Global survey details how poor nations were ‘left behind’ during Covid response
Big Pharma and its wealthy government allies have tried to blame low inoculation rates in poor countries on vaccine hesitancy, but a new cross-national survey released Friday documents how low-income countries have been left behind in the response world to the ongoing coronavirus pandemic, with many barriers still preventing billions of people from getting life-saving injections, tests and treatment.
“People in southern countries have been left behind. Their lives have been treated as an afterthought.”
Leading public health researchers have spent the past few months studying access to vaccines, diagnostics and treatments for Covid-19 in 14 low- and middle-income countries and territories: Bangladesh, Democratic Republic of Congo (DRC) , Haiti, Jamaica, Liberia, Madagascar, Nepal, Nigeria, Peru, Senegal, Somalia, Somaliland, Uganda and Ukraine.
As detailed in a report compiled by Matahari Global Solutions, the People’s Vaccine Alliance and the International Treatment Preparedness Coalition (ITPC), they found that “a combination of undersupply of vaccines and treatments, underfunding of health systems , under-assessment of health workers and poor adaptation to local needs have been major drivers of low immunization rates,” reads an abstract.
Key findings include:
- Testing and vaccination sites are inaccessible, meaning the true infection and death rates are likely much higher than official figures. PCR test results can take anywhere from 8-12 hours in Bangladesh to more than two weeks in rural areas of the DRC. People cannot leave work on short notice, travel long distances to a vaccination/testing site, and then wait for an unpredictably long period of time. For rural populations and nomads in countries like Somalia, this problem is particularly acute. Vaccination and mobile testing are not widespread enough.
- Vaccine supply remains a major problem. Vaccines were delivered irregularly and in short supply, leading to stock fluctuations at vaccination sites. Doses arrive with little or no notice or information about what type of vaccine will be delivered or whether it is suitable for a country’s conditions. Dr Saeed Mohamood from the Somaliland Ministry of Health said: “Sometimes we find out that the cargo from Somaliland is on a plane in the air, en route, and we don’t know when it will expire and how many resources we will have. . “
- Access to antiviral treatment is non-existent in most of the countries studied. Health workers on the ground in some countries don’t even know that treatments like Paxlovid exist. Some countries will have access to doses through generic licensing agreements, but that is unlikely to happen this year, meaning the severe inequities encountered with the global rollout of the vaccine will be repeated with treatments. Peru, among other middle-income countries, is considering replacing patents to ensure access.
- People cannot access accurate information in an accessible format for them, which reduces the likelihood of vaccination. Information campaigns are often in the “official language” of the former colonizers (eg English, French, Spanish), instead of local languages, and use technical terms that are difficult to understand. Richard Musisi, Executive Director of MADIPHA in Uganda, said: “When the main vaccinations started, the fact [was] that people couldn’t find access to this information, most of the information was communicated in English, it was not put in the local languages.”
- A history of colonial oppression and racist medical experimentation means that people in some areas are wary of Western medical products provided by white doctors and Western aid programs. This situation has been compounded by problems of access and wider mistrust of government in some areas. Building more pharmaceutical manufacturing into low-income countries could help combat these perceptions, campaigners say.
- Oxygen supply planning and funding has been poor. A WHO public health official in Nigeria told the researchers: “The oxygen plant breaks down whenever there is a high demand and it needs to be upgraded in other departments and installed. another with regular maintenance”. Governments need multi-year oxygen supply and infrastructure plans that include national inventories on oxygen infrastructure and technical support, as well as modified donor requirements that include medical oxygen.
- Essential community health workers are often unpaid. Vuyiseka Dubula, former head of the Treatment Action Campaign, described the erratic and sometimes non-existent payment as “a modern-day form of slavery”. In the DRC, nurses in North Kivu earn just $80 a month, and some said they had not been paid since the start of the pandemic. A clinician in Haiti, Dr. Marie Delcarme Petit-Homme, told researchers, “Sometimes doctors and nurses can go 6 months, a year without receiving compensation. The lower brackets have it worse, they don’t really have access to compensation. Sometimes we are forced to leave the country if we want a better salary.”
Pfizer CEO Albert Bourla – whose monopolization of state-funded knowledge and technology has allowed the pharmaceutical giant to reap billions in private profits while more than 15 million people have died – has repeatedly attempted to play down its role in perpetuating unequal access to Covid-19 medical tools, accusing poor countries of having “much, much higher” levels of vaccine hesitancy.
“Our report concludes that this allegation is false,” Dr. Fifa A Rahman, senior consultant at Matahari Global Solutions, said in a statement. “These are issues of fairness.”
“This report shows that communities have been repeatedly let down by a system aimed at protecting people in wealthy countries,” said Maaza Seyoum, Global South coordinator for the People’s Vaccine Alliance. “People in southern countries have been left behind. Their lives have been treated as an afterthought.”
“Local people are expected to bear the blame and be grateful for the vaccines they receive, when there has been little effort to meet their needs,” Seyoum added. “This is further evidence of the systemic racism that has plagued the global response to Covid-19.”
Thanks to the hoarding of doses by wealthy governments and the hoarding of knowledge by pharmaceutical companies, less than 21% of people in low-income countries have received at least one vaccine against Covid-19, compared to 79% of people in high-income countries, prolonging circulation of the virus and increasing the risk of a vaccine-resistant variant emerging.
COVAX, the United Nations-backed initiative to encourage vaccine donations to poor governments, has fallen far short of its own goals, leading critics to declare the charity model a failure.
Nadia Rafifi, head of advocacy at ITPC, said on Friday that “governments, pharmaceutical companies (including domestic manufacturers) and international agencies need to meaningfully address the real issues that prevent people from accessing vaccines and treatments”.
“Invest in more pharmaceutical manufacturing in low-income countries and maximize the use of existing public health safeguards such as the [Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement] flexibilities, could improve the reliability of access to vaccines and treatments,” said Rafifi.
A widely supported campaign to push the World Trade Organization to suspend coronavirus-related patents for the duration of the pandemic, which would allow drugmakers to produce generic shots, diagnostics and therapies without fear of legal reprisals, recently suffered a major defeat at the hands of a few wealthy governments. The fight for a temporary exemption from the TRIPS Agreement limited to tests and treatments continues, however.
Regarding the expansion of generic vaccine manufacturing, several other initiatives are underway, including the World Health Organization’s mRNA Vaccine Technology Transfer Center, which aims to facilitate knowledge sharing and increase local production capacity in low- and middle-income countries.
The first consortium, based at Afrigen Biologics in Cape Town, South Africa, successfully replicated the Covid-19 mRNA vaccine co-developed by Moderna and the US National Institutes of Health despite Big Pharma’s best efforts to undermine their work.
In April, 15 manufacturers from low- and middle-income countries were named “champions” or recipients of mRNA technology and training from the Afrigen Hub. In addition, WHO has partnered with South Korea to establish a global learning center that will popularize lessons learned by researchers involved in the South African project.
Additionally, US government scientists agreed last month to share their technical know-how related to the development of next-generation mRNA vaccines and treatments with Afrigen with the aim of not only combating the current pandemic, but also of ward off other infectious diseases and cancer.
Such efforts to expand the geography of vaccine production, Rafifi said, could help “counter the distrust of Western medical products that exists in some regions due to pharma greed, health nationalism and ‘a legacy of colonial oppression and racist medical experimentation’.