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Africa's struggle to get COVID vaccine doses: 'We feel forgotten'

The pandemic is entering its third year with a significant percentage of the world's vulnerable population still unvaccinated. The discrepancy is stark, with 66% of the eligible population fully vaccinated in the U.S., while on the African continent, less than 10% are fully vaccinated.

Tian Johnson, founder of the African Vaccine Delivery Alliance, said the dire situation in low- and middle-income countries (LMICs) could have been avoided if a global strategy had been adopted at the get-go.

"Other countries go ahead and vaccinate zoo animals, people are going on second and third boosters. We're still in the situation where we're just over 7%" vaccinated, Johnson told Yahoo Finance in a recent interview.

The stark contrast is why a group of investors from various countries signed a letter sent to leading vaccine manufacturers, expected to earn billions from vaccine sales during the pandemic, asking them to tie CEO pay to fair global distribution of COVID-19 vaccine.

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The clear disparity in global vaccinations has also caused the Biden administration to rethink the impact of providing U.S. vaccine boosters on global efforts — a marked shift in sentiment from a few short months ago.

In August, when the U.S. was weighing vaccine boosters, the administration said it was possible to authorize boosters in the U.S. as well as invest in global vaccine distribution and infrastructure — despite global health officials voicing strong opposition to the idea.

"We are doing both, we think we can do both, and we will continue to do both from the United States," press secretary Jen Psaki said in September.

U.S. officials defended the decision to boost by purchasing 1.2 billion doses, mostly of the Pfizer (PFE)/BioNTech (BNTX) vaccine, and supplying syringes and providing training in some areas, and saying the effort was far more than other countries were doing to help end the pandemic.

While deliveries to low- and middle-income countries are slowly picking up as the third year of the pandemic begins, the current situation is still far less than ideal. The road to vaccinations remains fraught with obstacles.

The implications of the ongoing struggle to vaccinate the world are many. Most notably is the potential for more troublesome variants to emerge and circulate and continue to impact the global economy, experts say.

As World Health Organization director Dr. Tedros Adhanom Ghebreyesus recently said, "Alpha, Beta, Delta, Gamma and Omicron reflect that, in part because of low vaccination rates, we’ve created the perfect conditions for the emergence of virus variants."

What happened

In 2020, the World Health Organization (WHO) and Gavi, the global vaccine alliance, created the COVAX Facility that was meant to raise funds from member countries and other sources to help fund equitable distribution to middle and low income countries.

The WHO previously set a global goal of 70% vaccinated by the end of 2021, which it has now extended to mid-2022 — but not without expressing significant disappointment.

"Pharmaceutical companies did not prioritize and deliver according to their contractual obligations with COVAX, seriously reducing its supply and making it highly unpredictable," WHO said in a statement.

Doses from AstraZeneca (AZN) — via the Serum Institute of India — and Johnson & Johnson (JNJ) had been promising for their ease of transportation and storage. Meanwhile, Pfizer/BioNTech and Moderna (MRNA), leaders in the U.S., required more demanding transportation and cold-chain requirements.

But a confluence of unfortunate events lead to a flip in the global market. First, AstraZeneca ran into manufacturing issues, followed by perceptions of being less protective compared to the astonishing numbers and levels of protection reported by mRNA companies like Pfizer and Moderna in late 2020. Then, in spring of 2021, the Serum Institute was ordered to halt vaccine exports as India battled a deadly COVID-19 surge.

Dr. Ayoade Alakija, a WHO special envoy and a co-chair of the African Vaccine Delivery Alliance, told Yahoo Finance that India's decision to ban exports of vaccines was entirely reasonable considering the situation it found itself in in early 2021.

"India ... initially started off with their (palms) open, sharing to the world, Vaccine Maitri (friendship) and all that. Can you imagine if the Indian government had had to be dependent on Covax or Western countries to send vaccines to them when that horrific wave of Delta was ongoing? There would have been millions and millions more dead," Alakija said.

Meanwhile, J&J languished as it hit a costly manufacturing issue with a partner, and faced pressures from South Africa — which had been a site of its global clinical trial as well as was finishing and filling doses — to distribute doses solely on the African continent.

"There are thousands of Africans who took part in clinical trials to make the thing that the world is enjoying right now a reality," Johnson noted.

It's why J&J, and eventually others, began the process of setting up manufacturing in and for Africa.

A health-worker holds a syringe and vaccine vial before administering the coronavirus disease (COVID-19) vaccine to civilians at a makeshift tent as the government orders for proof of vaccination to access public places and transport, in downtown Nairobi, Kenya December 23, 2021. REUTERS/Monicah Mwangi
A health-worker holds a syringe and vaccine vial before administering the coronavirus disease (COVID-19) vaccine to civilians at a makeshift tent as the government orders for proof of vaccination to access public places and transport, in downtown Nairobi, Kenya December 23, 2021. REUTERS/Monicah Mwangi (Monicah Mwangi / reuters)

Vaccine hesitancy, wasted doses

African countries have found themselves receiving mostly donations rather than the purchased doses they wanted, paid for, or were willing to pay for.

"We've never wanted donations, we've never asked for donations. At the outset of the pandemic, we've always said we want to pay for vaccines, we can pay for vaccines, we just wanted a place in the queue," Johnson said.

"In addition, we want the countries that paid for the vaccines in Africa to get the vaccines. It's just absolutely outrageous," he added.

Alakija said that the problem is exacerbated by "sensational" reports about the situation that lack context, such as a recent report about Nigeria throwing away 1 million doses.

"Countries are finding out like one week before that ... Germany or Switzerland is donating a batch of AstraZeneca, because Europe decided they didn't want them so they held on to them for the last possible moment. And now because they're about to expire, they're sending them out to African nations," she said.

Sometimes it takes three weeks to get these vaccines onto a plane because of space, and the logistics, even for donations, are terribly complex, Alakija said.

"The last couple of weeks they have been trying to manically rush these vaccines out of the door because they don't want them to expire in their countries ... and yet they're willing for them to go and expire in Africa," she said. "We cannot be giving the leftovers of our leftovers to people in African countries or other low income countries of the world."

She and others worry it will lead to even more constricted supplies.

"We're in an era of nationalistic governance globally that are just waiting for an excuse so they can say to their citizens, 'Oh well, we're not sending any more vaccines to Africa because they're wasting them,' Alakija added.

While it is true that there are far more hurdles for mRNA vaccines to reach some parts of the countries, especially with the strict cold-chain demands, it isn't impossible, Alakija said. The Ebola vaccine developed by Merck had a similar cold chain struggle. But no one is talking about that, and how African countries worked around it then, she noted.

And reports about vaccine hesitancy ignore the inconsistencies in vaccine supply the countries have had to contend with, Johnson said. Public health officials are wary of creating demand for a vaccine they aren't certain will be supplied, he said.

Even so, hesitancy in African countries is less than in the U.S. and Russia, according to Dr. Saad Omer, director of the Yale Institute for Global Health.

Omer said that countries wanted to invest in messaging and create demand for the vaccines— but they didn't want to create demand that was going to be met with zero supply.

In fact, data that Omer has monitored on vaccine hesitancy shows that low and middle income countries, overall, have higher baseline vaccine acceptance compared to the U.S. and Russia.

"I think there is hesitancy everywhere in the world. We will always have vaccine hesitancy, because we are a thinking, questioning people," Alakija said.

"There is no vaccine confidence without vaccine equity, because until there is a saturation" of vaccinations, and the virus will continue to spread and threaten vaccine protection, thereby fueling hesitancy, she added.

Alakija said that moving on from branding vaccines by their companies or countries of origin could help reduce hesitancy and increase momentum for global vaccinations.

"We all have to move away from this American vaccines versus European vaccine versus UK versus Chinese or Russian. Vaccines are vaccines, lives are lives, whether you're yellow, brown, white, black — whatever you are, whatever the vaccine is, we just need to get them into peoples' arms...as quickly and as efficiently as possible," Alakija said

'We feel forgotten'

South Africa, the third richest African country, behind Nigeria and Egypt, has been a standout amid the pandemic. It is gaining traction as an mRNA manufacturing hub, and has been quick to sequence and identify new variants. The country was the site of clinical trials for J&J, is filling and finishing the company's vaccine, and has entered into an agreement to produce doses exclusively for Africa. In addition, Pfizer announced a partnership with a manufacturer to produce its vaccine doses.

"Of course we should have invested in additional manufacturing capacity long ago. Of course, we should have ensured that we were some of the first people around those negotiating tables in Europe — the same negotiating tables where we were told that the reason why we're paying double the cost of a vaccine, about three months into vaccine access...was because the Europeans bargained better," Johnson said.

Alakija said the underlying reason is largely geopolitical — the power structures that hold the world together.

"The only reason we are in this position, asking almost for pity and for charity is because our pipeline has been cut off. Pharmaceutical companies continue to supply countries that are hoarding." Johnson added.

Many LMICs didn't begin to receive doses until the second half of 2021.

Pfizer CEO Albert Bourla told Yahoo Finance in October that the company has significantly boosted shipments.

"Right now...we are shipping more to low- and middle-income countries than to high-income countries, which is the opposite of what we did the first six months," he said.

It wasn't unexpected, Alakija said.

"My daughter told me ... 'They showed us at the beginning of the pandemic with toilet paper, particularly rich countries, what they were going to do with vaccines,'" she said.

"They rushed in and bought far too much....hoarded the toilet paper, and then the rest of us who couldn't get into the supermarket. And we weren't outside saying to you to come outside and give us what you've already paid for. We would just say, 'Let us through the door so that we can purchase our own. We just want to buy what we need.You're buying enough for 50 families."

Johnson said he and other global equity advocates are exhausted, and feel there is no use in fighting anymore.

"I get the feeling that large portions of this world have just moved on. We feel forgotten. I believe that global solidarity is a myth, it's a lie," he said.

"Until today, I think a lot of us really have difficulty computing how we got here ... how these countries have turned their backs on us," Johnson said.

WHO's Dr. Mike Ryan recently told STAT News, "The world just has not ever come to terms with the fact that vaccinating the most vulnerable people first would have been a better bet, not only epidemiologically but just from an equity perspective."

Follow Anjalee on Twitter @AnjKhem

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