World View: Rich countries get boosters as vaccine inequality rages

Africa not expected to have 70% Covid-19 vaccination until second half of 2024

As rich countries intensified efforts to give booster Covid-19 vaccinations to their populations in late November, the World Health Organisation came out with a shocking statistic: only one in four African healthcare workers had been fully vaccinated against the virus.

“The majority of Africa’s health workers are still missing out on vaccines and remain dangerously exposed to severe Covid-19 infection,” said Dr Matshidiso Moeti, WHO regional director for Africa. “Unless our doctors, nurses and other frontline workers get full protection, we risk a blowback in the efforts to curb this disease. We must ensure our health facilities are safe working environments.”

The figure was taken from an analysis of data from 25 countries, but vaccine access is a problem across the continent. In mid-December, Moeti said, with the way things are going, Africa is not expected to reach a 70 per cent coverage target until August 2024. Only six countries have vaccinated 40 per cent of their citizens; 20 African countries have reached 10 per cent.

Tens of thousands of deaths could have been averted in 2021 with more protection, Moeti said. “These are not just numbers, they reflect the loss of mothers, fathers, sisters, brothers, children, colleagues and neighbours whose deaths caused untold suffering for those they left behind.”


In the six weeks to Christmas, rich countries received more boosters than the vaccines delivered to African countries in the year to date. This came as the new Omicron variant spread quickly across the continent. Kenya’s test positivity rate jumped to nearly 40 per cent this week; Zimbabwe’s topped 47 per cent on December 20th.

Oxygen canisters

The latest Covid-19 wave arrived in the run-up to Christmas, when huge numbers of people fly in and out of the region, gather in large groups, or travel domestically to be with family. In West Africa, it also came at the same time as Harmattan, a season where people typically come down with flus or coughs, meaning they may not recognise Covid-19 symptoms. In Sierra Leone, one of the world’s poorest countries, ministry of health spokesman Harold Thomas said the cases they are currently registering could be the “tip of the iceberg”, and anecdotally that seems to be true.

A doctor working on Covid-19 said  60% of patients admitted to hospital die because of the lack of capacity to treat them.

“It’s going up exponentially and we are concerned,” said Thomas. Only 14 per cent of the beds designated for Covid-19 patients are currently being used but, during the third wave, which hit Sierra Leone last June, people were dying not from the lack of a hospital bed, but because they could not afford $75 canisters of oxygen, while even those who could did not have access to the ventilators they needed.

This lack of capacity is echoed in many other countries. In Maiduguri, northeast Nigeria, a region already struggling with the impacts of a decade-long insurgency, a doctor working on Covid-19 told me 60 per cent of patients admitted to hospital die because of the lack of capacity to treat them.

In Sierra Leone, where the healthcare system was badly affected by West Africa’s 2014-2015 Ebola outbreak, government-hired staff who manage Covid-19 cases say they haven’t been paid in months. When I asked Thomas about this, he confirmed it was true and said some had also been laid off during preceding months when few cases were being registered, as it was too costly for the government to continue to pay them.

Domestic production

The lack of domestic production means African countries are reliant on donations of vaccinations. Often, they arrive too close to the expiry date to be distributed, leading to them going to waste. In Nigeria – where only about 2 per cent of people are fully vaccinated – one million vaccines were recently destroyed for this reason.

Campaigns are ongoing to get approval for the so-called TRIPS waiver, a proposal first made by India and South Africa in October 2020, which calls for high-income countries to temporarily waive intellectual property rights on Covid-19 medical products, including vaccines. It is now backed by more than 100 other low- and middle-income countries.

The lack of domestic production means African countries are reliant on donations of vaccinations

The People’s Vaccine Alliance Ireland, a coalition of organisations with membership including Access to Medicines Ireland, Amnesty International, Christian Aid, Goal, the Irish Congress of Trade Unions, and the Irish Nurses’ and Midwives’ Organisation, has accused Ireland and the EU of supporting a “a rich country stitch-up”. More than 400 leading scientists and medical professionals signed a public statement urging the Government to support the waiver and do even more, such as ensuring that strategies for booster vaccines were “ethical within a global context”.

In late November, campaigners held a protest outside Leinster House modelled on a funeral cortege. They rang a bell every four seconds to signify someone dying with that regularity as a result of vaccine inequity.

“The heavily mutated new Omicron variant . . . is clear evidence that the only way to end the pandemic is to vaccinate the whole world. The global vaccine inequity created by rich countries and western pharmaceutical companies has helped to enable the conditions necessary for this kind of deadly mutation to thrive,” said Jim Clarken, chief executive of Oxfam Ireland.

“Rather than granting developing countries manufacturing rights and ensuring people get vaccinated to cut off new variants . . . the best response [rich countries] can muster is to put up walls to a variant they have allowed to develop.”