Mutation of vaccine apartheid threatens public health

The reaction by governments in the Global North to the discovery of the Omicron variant of Covid-19 in South Africa has provided further proof – as if any more were needed – of the deeply inequitable response to the coronavirus pandemic. The backlash against African countries was swift and severe, as if barring travellers from the region could somehow keep the rest of the world safe.

It hasn’t, and closing borders won’t work when the next frightening variant emerges. Global injustice, it turns out, is very bad for public health.

Although more than half the world’s population has now been vaccinated against Covid-19, only 8 per cent of people living in lower-income countries have received a vaccine dose, compared to 48 per cent in lower-middle-income countries and much higher rates in high-income countries. As of November, the United States had administered more than twice as many doses than had been given in all of Africa.

Given these numbers, it is no surprise that variants of concern continue to emerge and spread rapidly in countries with low vaccination rates. And the disparity is not an accident. It is a direct result of nationalist policies and vaccine hoarding by wealthy countries.

Even before vaccines became available, many experts, including Director-General of the World Health Organisation Tedros Adhanom Ghebreyesus, warned about the consequences of vaccine nationalism. Despite this, wealthy countries have monopolised vaccine supplies, in some instances purchasing enough doses to inoculate their populations nine times over.

This summer, it seemed like the tide was turning. In June, members of the G7 pledged to donate their excess doses to low- and lower-middle-income countries either directly or through mechanisms like the Covid-19 Vaccine Global Access (Covax) facility. As more and more people in wealthy countries were vaccinated, there was some hope that vaccine nationalism and hoarding might end and that doses might finally make their way to countries desperately in need of them.

But in the past few months it has become clear that vaccine nationalism hasn’t ended. Instead, it has mutated. Wealthy countries like the US began pushing to administer additional doses of some vaccines even before there was evidence to support the use of booster shots. In fact, shortly before the WHO called for a moratorium on boosters until vaccines had reached those who need them most, the US signed a deal to purchase 200 million doses of the Pfizer-BioNTech vaccine for use as boosters. At the time, the use of third shots as boosters was not even approved by the US Food and Drug Administration.

But booster shots in developed countries are not the only reason low- and middle-income countries lack doses. Canada, Spain, and Germany, among others, pledged months ago to donate millions of Covid-19 vaccines directly to low- and middle-income countries as well as to Covax. Yet recent figures show that many governments have failed to deliver on these commitments. For example, the United Kingdom pledged to donate over 70 million doses, but has delivered less than 7% of this commitment.

Safura Abdool Karim, a public health lawyer at the University of KwaZulu-Natal, is a member of the Africa CDC’s African Vaccine Delivery Alliance and Partnership for African Vaccine Manufacturing.