Covid vaccine gap: How South Africa hopes to bridge the divide

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  • Coronavirus pandemic

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With South Africa's vaccination campaign moving at a snail's pace, President Cyril Ramaphosa has been forced to tighten lockdown restrictions in a bid to contain a third wave of the coronavirus pandemic.

South Africa has vaccinated less than 2% of its population of about 59 million since it started its programme in February.

This is in contrast with the US where almost 46% of the population of more than 330 million has been fully vaccinated.

"Covid is down. The economy is up. America is on the move again," boasted US President Joe Biden in a recent tweet.

In contrast, President Ramaphosa has been forced to:

  • Order the closure of all schools
  • Advise people to work from home where possible
  • Ban all indoor and outdoor gatherings, including weddings
  • Limit funerals to 50 people
  • Ban the sale of alcohol to ease pressure on hospitals
  • Order the closure of all non-essential establishments at 20:00
  • Introduce a curfew from 21:00 to 04:00.

Hospitals admissions are rising fastest in the economic heartland of Gauteng, and in many places beds have run out.

But producing vaccines is only half the challenge, and what matters crucially is getting the jab into people's arms.

Devastating wave

A slow vaccination rollout has left millions of people vulnerable to infection.

image copyrightAFPimage captionLess than 2% of South Africans have had the jab

The main opposition Democratic Alliance (DA) has condemned it as "sluggish", saying the government would fail to meet its target of vaccinating 40 million people by the end of the year.

The second-biggest opposition party, the Economic Freedom Fighters (EFF), condemned what it called the "utter failure of this government to vaccinate even a million people in the space of over a year". It organised a march last week, demanding Russian and Chinese-manufactured vaccines in addition to the Pfizer and Johnson & Johnson vaccines already in use.

"We are in the grip of a devastating wave," Mr Ramaphosa said in an address to the nation on Sunday night.

"By all indications [it] seems like it will be worse than those that preceded it," he added.

Mr Ramaphosa said the government was concerned about the "rapid spread" of the Delta variant, but evidence suggested that the vaccines being used in South Africa were effective.

He defended the vaccination campaign, saying that nearly 2.7 million people had received a dose and the daily vaccination rate had surpassed 100,000.

Real and rising threat

Other African states – including Namibia, the Democratic Republic of Congo and Uganda – are also witnessing a surge in cases.

Uganda's President Yoweri Museveni has called out "vaccine selfishness" in the world but said it would "wake up" Africans to be self-sufficient.

Currently, only five African countries are involved, in a limited way, in the productions of vaccines.

Tunisia and Morocco have companies that can package and label, meanwhile South Africa, Egypt and Senegal can "fill and finish" – which entails big pharmaceutical companies using third parties to fill and prepare vials for distribution.

In Africa less than 1% of the continent's 1.3 billion people have been vaccinated and as a result the pandemic is far from over – in fact it is escalating.


mapped

Confirmed cases around the world

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The world
Africa
North America
Latin America & Caribbean
Asia
Europe
Middle East
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181,102,393 cases

3,923,132 deaths

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Circles show number of confirmed coronavirus cases per country.

Source: Johns Hopkins University, national public health agencies

Figures last updated

28 June 2021, 09:49 BST

"The threat of a third wave in Africa is real and rising," Dr Matshidiso Moeti, World Health Organization (WHO) regional director for Africa, said last week.

"It's crucial that we swiftly get vaccines into the arms of Africans at high risk of falling seriously ill and dying of Covid-19," she added.

South Africa and India have been pushing the World Trade Organisation (WTO) to waive intellectual property rights for coronavirus vaccines so that they can become more easily available in the developing world.

"We are tired of waiting in the queue, we want to be at the front," said Mr Ramaphosa in a meeting with French President Emmanuel Macron last month.

image copyrightAFPimage captionHospital admissions have been rising sharply in South Africa's economic heartland of Gauteng

The European Union (EU) plans to invest €1bn ($1.1bn; £0.8bn) in vaccine production and access on the continent, while a $50bn world vaccination plan has been proposed by the International Monetary Fund chief Kristalina Georgieva.

"Pandemic policy is economic policy. Unless we get out of the health crisis, we cannot see the world economy fully recovering," she told the BBC.

The pressure is yielding results, with Mr Ramaphosa and Mr Macron announcing last week that South Africa would become the continent's first major manufacturer of vaccines.

image copyrightAFPimage captionFace coverings are mandatory in South Africa

South African vaccine manufacturer Biovac will partner with Afrigen Biologics, a network of universities, and the Africa Centres for Disease Control and Prevention to establish Africa's first Covid messenger RNA vaccine technology transfer hub – where innovation, production and training will happen.

But it could take at least a year to complete, and there is a growing global consensus that in order to beat the pandemic countries in the global south needs greater support – and fast.

Both India and South Africa say the only way to allow for a "fair, equitable and affordable access" to life-saving vaccines is for the WTO to waive an agreement to protect international property rights, called Trade-Related Aspects of IP Rights (Trips).

HJIYou can't defer only to vested interests and well-funded lobbies."Fatima Hassan
Director, Health Justice Initiative

The proposal has gained traction after receiving backing from the US, but there is no guarantee that it will go ahead, and there are concerns that businesses hold too much sway.

"You can't defer only to pharmaceutical interests and to vested interests and to well-funded lobbies in the negotiations," said Fatima Hassan, the director of civil society organisation the Health Justice Initiative.

"It needs to be transparent, civil society needs to have a seat at the table", she adds, and wants the waiver expanded beyond vaccines so that testing kits, ventilators and oxygen treatments and more can be made locally by and for poorer nations.

Vital to transfer skills

The EU does not support a Trips waiver and wants compulsory licensing agreements instead – whereby governments produce vaccines without the patent owners' consent, but the owners still exert rights over the patent and are entitled to compensation. Under a patent waiver these restrictions are not in place.

"The EU and other nations opposing this waiver need to stop blocking other countries' efforts to protect their populations in a public health emergency," said Dimitri Eynikel of the medical charity, Médecins Sans Frontières.

He called compulsory licensing "a safeguard that can only bypass patents but not all IP [intellectual property] barriers".


data in detail

Scroll table to see more data

*Deaths per 100,000 people

Filter:

The world
Africa
North America
Latin America & Caribbean
Asia
Europe
Middle East
Oceania

Country

Deaths

Death rate*

Total Cases

New Cases

0

10
100
1k
10k

**

US

601,250

183.8

33,472,848

Brazil

513,474

245.1

18,420,598

India

396,730

29.3

30,279,331

Mexico

232,564

184.3

2,505,792

Peru

191,584

598.9

2,046,057

Russia

131,070

89.9

5,387,486

UK

128,100

190.8

4,732,434

Italy

127,472

210.3

4,258,069

France

110,968

170.7

5,770,021

Colombia

104,678

210.8

4,158,716

Argentina

92,568

208.7

4,405,247

Germany

90,768

109.2

3,734,489

Iran

83,845

102.5

3,167,741

Spain

80,779

173.0

3,782,463

Poland

74,979

197.7

2,879,638

South Africa

59,900

103.6

1,928,897

Indonesia

57,138

21.3

2,115,304

Ukraine

54,507

123.2

2,298,086

Turkey

49,576

60.2

5,409,027

Romania

33,253

170.5

1,080,630

Chile

32,298

172.4

1,547,103

Czech Republic

30,298

284.1

1,666,947

Hungary

29,980

308.8

807,910

Canada

26,187

70.6

1,420,607

Belgium

25,160

219.1

1,082,476

Philippines

24,372

22.9

1,397,992

Pakistan

22,231

10.5

955,657

Ecuador

21,523

126.0

454,336

Bulgaria

18,027

255.6

421,531

Netherlands

17,758

104.1

1,684,911

Iraq

17,091

44.5

1,325,700

Portugal

17,084

166.6

874,547

Bolivia

16,581

146.0

433,935

Egypt

16,092

16.3

280,394

Tunisia

14,654

126.7

407,017

Japan

14,621

11.5

796,118

Sweden

14,619

146.6

1,088,896

Bangladesh

14,172

8.8

888,406

Greece

12,655

120.3

420,905

Paraguay

12,517

179.9

418,330

Slovakia

12,505

229.3

391,551

Switzerland

10,882

127.6

702,507

Austria

10,700

120.3

650,261

Jordan

9,727

97.6

749,784

Bosnia and Herzegovina

9,655

290.5

204,945

Morocco

9,277

25.7

529,676

Guatemala

9,050

52.5

291,595

Nepal

9,009

32.1

633,679

Croatia

8,200

197.3

359,652

Lebanon

7,843

114.3

544,454

Saudi Arabia

7,775

23.1

483,221

Serbia

7,031

100.7

716,301

Honduras

6,922

72.2

260,331

Panama

6,524

156.2

400,666

Israel

6,429

76.7

840,888

Moldova

6,184

152.6

256,559

Uruguay

5,494

159.3

365,866

North Macedonia

5,484

263.3

155,673

Georgia

5,266

131.6

363,522

Ireland

4,989

103.5

271,260

Azerbaijan

4,968

49.9

335,836

Malaysia

4,944

15.7

734,048

China

4,846

0.3

103,724

Costa Rica

4,602

92.1

361,005

Afghanistan

4,519

12.2

111,592

Armenia

4,508

152.7

224,797

Slovenia

4,419

212.7

257,240

Lithuania

4,381

156.4

278,689

Ethiopia

4,314

3.9

275,935

Dominican Republic

3,797

35.7

322,778

Algeria

3,693

8.7

138,465

Kenya

3,595

7.0

182,597

Palestinian Territories

3,559

73.2

313,721

Kazakhstan

3,524

19.2

476,740

Myanmar

3,297

6.1

153,160

Libya

3,187

47.7

192,470

Belarus

3,113

32.9

415,339

Venezuela

3,068

10.6

269,635

Oman

2,967

61.4

262,059

Sri Lanka

2,944

13.9

253,618

Sudan

2,754

6.6

36,574

Denmark

2,532

44.0

292,943

Latvia

2,503

129.8

137,210

Albania

2,456

85.2

132,512

El Salvador

2,371

36.9

78,572

Kosovo

2,260

122.5

107,299

Nigeria

2,119

1.1

167,467

Zambia

2,022

11.7

148,568

South Korea

2,015

3.9

155,572

Kyrgyzstan

1,982

31.4

121,946

Thailand

1,934

2.8

249,853

Kuwait

1,933

46.7

351,481

Syria

1,867

11.0

25,404

United Arab Emirates

1,796

18.6

626,936

Zimbabwe

1,736

12.0

46,442

Montenegro

1,609

256.3

100,190

Namibia

1,400

57.2

84,705

Yemen

1,360

4.8

6,908

Bahrain

1,345

85.7

265,247

Cameroon

1,320

5.2

80,487

Estonia

1,269

95.9

130,968

Cuba

1,241

10.9

182,354

Malawi

1,182

6.5

35,629

Senegal

1,164

7.3

42,904

Botswana

1,095

48.6

67,492

Jamaica

1,061

36.2

50,005

Finland

969

17.5

95,084

DR Congo

916

1.1

40,254

Australia

910

3.7

30,528

Madagascar

906

3.4

42,194

Uganda

903

2.1

78,394

Angola

889

2.9

38,556

Mozambique

868

2.9

75,138

Luxembourg

818

135.4

70,600

Trinidad and Tobago

817

58.8

32,198

Ghana

795

2.7

95,369

Norway

792

14.8

130,588

Somalia

775

5.2

14,892

Uzbekistan

731

2.3

109,692

Eswatini

678

59.7

19,035

Taiwan

632

2.7

14,634

Qatar

588

21.1

221,692

Cambodia

556

3.4

48,532

Mongolia

533

16.8

111,505

Mali

525

2.8

14,417

Suriname

507

88.0

21,249

Mauritania

486

11.0

20,635

Guyana

462

59.3

19,877

Rwanda

420

3.4

36,627

Malta

420

95.6

30,606

Haiti

400

3.6

17,963

Cyprus

374

31.4

74,785

Belize

329

85.9

13,137

Lesotho

329

15.6

11,239

Ivory Coast

312

1.2

48,192

Cape Verde

286

52.6

32,372

Guadeloupe

266

66.5

17,427

Bahamas

245

63.5

12,467

Réunion

226

25.6

29,502

Maldives

209

40.5

73,327

Niger

193

0.9

5,479

Nicaragua

189

2.9

7,920

Gambia

181

7.9

6,069

Mayotte

174

67.0

19,405

Chad

174

1.1

4,951

Papua New Guinea

173

2.0

17,098

Guinea

168

1.4

23,692

Burkina Faso

168

0.9

13,478

Congo

165

3.1

12,485

Gabon

159

7.5

24,984

Djibouti

155

16.2

11,601

Comoros

146

17.5

3,912

French Guiana

142

50.2

27,040

French Polynesia

142

51.1

18,994

Togo

128

1.6

13,816

Andorra

127

164.9

13,882

Curaçao

126

77.4

12,330

Equatorial Guinea

121

9.2

8,723

Liberia

120

2.5

3,736

South Sudan

115

1.0

10,812

Aruba

107

101.1

11,131

Benin

104

0.9

8,170

Martinique

99

26.4

12,199

Central African Republic

98

2.1

7,139

Sierra Leone

94

1.2

5,381

Gibraltar

94

278.8

4,345

Tajikistan

90

1.0

13,439

San Marino

90

266.4

5,090

Channel Islands

86

50.4

4,220

Saint Lucia

84

46.2

5,278

Vietnam

76

0.1

15,740

Guinea-Bissau

69

3.7

3,846

Seychelles

63

64.9

15,116

Liechtenstein

59

155.6

3,032

Barbados

47

16.4

4,075

Antigua and Barbuda

42

43.6

1,263

Sao Tome and Principe

37

17.5

2,365

Singapore

36

0.6

62,544

Saint Martin

33

88.6

2,601

Monaco

33

85.3

2,571

Bermuda

33

52.6

2,510

Iceland

29

8.6

6,555

Isle of Man

29

34.5

1,608

New Zealand

26

0.5

2,739

Timor-Leste

21

1.7

9,035

Eritrea

21

0.6

5,780

Tanzania

21

0.0

509

Turks and Caicos Islands

18

47.8

2,424

Mauritius

18

1.4

1,833

Fiji

15

1.7

3,591

Diamond Princess cruise ship

13

712

St Vincent and the Grenadines

12

10.9

2,219

Burundi

8

0.1

5,348

Laos

3

0.0

2,110

Saint Kitts and Nevis

3

5.7

429

Brunei

3

0.7

259

Cayman Islands

2

3.1

609

MS Zaandam cruise ship

2

9

Bhutan

1

0.1

2,052

Saint Barthelemy

1

10.2

1,005

Faroe Islands

1

2.1

772

British Virgin Islands

1

3.4

298

Grenada

1

0.9

161

Montserrat

1

20.0

20

Vanuatu

1

0.3

4

Dominica

0

0.0

193

New Caledonia

0

0.0

129

Anguilla

0

0.0

109

Falkland Islands

0

0.0

63

Greenland

0

0.0

50

Vatican

0

0.0

27

Saint Pierre and Miquelon

0

0.0

26

Solomon Islands

0

0.0

20

Marshall Islands

0

0.0

4

Samoa

0

0.0

3

Kiribati

0

0.0

2

Micronesia

0

0.0

1

Palau

0

0.0

0

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This information is regularly updated but may not reflect the latest totals for each country.

** The past data for new cases is a three day rolling average. Due to revisions in the number of cases, an average cannot be calculated for this date.

Source: Johns Hopkins University, national public health agencies and UN population data

Figures last updated: 28 June 2021, 09:49 BST

For Africa generally, even if the waiver is implemented, it is unlikely it will be able to produce vaccines on a massive scale for some time, said Dr Stavros Nicolau of Africa's largest pharmaceutical manufacturer, Aspen Pharmacare, and current chairman of Pharmaceuticals Made in South Africa (Pharmisa).

"Patents are only one step. You've got to get what we call technology and know-how transfer. Know-how includes everything from the formulation, how you produce the product, the manufacturing processes, the machinery and equipment that is used. A patent is not going to give you that on its own," he told the BBC.

The African Union has belatedly acknowledged the gap in Africa's vaccine manufacturing capability for all illnesses and has pledged to increase the share of vaccines made in the continent from 1% currently, to 60% in 2040, calling the pandemic a "unique opportunity" to boost production because "this level of interest and commitment may not last".

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