Covid-19 vaccine inequity: when Africa sneezes, the world sneezes too!

Image by: Nataliya Vaitkevich ( Source: Pexels)

Omicron is the 15th letter of the Greek alphabet that most of the world probably never knew existed until late last month. Today we know omicron as the highly transmissible B.1.1.529 mutated variant of the SARS-CoV-2 (Covid-19) virus that was detected in South Africa on 23 November 2021, sending the world scrambling to shutdown borders against Southern African countries.

South Africa and the rest of Africa are not to blame for the omicron variant. The real culprit here is vaccine inequity – also dubbed ‘vaccine apartheid’. In a world where only about 60% of the African continent will be vaccinated by end of 2022 – a disaster waiting to happen.1 The costs of procuring Covid-19 vaccines in LMICs are much higher as compared to high income countries. For instance, Botswana was paying an equivalent of $15 a dose of China’s Sinovac Covid-19 vaccines manufactured by Sinovac Biotech and about $29 a dose for Moderna based in the US, while the US and Europe paid relatively less.2,3

How cost-effective is South Africa’s vaccine rollout programme versus no vaccination? A collaborative study by researchers from across the world used a microsimulation model to evaluate the clinical outcomes and cost-effectiveness of the COVID-19 vaccination program in South Africa versus no vaccination.4

Figure 1. Multi-way sensitivity analysis of vaccine effectiveness against infection and vaccination cost (Source: Nature Communications)

A multi-way sensitivity analysis (see figure 14) that simultaneously varied vaccine effectiveness against infection and cost per person vaccinated, which compared a cost-saving vaccination programme against a scenario without vaccination, revealed that the cost per person vaccinated in South Africa was $14.81, even at a low 20% efficacy (vaccine effectiveness against infection).

Resistance to the temporary TRIPS waiver

When India and South Africa requested for an amendment to the TRIPS Agreement waiver, which would under these unprecedented times enable certain provisions in the agreement to relax restrictions to enable these countries to manufacture their own vaccines, this was met with some resistance by Big Pharma in high income countries.5 This was not supposed to be about profits before lives, because no country is an island, so to speak, and when you protect your neighbours from Covid-19, you’re protecting yourself too. Until the Western World, including Europe, accept that we live in a global village and that when Africa sneezes, the world sneezes – this Covid-19 pandemic is going nowhere.

Until the Western world, including Europe, accept that we live in a global village and that ‘when Africa sneezes, the world sneezes’ – this Covid-19 pandemic is going nowhere.”

Buhle Ndweni, Independent Health Economist

Had vaccine inequity been addressed before affluent countries bulk-ordered Covid-19 vaccines even before their efficacy and safety were confirmed and hoarding them once delivered, perhaps we wouldn’t be here. Once high-income countries had stockpiled these lifesaving vaccines, many got inoculated, but it was evident vaccine hesitancy from antivaxxers was hampering the plan to vaccinate the majority of the US population. Meanwhile hundreds of thousands of unvaccinated people in Africa succumbed to Covid-19.

African countries had to plead and beg for leftover crumbs from the table and soon enough the wealthy countries started sharing their Covid-19 vaccine surplus. However, the damage had already been done – the virus had mutated. The B1.1.351 variant seemed to have reduced efficacy to the vaccines.6 The coronavirus mutated into a more highly infectious delta variant that killed more people in low to middle income countries (LMICs).

Figure 2a. The daily statistics of covid-19 infection in Africa (Source: Reuters)

Figure 2b. The daily statistics of covid-19 infection in Africa (Source: Reuters)

Countries like India, where AstraZeneca, one of the largest Covid-19 vaccines manufacturers is based, grappled with internal shortages during the second wave of Covid-19.7 Although South Africa’s Covid-19 death rates did not reach the high rates India did, the country saw big pharma Johnson & Johnsson (JnJ) set up a manufacturing plant in South Africa’s city of Gqeberha and not to the benefit of the country. Instead of supplying the South African population and the rest of Africa, JnJ vaccines were routed straight to Europe. Many African countries could have benefitted from those vaccines.

This is the reason why a temporary TRIPS waiver is important. Africa must be enabled to be independent enough to produce its own vaccines and African countries be enabled to take care of their own population’s needs versus being at the mercy of high income countries.

The past 7 days have seen a surge in the number of Covid-19 infections that are believed to be driven by the highly infectious omicron variant. South Africa had been in expectation to hit the 4th covid-19 wave in December 2021/January 2022 and was hoping for low numbers of hospitalisation following its vaccination rollout programme. This was until the omicron virus put a spanner in the works, so to speak.

Figure 3. Daily new confirmed Covid-19 cases in South Africa8 (Source: Our World in Data)

The number of vaccine doses administered in South Africa suggests that only 30% of the population has been vaccinated against Covid-19, which is not enough for the country to reach heard immunity. In the last ‘family meeting’ as the address by the South African president to the nation is fondly known, President Cyril Ramaphosa announced that the government would be in discussion about making the Covid-19 vaccination mandatory, following closely behind steps taken by US President Joe Biden.9

Ubuntu‘ essential to winning the fight against the Covid-19 pandemic

Omicron has shown the extent of the world’s interconnectedness. Despite attempts to try to contain the spread of the new Covid-19 variant through travel bans, the omicron variant managed to cross borders and was soon in the very countries that imposed those restrictions on southern African countries. South African virologists and health economists had long informed the world that closing borders does not prevent transmission of the virus.10

The real culprit here is not this Covid-19 variant that has now been given an African face. It is lack of the ubuntu (or togetherness) that high income countries still grapple with. The shutting of the borders still did not prevent Omi from entering those countries that placed the southern African countries on their Red List. This is a plea to high income countries to address this vaccine inequity because if there’s anything that Covid-19 has shown us it is that it will take a collective to slow down the transmission of the virus.


1. Africa foresees 60% of people vaccinated against COVID in two to three years, 2021

2. Winning Botswana pays equivalent of $15 a dose for Sinovac’s COVID-19 vaccine, 2021

3. Covid-19: Countries are learning what others paid for vaccines, 2021

4. Clinical outcomes and cost-effectiveness of COVID-19 vaccination in South Africa, 2021

5. COVID-19: Time for countries blocking TRIPS waiver to support lifting of restrictions, 2021

6. Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant, 2021

7. India is the home of the world’s biggest producer of Covid vaccines. But it’s facing a major internal shortage, 2021

8. Our World in Data, 2021

9. Covid-19: US imposes mandatory vaccination on two thirds of workforce, 2021

10. New COVID variant Omicron triggers global alarm, market sell-off, 2021

The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of Safrea or its members.


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