In August, I received my second dose of a COVID-19 vaccine, making me one of the privileged 4% of Africans to have this opportunity. While I cherish my protection, I am acutely aware that gross inequality in vaccine access during this pandemic has left millions of people vulnerable. Having lost a nephew, work colleagues, and others to COVID, I view the tens of thousands of Africans who have died not just as statistics.
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My 25 years of experience in development and health, working at the forefront of the management of epidemics — such as HIV/AIDS, malaria, and Ebola — has repeatedly shown that, when faced with a global crisis, the global health response tends to favor the needs of high-income countries, at the expense of low- and middle-income countries, especially in Africa.
Instead of global solidarity, COVID-19 has once again spurred disappointing expressions of vaccine nationalism, rooted in asymmetrical power relationships among countries and the domination of vaccine production by a handful of global pharmaceuticals.
In addition, COVAX, the worldwide initiative aimed at equitable access to COVID-19 vaccines, has been hindered by inadequate vaccine supplies, the monopolization of available stocks by high-income countries, and insufficient funding to buy the vaccines needed. COVAX looks unlikely to meet even its minimum goal of 2 billion doses in 2021.
There is still time, however, for wealthy nations to re-distribute an expected surplus of more than 1 billion vaccines by the end of this year, and thereby avoid the loss of up to 2.8 million lives.
Poorer countries have been offered charity, when what they need is solidarity. When I was growing up in Ghana, if tragedy struck, it was not charity but solidarity — “ubuntu” — that got us through. Ubuntu is indeed a hallmark of resilience in so many African cultures. I recall the courageous actions of my mother during the famine of 1983. Compelled by the spirit of ubuntu, she shared the little food we had with others and vice versa, to sustain us all through the tough times. Nations must also act in the spirit of ubuntu.
To protect the countless unvaccinated people in poorer countries around the world, global leadership must align on key actions needed to end this pandemic and prevent future ones. A shared vision and concerted action can transform the global health system to be fully responsive in times of crisis, and better coordinate actions to prevent, detect, and respond to pandemic threats, leaving no one behind.
Three approaches that would help bring an end to this pandemic and address underlying inequities in global health include:
• High-income countries must rapidly follow through on their promises to share vaccines by taking concrete actions that increase coverage and reduce COVID-19 illness and death, while simultaneously sharing vaccine technology and tools for production. This includes implementing a temporary suspension on intellectual property rights to make COVID-19 vaccines and other new technologies available to low- and middle-income countries, as called for by a coalition of countries led by South Africa and India.
• Governments across LMICs must invest more in strengthening their health systems. Chronic underspending on health systems — often mandated by the terms of development loans from global institutions, or the result of local competing priorities — has resulted in a lack of the requisite capacity needed to function efficiently and effectively. Even if low-income countries receive promised vaccine donations, boosting vaccination rates to 70% will require national governments to increase their health care spending by 57% on average.
• Global health leaders and funders must undertake structural reforms and new initiatives to address systemic weaknesses and inequalities. The worldwide pandemic treaty proposed by the World Health Organization and more than 20 world and global health leaders would be a good start. It is designed to avert pandemics by clarifying states’ legal obligations to prevent, detect, and respond to pandemic threats and by strengthening WHO’s authority. This, coupled with the new WHO pandemic intelligence hub, hosted by Germany, and other initiatives to ensure equity in global decision-making, would provide stronger and more coordinated mechanisms for pandemic preparedness and response.
Commitments made this autumn at the Global COVID-19 Summit convened by the United States — including President Biden’s pledge to donate an additional 500 million vaccines — are positive. Now we need decisive and visionary leadership to enact comprehensive reforms that can both end this pandemic and prevent the next.
Too many lives have been lost and dreams cut short by COVID-19. The loss of family members, friends, and colleagues are personal and profound. As I recall my nephew’s zest for life, I know the sense of sorrow I feel is shared by millions around the world. The losses to society in human talent, ambition, and capacity are immeasurable.
As emphasized by the recent World Health Summit, we must end the inequalities in vaccine access, and re-tool the global health system to overcome inaction, panic reaction, nationalism, and a lack of preparedness that has characterized so much of the global pandemic response. Instead, let us ensure that solidarity — ubuntu — guides our actions in the midst of global tragedy.