Covid-19: why vaccination is not taking off in Africa?

In France, the signals are green: vaccination coverage among the highest in the world and an incidence rate that keeps dropping, approaching the threshold of 50 (number of cases recorded in one week per 100,000 inhabitants ).

So, is the end of the Covid-19 pandemic soon?

Besides the fact that an epidemic resumption remains possible with the re-entry, it would be to forget that part of the planet is much less well protected against the virus.

In Africa, barely 6% of people have received at least one dose of vaccine, compared to more than 45% in each of the other continents, according to the latest data from the OurWorldInData site.

And only 4% of Africans are fully vaccinated, therefore effectively protected.

This constitutes an "injustice", moved Emmanuel Macron this Saturday.

This observation is explained above all by "a lack of access to doses" linked to financial constraints, points out the epidemiologist Antoine Flahault.

With prices of up to 20 euros per dose for messenger RNA vaccines, many poor states cannot afford to buy them directly.

To remedy this, the World Health Organization (WHO), the Coalition for Innovations in Epidemic Preparedness (CEPI) and the GAVI Vaccine Alliance have developed the international Covax device, intended to deliver doses vaccines in poor countries.

But more than one after its launch, the program is far from its original objectives.

Covax in trouble

While 2 billion doses were to be distributed by the end of the year, it will ultimately be around 1.4 billion, according to the latest forecast published on September 8.

By this date, only 243 million doses had been sold, in 139 disadvantaged countries.

"This is the first time that such an initiative has been launched, but the results do not live up to expectations", judge Pierre-Marie Girard, professor of infectious diseases at Sorbonne University and at Saint-Antoine hospital ( AP-HP).

"Of the 5.76 billion doses injected in the world, a derisory share (0.3%) went to low-income countries", for its part protested Amnesty International in a study published on Wednesday 22 September.

The main reason ? Covax depends in particular on the goodwill of rich countries which can buy more vaccines than they need for their population, and of those which have significant production capacities. However, the most developed States dragged their feet for a long time, relying above all on the fastest possible vaccination of their inhabitants. As for India, on which the international bodies relied a lot - the Serum Institute of India (SII) is a very large producer of AstraZeneca vaccines - it blocked exports when it found itself confronted with a very strong wave epidemic last spring.

For Antoine Flahault, "the original sin of Covax is perhaps to have been an initiative of a little too Western origin" and to have "not believed at the time that the Russians and Chinese would quickly succeed in developing safe and effective vaccines ”.

“Initially, Covax was based on a mutualized purchase of vaccine doses (

before supplying them to poor states

) but many countries no longer exported any, and the richest left alone in their corner”, summarizes for her part Nathalie Ernoult, researcher at the Institute of International and Strategic Relations (Iris) and co-director of the Observatory for Global Health.

France doubles its donations

Hopes are now on donations from rich countries.

And things appear to be turning out, with promises having multiplied in recent weeks.

For the United States, Joe Biden said Wednesday, September 22 that he intended to increase the number of doses delivered to Covax (mainly Pfizer) to 1.1 billion, or 500 million more than expected.

France had pledged to deliver 60 million doses of vaccines by next year and Emmanuel Macron announced this Saturday evening the doubling of this target ... even if only 6 million of them (the vast majority AstraZeneca and Janssen) have already been delivered.

In Africa, barely 3% of the population is vaccinated.

We have to go faster, stronger.

France is committed to doubling the number of doses it gives, ie 120 million doses.

- Emmanuel Macron (@EmmanuelMacron) September 25, 2021

“The rich countries have vaccinated their populations well and they are finally ready to release some of the doses.

In addition, at the diplomatic level, they have every interest in bringing this Covax system to life, for which they made a political commitment from the start, ”notes Nathalie Ernoult.

On several occasions in recent weeks, the WHO has been annoyed to see rich countries administering third doses to their entire population (or considering it, like the United States), while at the same time the vast majority of people in Africa have not yet received any injection.

“We can understand that there were priorities for the rich countries, but not anymore.

And it is never too late to do well, especially since we now have the blatant demonstration that vaccination is essential for the control of this epidemic, everywhere in the world ”, estimates Pierre-Marie Girard, expert. of the African continent.

Train and manufacture on site

Delivering vaccines is one thing, but it shouldn't be enough anyway.

Nothing will be possible without on-site support, as the logistics infrastructure is generally much less developed.

"When you meet a hungry person, you have to give him a fish but also teach him to fish", summarizes Pierre-Marie Girard, who calls for "

to rely on the teams in the field by training them ”.

"The support for the implementation of the vaccination was not sufficiently well developed, in particular the information work on what vaccines are, and Covax realized this two or three months ago" , points Nathalie Ernoult.

Read alsoVaccines and poor countries: survey of Covax and the WHO's "somewhat naive" dream

Such an approach could in particular make it possible to respond to vaccine mistrust, even if this does not seem to be a major obstacle in Africa.

According to a study conducted by the African Centers for Disease Control and Prevention in 15 African countries between August and December 2020, 8 out of 10 inhabitants said they intended to be vaccinated against Covid-19 if a safe product and efficient was available.

Which turned out to be the case.

And Pierre-Marie Girard to rebel: "It's too easy to hide your face by saying:

if Africans are not vaccinated, it is because they do not want it

.

Of course there is mistrust of vaccination in Africa, but like everywhere and no more than elsewhere.

"

In the longer term, Antoine Flahault calls for "to stop thinking of aid to the Third World as a philanthropic donation from rich countries to poor countries" and to "rapidly transfer technologies to manufacture these global public goods in poor countries" .

This implies the lifting of patents, which are opposed by certain countries and manufacturers.