NOT UNTIL COVID-19 OUTBREAK did the business community and conveners of business conferences begin to take health and related issues seriously as matters of urgency. But even then, such conference conveners, discussants and the business community approached the health situation from the wrong perspectives, notably the vaccine distribution which pushed emphasis more on production rather than on the real public health challenges that have immediate and long term implications. It has been variously argued that the emergency and the uniqueness of the COVID-19 outbreak necessitated the trial and error responses and extreme measures in many cases. That, to some extent, was understandable. The rather warped understanding of many vaccine advocates at the peak of COVID-19 outbreak became evident as talks of vaccine equity were muddled up with vaccine distribution. While the former had more to do with charity, the latter had more to do with pure business. In these circumstances, therefore, the champions of vaccine distribution confused humanitarianism with pure mercantilism, in which case markets are drivers of dissemination of goods.
As noble and foresighted as the motivation of vaccine manufacturers might have been, it was most unlikely that they were out to produce the vaccines just for humanity’s sake without expectation of any material gains in return. This became evident from the events that arose since the first sets of vaccines were approved for rollouts. With the benefits of hindsight, it was clear that the vaccines were meant for sale and for profit. Pure and simple! The 2021 annual revenue of Pfizer nearly doubled to $81.3 billion over the preceding year, $36.8 billion of which came from the sales of COVID-19 vaccines. This revenue from COVID-19 vaccines alone is far greater than Kenyan government’s revenue of $15.7 billion for the 2020/2021 fiscal year, Ghana’s $8.8 billion for 2021 and $1.4 billion Malawi’s tax revenue for 2020 combined. Countries with deep concerns about their citizens understood their needs and stocked up assorted types of the vaccines from various manufacturers such as AstraZeneca, Moderna as well as Johnson & Johnson, thus hedging their bets in anticipation of which one might work or which one might fail.
Snowball, the prominent character that led the battle of the cowshed in George Orwell’s “Animal Farm,” told his colleagues that there was “no sentimentality, comrades! War is war.” And those who understood the unstated rules of the game realised it early that the outbreak of COVID-19 was a war of some sorts. They needed to build their arsenal in readiness and that was not a time to hold talks on equity as there is no such rule in war. To further complicate things, intellectual property was another tall hurdle, hindering the sharing of the vaccine technologies with less developed and less affluent countries. This gave further vent to the talk of vaccine equity as if those companies that did the original research and development of the breakthrough vaccines were under any obligation to give out their patents in the name of being considerate. Again, the market ruled and dictated the rules of the game. It is not only for COVID-19. Those interested or involved in vaccine distribution need to understand that the market is not an idealistic environment, just as the place for sentiments is very narrow in the market. But was that not the unstated idea expressed on the floor of the World Economic Forum (WEF) in 2017 where and when the Coalition for Epidemic Preparedness and Innovation (CEPI) was first launched? Even the idea of GAVI was not launched in an Academy of Sciences or a medical conference. The knowledge and policy gaps can thus be easily figured out as the roles played by these vaccine promoters are juxtaposed with those of the World Health Organisation (WHO) that has become their partner. Considering the annual sources of its revenues, the inconsistencies of the WHO in its responses to various countries could be understood. China or Japan are not expected to be treated the same way as Cameroon or Jordan.
The hypes, fear mongering, accusations, counter accusations, blackmails and drastic measures that followed the introduction of new types of vaccines all heightened apprehension and social tensions, which were seized upon by politicians who further muddied the waters and widened the gap in people’s understanding of the crisis; in effect, polarising the people in their perception of the COVID-19 vaccines. The whole argument about the failure of the international community to arrive at a consensus on COVID-19 vaccines became a problem on its own. In addition to the uniqueness of COVID-19 as a disease with many unknowns, the usual mistakes scientists have been making in communication and public engagement came again to the fore. Many front liners in COVID-19 vaccine promotion – scientists and non-scientists alike – missed a vital point and tended to flow with the wrong assumption that the general public was just a set of dummies that would accept the vaccines anyhow, anyway. The great mistake that made people suspicious and resistant to genetically modified organisms (GMOs) played out in the course of the introduction of COVID-19 vaccines. The promoters appeared to have taken people for granted, preferring rather to assume that – for their health’s sake, the public and potential users were simply expected to accept the vaccines without any question. Matters were made worse as whoever expressed any misgiving was tagged as non-compliant, resisting the attempts to rid the world of COVID-19.
That unidirectional flow of thought was both misguided and wrongheaded as the promoters did not comprehensively address the fears of the target public, even if those fears were unfounded. One of the first offenders was the WHO that chose rather to dissipate energy on fighting “infodemic” at the initial stage of the pandemic instead of feeding the public with various messages of assurance and hope, while also using the public’s reactions as feedback to provide good foundation for effective emergency response strategies. Dismissing people’s fears and doubts was not a good idea at all. Attempts to exclude opposing views did much more damage. The problems with the rollouts of the vaccines were also similar. Expecting people to just accept mRNA vaccines that they were not earlier accustomed to was rather too presumptuous. The promoters thought that, for the fear of dying, everyone would naturally accept the mRNA vaccines, without asking questions. They missed it. A real scenario that did more damage to people’s trust in scientists was that of the Gain of Function mutation research that gained so much publicity as it led to an international diplomatic fiasco between the US and China. While the scientists could argue that they had a point to their credit, the social universe appeared to have been scared stiff from those scientists’ chess game. Adding this adventure into the COVID-19 scare mix, the idea that the vaccine dissemination was going to be demand-driven or supply-driven was not well thought out initially. It is clear that they have realised that, as retrospections have shown in the US and other countries where there were deaths in the thousands even when vaccines were already available.
The misinformation, which the scientists themselves and the commercial as well as political promoters of the vaccines did not seem to realise, let alone acknowledge, remained rather elusive as their own rigid approaches have not succeeded in winning over many sceptics. The big tech and tele-guided social media did not help matters. They worsened the situation as they made themselves infallible gatekeepers for information flow, shutting out opinions that did not flow with the mainstream. They arrogated to themselves the unsolicited task of fact checkers. In their overzealousness, some of them even tried to shut down the expert opinions of some notable scientists with proven ideas just because the fact checkers did not understand the profundity and intricacies involved in the COVID-19 outbreak and the vaccine breakthrough. Practical knowledge of epidemiology would help people to know the importance of mass vaccination and the need to ensure that all are carried along. To their credit, those who did research on COVID-19 were more proactive, while the representatives of many countries that did not embark on any relevant work were vociferous in their campaign in favour of vaccine equity. It could be that those who should know truly did not understood that the flurry of activities by vaccines promoters and the frenzy of efforts by social marketing succeeded more in raising fears, doubts and apprehensions among many people who have vowed to resist anything COVID-19 vaccines despite the all-out efforts being made to promote them. Even when these fears were acknowledged, the efforts and strategies towards defusing the built up tension did not seem far-reaching enough. Even if those countries did some things wrong, were they not better than countries of Africa that did next to nothing while the COVID-19 fire first raged?
It is on record that, at the onset of the COVID-19 pandemic, many pundits turned prognostic experts and predicted that African streets were going to be littered with the corpses of people projected to die of the infections. The failure of that prediction notwithstanding, many different reasons could be alluded to, particularly concerning people’s vaccine hesitancy. Until scientifically proven and elaborately explained, the African situation will continue to confound many pundits, especially when large numbers of fatalities were recorded in countries from which the vaccines were produced and who bought out the vaccines in large scale. A mistake often made in logical statistical reasoning will remain prevalent here as people will keep confusing causation with correlation; this means that the scientists and publicists have a lot more tasks ahead of them, not only on COVID-19, but possibly any other pandemic in the future. While those in less developed countries accuse those from developed countries of not ensuring vaccine equity, two questions need to be asked about Africa, a continent with over a billion people. Where is the cohesive policy on vaccine production? Between market driven and genuine demand driven production, which one suits African populace better, at least for now? The Institut Pasteur de Dakar (IPD), a biomedical research centre in Senegal, comes readily into reckoning. COVID-19 may not have done much for Africa’s good, but its outbreak has succeeded in bringing IPD – and Africa – back into focus. This same IPD was where yellow fever virus was first isolated in Africa and where the first vaccine for the disease was discovered.
Suddenly, the world began to notice Africa and realised the need for partnership with Africa in a global fight against COVID-19 and any other disease that could potentially turn pandemic. An agreement reached in July 2021 between Senegal, the European Commission, European Investment Bank (EIB), France, Germany and Belgium to build a large-scale manufacturing facility at the Pasteur Institute for the production of vaccines against COVID-19 and other endemic diseases led to inflow of funds one of which was the EIB’s €75 million for a new vaccine manufacturing facility. This facility was expected to “significantly reduce Africa’s dependence on imported vaccines and support equal access to vaccines, producing up to 300 million doses a year against COVID-19 and other endemic diseases.” In theory, therefore, IPD should help solve vaccine equity problems to some extent and be able to meet nearly a quarter of Africa’s annual vaccine needs with such a facility in place. It appears like there is a growing awareness about this. During the visit of US Secretary of State Antony Blinken to Senegal in November 2021, he highlighted “future pandemic resilience not just in Senegal but across the continent.” Africa, which currently imports 99 percent of its vaccines, could transform into a production hub. “By increasing vaccine production in Africa, we’ll increase production overall, but we’ll also make it easier, more effective, more efficient to distribute vaccines throughout the continent. And that is, simply put, going to save lives,” observed Blinken who announced his country’s commitment of $3.5 million to bolster vaccine production at IPD. In South Africa too, something remarkable seems to be happening. In March 2022, a consortium of nine development and finance institutions announced a partnership with Biovac in Cape Town to support Biovac’s vaccine manufacturing expansion. This was to support South Africa and the African continent in efforts to increase vaccine manufacturing capacity and reduce reliance on imports. This did not go without the imprint of the market in it as the efforts are also to enable the production of Pfizer-BioNTech’s COVID-19 vaccine and other vaccines.
If Africa is to achieve appreciable coverage in the present, it is doubtful if the market-driven approach alone will go far. Rather, the key to the so-called vaccine equity is in the hands of Africa. Innovative financing or contributions from financial institutions may not be enough. Governments of over 50 African countries need to get directly involved in financing and ownership. South Africa and Senegal have become relevant in the vaccine intervention. The intended beneficiary countries too need to get involved in financing. Interventions from elsewhere outside Africa are commendable, but that is not all that Africa needs. The continent has had enough plausible face-saving statements by activists and advocates without commensurate local action. It is getting clearer that Africa can reduce its dependence on other countries and continents to meet part of its vaccine needs. Let more energy and resources now be devoted into achieving this, and less energy dissipated on accusations and recriminations over what others have more than Africans. Africa will be better for it.
