Addressing production gaps for vaccines in African countries

Global health initiatives rely on international solidarity. However, the extreme inequity in access to vaccines for coronavirus disease 2019 (COVID-19) across countries demonstrates that we cannot depend on national politicians and industry alone to make strategic choices for our global common good. High-income countries have been accused of undermining the coordinated purchase and equitable distribution of COVID-19 vaccines through non-transparent pharmaceutical deals, production delays and vaccine export restrictions.1 As of 1 November 2021 fewer than 35 million of over 7 billion COVID-19 vaccine doses have been administered in low-income countries.2 Nevertheless, high-income countries have disregarded the World Health Organization's (WHO) plea to pause booster doses of vaccines to give low- and middle-income countries a chance to vaccinate their most vulnerable populations. Despite these challenges, vaccine allocation to low- and middle-income countries through COVAX, the COVID-19 Vaccines Global Access initiative, is finally accelerating. Even so, only five African countries, fewer than 10% of its 54 nations, are expected to reach the year-end target of fully vaccinating 40% of their population,3 a goal that would require 800 million more doses of vaccine. Meanwhile, high-income countries will have over 1 billion surplus doses of vaccine.4Africa currently imports 99% of its vaccines5 and by November 2021 fewer than 123 million (10%) of 1373 million Africans have been fully or partly immunized against COVID-19.2 This deficiency in local vaccine production in Africa and other low- and middleincome countries is a result of chronic underinvestment in research and development, poor knowledge transfer, imbalanced scientific exchange and emigration of highly trained professionals. The annual loss to the African health sector of investment in trained doctors is around 2 billion United States dollars (US$).6 This current dependency on a limited number of vaccine manufacturers, with just four companies controlling about 90% of the global vaccine market,1 has contributed to an unsustainable pandemic response, a problem that was seen during the 2009 H1N1 influenza pandemic and the 2014 Ebola virus disease outbreak. As the Director-General of the World Trade Organization (WTO) declared in 2021, "We have now seen that over-centralization of vaccine production capacity is incompatible with equitable access in a crisis situation."