The globe’s new public health strategy: Every country for itself

This article is part of After Corona, a series exploring how the pandemic has changed the world.

If there’s one lesson the poor countries have taken away from the coronavirus pandemic it’s this: They can’t depend on others to help them.

Unlike diseases like hookworm or malaria, which mostly plague the poor and so suffer from a lack of urgency to fight them, the coronavirus turned out to be a first-world problem. But that only meant rich governments snatched up all the vaccines, ventilators and oxygen.

That reality — the global need for resources and the fact that rich countries hoarded them during the pandemic — has sparked a round of hand-wringing among public health experts. But while policy wonks, U.N. brass and some European governments are calling for new global guidelines to help ensure the world does better next time, rich countries are continuing to brush off guidance from the World Health Organization and back-burner efforts like the COVAX plan to ensure equitable access to vaccines.

As a result, countries in Africa and other less-developed regions are feeling abandoned by the global health system and starting instead to look at what they can do on their own.

“The continent is not sitting with its hands folded and waiting for COVAX to come and save them,” said Africa CDC chief John Nkengasong, a Cameroonian virologist and director of the Africa Centres for Disease Control and Prevention.

Faster than COVAX

When the African Union realized COVAX wouldn’t deliver, it scrambled to set up the African Vaccine Acquisition Task Team. The team inked a deal for up to 400 million doses of the one-shot Johnson & Johnson vaccine as COVAX struggled to follow up on promised doses of the Oxford/AstraZeneca jab.

Sani Aliyu, the coordinator for Nigeria’s coronavirus task force and former director general for Nigeria’s National Agency for the Control of AIDS, believes that the AU’s arrangements for vaccines have in fact “been much better and probably faster than the COVAX facility.”

The bigger problem was the lack of vaccines to buy.

The fact that whole continents are dead zones for vaccine manufacturing was cast into sharp relief during the pandemic. Without the ability to make its own shots, Africa has been reliant on shipments (and goodwill) from elsewhere. The problem became particularly acute when India halted exports of the Oxford/AstraZeneca vaccine COVAX was relying on, leaving many countries reliant on a trickle of vaccine donations. 

Some African countries are looking to change the vaccines landscape for good, aiming to produce not only a coronavirus shot but perhaps even a cutting-edge mRNA vaccine for TB or HIV.

The novel coronavirus is unlikely to be the last to sweep the world, so Africa needs to have control over the production of vaccines, said Petro Terblanche, managing director of Afrigen, a South African company that will train others to produce the mRNA vaccines as part of a new WHO-backed IP sharing hub in the country, the first of its kind. 

The driving motivation, she said, is countering the West’s “vaccine nationalism” with a new “vaccine security” for Africa.

Senegal is building a factory to produce COVID-19 vaccines with the aim of producing 25 million doses by the end of 2022. Rwanda is hoping to attract investments in vaccine manufacturing. In April, the AU and the African CDC launched a partnership with the aim of having the Continent producing 60 percent of the vaccines it needs by 2040.

‘Take care of your own’

The conversation in Europe and the U.S. may have turned toward fixing the global health system so it works better next time — but in the Global South, trust is shattered.

U.S. President Donald Trump didn’t make a secret of his plans for a me-first response to the pandemic. But Europe, by (intentional) contrast, declared that “no one is safe unless everyone is safe” and hosted fundraisers for the global response.

Yet Africans didn’t see this translate to much actual help from their former colonizers-turned-development partners.

“COVID has exposed the West,” said Peter Waiswa, a Ugandan public health specialist and member of the country’s immunization advisory group. He pointed to countries hoarding vaccines or refusing to recognize Indian-produced versions of the Oxford/AstraZeneca vaccine. “This is not the kind of West we’ve been taught to believe — that they’re democratic, they’re equitable,” he said.

Some richer countries recognize there’s a problem. France and Germany are spearheading a push to “strengthen” the World Health Organization — an effort that has morphed into a proposal for a pandemic treaty that is being hashed out by a working group. 

“A key concern to Germany is the growing discrepancy between the world’s expectation vis-à-vis the WHO on the one hand, and the de facto capacities of the WHO, legally, technically and above all, financially,” said a spokesperson for the German health ministry.

The open question is whether such efforts will make a difference. As the pandemic showed, it doesn’t much matter what sort of agreements or guidelines are in place on paper if power players don’t want to help when a crisis sets in.

“There’s no political leadership that is accountable at global level,” said Lieve Fransen, an architect of the EU’s humanitarian response to the AIDS epidemic in the 1990s and 2000s and a founder of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

For countries around the world, the political pressure to prioritize domestic demand is inescapable. EU countries — including Germany and France — have repeatedly ignored the WHO’s pleas, including most recently a call for a moratorium on third doses until 10 percent of every country’s population is vaccinated.

Or take India. At first, Delhi saw the pandemic as an opportunity to show off its drugmaking prowess, boasting in late March that it had supplied more vaccines abroad than at home. But when the Delta variant surged through the subcontinent weeks later, the government quickly did a U-turn and banned exports.

“I think the lesson learned from all countries now — which India will definitely remember — is, first take care of your population and then see whether you can send out to others,” lamented K. Srinath Reddy, president of the Public Health Foundation of India.

Vaccine gap

The trouble for Africa is that while its resolve for regional self-reliance is there, resources and clout are another matter. With few economic powerhouses, the continent’s “ability to influence things at the global scale is limited,” said Nigeria’s Aliyu.

“It’s good to have regional solidarity,” he added. “But it’s also important … for the West to understand that cooperation with developing countries is key to stopping future pandemics.”

That sentiment has been helpful to poor countries in the past.

Diseases like Ebola and Zika inspired rich countries to pour resources into Africa and Latin America in hopes of keeping those threats contained on those continents. Unequal access to HIV medicines led to the Global Fund. The 2014 Ebola outbreak helped spur the creation of the Coalition for Epidemic Preparedness Innovations (CEPI), a foundation that went on to bankroll early research into Moderna’s coronavirus vaccine.

COVID-19, however, marks a “regression” toward a more fortress-like approach to health security, said Ranu Dhillon, an adviser to Guinea’s president during the Ebola outbreak. Western nations “may be inclined to — in a step further away from globalism — look inward to building up better resources within their country,” said Dhillon, now at Harvard Medical School.

Big Pharma is also resisting most Global South entreaties to cooperate. As yet, no company has signed on to share knowledge with either the South African mRNA hub or the Senegalese factory for coronavirus vaccines — though BioNTech is working with Rwanda and Senegal in a European Commission-backed deal to produce experimental tuberculosis and malaria shots.

Another manufacturing tie-up shows that Africa is already overcoming obstacles to its new me-first posture. Cheers that Johnson & Johnson would work with the South African producer Aspen on the so-called fill-and-finish phase of production for its single-dose coronavirus vaccine quickly turned to jeers when it emerged that Europe was due some 10 million of the African doses by the end of September. Former U.K. Prime Minister Gordon Brown bemoaned it as a “neocolonial approach to global health.”

Yet after hasty negotiations between the AU and Brussels, the plan was scrapped, according to the AU’s special envoy Strive Masiyiwa last week.

“There will be no sharing,” he told reporters.

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