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

By Vumani Mkhize
BBC News, Johannesburg

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Rabasotho Community Hall vaccination site on June 23, 2021 in Tembisa, South AfricaImage source, Getty Images

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.

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.

Devastating wave

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

Image source, AFP
Image caption,
Less 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 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

Group 4

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Source: Johns Hopkins University, national public health agencies

Figures last updated 1 June 2022, 10:24 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 source, AFP
Image caption,
Hospital 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 source, AFP
Image caption,
Face 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).

Fatima Hassan quote box
HJI
You 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

US 1,002,208 305.3 83,475,439
Brazil 666,676 315.9 31,019,038
India 524,636 38.4 43,160,832
Russia 371,464 257.3 18,063,880
Mexico 324,922 254.7 5,775,977
Peru 213,195 655.8 3,580,960
UK 177,890 266.2 22,232,377
Italy 166,697 276.5 17,421,410
Indonesia 156,591 57.9 6,054,973
France 145,101 216.4 28,703,050
Iran 141,315 170.4 7,232,034
Colombia 139,854 277.8 6,103,455
Germany 139,091 167.3 26,360,953
Argentina 128,889 286.8 9,230,573
Poland 116,318 306.3 6,007,584
Ukraine 112,459 253.4 5,040,518
Spain 106,493 226.2 12,360,256
South Africa 101,190 172.8 3,957,777
Turkey 98,965 118.6 15,072,747
Romania 65,684 339.3 2,909,195
Philippines 60,455 55.9 3,690,581
Chile 57,892 305.5 3,702,941
Hungary 46,547 476.4 1,919,840
Vietnam 43,079 44.7 10,719,379
Canada 41,070 109.3 3,884,792
Czech Republic 40,288 377.6 3,920,299
Bulgaria 37,148 532.5 1,165,167
Malaysia 35,676 111.7 4,506,510
Ecuador 35,637 205.1 877,282
Belgium 31,754 276.5 4,152,558
Japan 30,619 24.2 8,838,747
Pakistan 30,379 14.0 1,530,453
Thailand 30,047 43.2 4,459,241
Greece 29,845 278.5 3,453,229
Bangladesh 29,131 17.9 1,953,507
Tunisia 28,641 244.9 1,042,872
Iraq 25,219 64.2 2,328,154
Egypt 24,718 24.6 515,645
South Korea 24,197 46.8 18,119,415
Portugal 23,115 225.1 4,683,018
Netherlands 22,343 128.9 8,169,928
Bolivia 21,948 190.6 909,110
Slovakia 20,100 368.5 2,542,564
Austria 19,927 224.5 4,288,153
Myanmar 19,434 36.0 613,336
Kazakhstan 19,015 102.7 1,394,909
Sweden 18,977 184.5 2,507,948
Paraguay 18,894 268.2 650,661
Guatemala 18,152 109.3 861,002
Georgia 16,811 451.9 1,655,221
Sri Lanka 16,517 75.8 663,834
Serbia 16,081 231.5 2,017,454
Morocco 16,076 44.1 1,168,303
Croatia 15,987 393.0 1,136,500
Bosnia and Herzegovina 15,788 478.3 377,904
China 14,604 1.0 2,426,932
Jordan 14,066 139.2 1,696,937
Switzerland 13,800 160.9 3,674,986
Nepal 11,952 41.8 979,140
Moldova 11,537 434.1 518,793
Honduras 10,899 111.8 425,371
Israel 10,852 119.9 4,138,515
Lebanon 10,429 152.1 1,099,199
Azerbaijan 9,713 96.9 792,767
North Macedonia 9,303 446.5 311,936
Saudi Arabia 9,148 26.7 768,079
Lithuania 9,146 328.2 1,062,669
Armenia 8,625 291.6 422,963
Australia 8,558 33.7 7,312,403
Cuba 8,529 75.3 1,105,319
Costa Rica 8,525 168.9 904,934
Panama 8,255 194.4 858,268
Afghanistan 7,705 20.3 180,347
Ethiopia 7,513 6.7 472,743
Ireland 7,304 147.8 1,561,632
Uruguay 7,238 209.1 925,777
Belarus 6,978 73.7 982,867
Algeria 6,875 16.0 265,884
Slovenia 6,637 317.9 1,025,030
Libya 6,430 94.9 502,016
Denmark 6,363 109.4 3,136,896
Latvia 5,824 304.5 828,614
Venezuela 5,721 20.1 523,654
Palestinian Territories 5,660 120.8 657,705
Kenya 5,651 10.7 324,976
Zimbabwe 5,506 37.6 252,703
Sudan 4,942 11.5 62,355
Finland 4,522 81.9 1,092,193
Dominican Republic 4,377 40.8 584,029
Oman 4,260 85.6 389,473
El Salvador 4,132 64.0 162,755
Namibia 4,038 161.9 166,363
Zambia 3,987 22.3 321,779
Trinidad and Tobago 3,917 280.8 161,584
Uganda 3,602 8.1 164,366
Albania 3,497 122.5 276,101
Syria 3,150 18.5 55,892
Nigeria 3,143 1.6 256,028
Norway 3,141 58.7 1,433,641
Kosovo 3,139 174.9 228,359
Jamaica 3,056 103.7 137,266
Cambodia 3,056 18.5 136,262
Kyrgyzstan 2,991 46.3 200,993
Montenegro 2,720 437.2 237,223
Botswana 2,697 117.1 308,126
Malawi 2,640 14.2 85,985
Estonia 2,574 194.0 576,870
Kuwait 2,555 60.7 633,225
United Arab Emirates 2,305 23.6 908,205
Taiwan 2,255 9.5 2,032,983
Mozambique 2,203 7.3 225,754
Mongolia 2,179 67.6 925,073
Yemen 2,149 7.4 11,822
Senegal 1,966 12.1 86,111
Cameroon 1,930 7.5 119,947
Angola 1,900 6.0 99,761
Uzbekistan 1,637 4.9 239,046
Bahrain 1,488 90.7 585,665
Rwanda 1,459 11.6 130,057
Ghana 1,445 4.8 161,370
Eswatini 1,409 122.7 72,510
Madagascar 1,395 5.2 64,377
Singapore 1,389 24.4 1,303,294
Somalia 1,361 8.8 26,565
Suriname 1,350 232.2 80,547
DR Congo 1,338 1.5 88,374
Guyana 1,234 157.6 64,763
New Zealand 1,140 23.2 1,170,815
Luxembourg 1,073 173.1 244,182
Cyprus 1,059 88.4 489,963
Mauritius 996 78.7 225,862
Mauritania 982 21.7 59,141
Guadeloupe 947 236.7 157,865
Martinique 918 244.4 162,163
Fiji 864 97.1 65,007
Tanzania 840 1.4 35,354
Haiti 835 7.4 30,818
Bahamas 810 208.0 34,759
Ivory Coast 799 3.1 82,215
Réunion 777 87.4 414,615
Laos 756 10.5 210,026
Mali 734 3.7 31,097
Malta 721 143.4 94,742
Lesotho 698 32.8 33,358
Qatar 677 23.9 368,788
Belize 677 173.4 59,365
Papua New Guinea 651 7.4 44,481
French Polynesia 649 232.4 72,951
Barbados 450 156.8 80,654
Guinea 442 3.5 36,764
Cape Verde 402 73.1 56,324
French Guiana 397 136.5 82,952
Congo 385 7.2 24,079
Burkina Faso 384 1.9 20,899
Saint Lucia 371 203.0 25,593
Gambia 365 15.5 12,002
New Caledonia 313 108.8 62,193
Niger 310 1.3 9,031
Gabon 304 14.0 47,650
Maldives 299 56.3 179,753
Liberia 294 6.0 7,456
Curaçao 277 175.8 43,864
Togo 273 3.4 37,095
Nicaragua 238 3.6 18,491
Grenada 226 201.8 17,750
Brunei 223 51.5 148,674
Aruba 213 200.3 37,034
Chad 193 1.2 7,417
Djibouti 189 19.4 15,675
Mayotte 187 70.3 37,581
Equatorial Guinea 183 13.5 15,921
Channel Islands 176 102.2 76,190
Guinea-Bissau 171 8.9 8,269
Seychelles 167 171.1 44,016
Benin 163 1.4 26,952
Comoros 160 18.8 8,120
Iceland 153 42.3 188,291
Andorra 153 198.3 42,894
Solomon Islands 146 21.8 18,174
South Sudan 138 1.2 17,617
Bermuda 138 215.9 14,755
Antigua and Barbuda 138 142.1 8,253
Timor-Leste 131 10.1 22,915
Tajikistan 125 1.3 17,786
Sierra Leone 125 1.6 7,682
San Marino 115 339.6 17,124
Central African Republic 113 2.4 14,649
St Vincent and the Grenadines 107 96.8 8,670
Isle of Man 106 125.3 32,966
Eritrea 103 2.9 9,759
Gibraltar 102 302.7 18,419
Sint Maarten 86 211.1 10,353
Liechtenstein 84 220.9 17,469
Sao Tome and Principe 73 33.9 5,991
Dominica 65 90.5 14,184
Saint Martin 63 165.8 10,668
British Virgin Islands 62 206.5 6,765
Monaco 57 146.3 12,186
Saint Kitts and Nevis 43 81.4 5,729
Burundi 38 0.3 42,034
Turks and Caicos Islands 36 94.3 6,123
Bonaire, Sint Eustatius and Saba 35 134.7 10,091
Faroe Islands 28 57.5 34,658
Cayman Islands 28 43.1 25,318
Samoa 26 13.2 13,499
Bhutan 21 2.8 59,628
Greenland 21 37.3 11,971
Vanuatu 14 4.7 9,088
Kiribati 13 11.1 3,098
Diamond Princess cruise ship 13 712
Tonga 12 11.5 11,644
Anguilla 9 60.5 3,203
Wallis and Futuna Islands 7 61.2 454
Palau 6 33.3 5,065
Saint Barthelemy 6 60.9 4,630
Montserrat 6 120.2 980
MS Zaandam cruise ship 2 9
Cook Islands 1 5.7 5,675
Saint Pierre and Miquelon 1 17.2 2,748
Falkland Islands 0 0.0 1,687
Micronesia 0 0.0 30
Vatican 0 0.0 29
Marshall Islands 0 0.0 17
Antarctica 0 11
Saint Helena 0 0.0 4

Please update your browser to see full interactive

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 and national public health agencies

Figures last updated: 1 June 2022, 10:24 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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