanced purchase agreements (APAs) between vaccine developers and high-income countries (HICs) which allowed them to secure a large proportion of global supply early , or the lack of technology transfer to expand production and the contested role of intellectual property (IP) rights in impeding greater supply (7,8,12,13,15,18,22,25,26,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Scholars have also highlighted regulatory and quality issues (8,12,17,41,42) and export restrictions (8,17,18,20,22,25,43) as important factors contributing to access inequities, although less frequently.…”

“…Scholars have also highlighted regulatory and quality issues (8,12,17,41,42) and export restrictions (8,17,18,20,22,25,43) as important factors contributing to access inequities, although less frequently. There is also significant analysis of the limitations and challenges faced by COVAX, the vaccine pillar of the ACT-A Accelerator, pointing to competition with HICs for doses, lack of sufficient financing, and internal transparency and governance issues (8,16,17,24,(26)(27)(28)(29)(30)(31)(32)(33)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54). .…”

“…The literature also discusses a range of policies that have been proposed or implemented to improve global access. Many scholars have argued in favor of waiving IP rights, together with the expansion of production capacities in L&MICs (7,8,10,(12)(13)(14)(15)18,21,22,25,26,28,(30)(31)(32)(33)37,39,45,46,55). Others argue for tying access conditions to public funding for pharmaceutical research and development (R&D), in light of the large amount of public investments in the development of many COVID-19 vaccines during the pandemic (18,19,21,26,36,52,(56)(57)(58)(59)(60).…”

Lessons learnt from COVID-19 to reduce mortality and morbidity in the Global South: addressing global vaccine equity for future pandemics

“…Individuals who are not vaccinated against COVID-19 are more likely to report Long COVID symptoms,4 with increased mortality 5. Vaccines, while not the only tool, have been essential in reducing morbidity and mortality 6. Given that all COVID vaccines currently require additional doses to protect against new variants,7 additional doses are needed globally to reduce mortality and to prevent future pandemics with COVID-19.…”

High SARS-CoV-2 incidence and asymptomatic fraction during Delta and Omicron BA.1 waves in The Gambia

“…Underreporting due to limited testing may, in part, explain these findings, with SARS-CoV-2 seroprevalence studies suggesting high infection rates during the first year of the pandemic in African settings 2 . Non-pharmaceutical interventions (NPI) to limit SARS-CoV-2 transmission were also variably enforced and vaccine inequity has resulted in lower SARS-CoV-2 vaccination coverage in Africa compared to the highly vaccinated populations in most HIC 3 .…”