The last few months have seen the debate on Covid turn decisively towards the issue of vaccines. The inequality of access to vaccines is truly staggering. Rich countries have practically demanded that young citizens be vaccinated against a disease that very few young people are at risk for, thus piling up vaccines and preventing equal access in poor countries. And yet, what is also astonishing is the way in which the debate on the Covid is entirely framed through the medical gaze of the rich countries.
In an African Arguments article in April, I stressed that it is essential that the priority of Covid vaccination does not disrupt other vital public health goals on the continent. A balance is required: ensuring that vulnerable and elderly people in Africa receive Covid vaccines, without hampering other vital health initiatives.
The importance of this perspective has become increasingly clear since then. The WHO malaria report 2021 suggests that there were 47,000 more deaths from malaria in 2020 – the vast majority of children under the age of 5. This was caused by various factors in the supply chain – including the diversion of resources from rapid malaria tests to Covid rapid tests – and supply shortages caused by lockdowns and the diversion of pharmaceutical companies to Covid work.
Beyond that, the impact of the narrow focus on Covid-19 on other childhood immunization programs has been enormous. A June 2020 report from Collateral Global found that 13 of 15 African countries for which data was available had experienced a drop in monthly vaccination rates: in Ethiopia, the average drop in regular vaccinations was in the order of 12.5 %, while there were also significant drops in measles vaccinations. in Senegal, to cite just two examples.
It is therefore essential to take into account all vaccination and associated medicine programs, and not just Covid-19, in the analysis of inequalities linked to vaccination. And yet, Western media sources failed to offer that perspective – leaving that task to the African doctors, who have spoken up to the realities where possible.
The doctors and scientists of medical background Africa were quick to highlight this prospect. Angolan doctor João Blasques de Oliveira wrote about it in detail in July, noting that: “The blockages have added difficulties to routine medical services for a variety of reasons… anecdotal evidence from many primary health care facilities in Angola describe a sharp decline in outpatient and emergency consultations in the region and for various ailments … preventive child health services have been affected and vaccination has often been postponed. For example, the national polio and measles vaccination was canceled or access to places where routine vaccinations were given.
Meanwhile, in Mozambique, a doctor wrote that “Covid-19 has not been a major health crisis compared to other endemic diseases… there is currently more attention and publicity on the vaccination campaign for Covid-19, while the focus is on normal – saving lives – vaccination campaigns for children are kept to a minimum. This is a serious concern in a country with a high prevalence of malnutrition and infectious diseases of infancy. In Mozambique, malnutrition is a major trigger for deaths from vaccine-preventable diseases, and these vaccination campaigns have stalled. “
Politicians and senior officials have started talking about the impacts of this current situation. In a December 8 Financial Times article, Ayoade Alakija, African Union Co-Chair, Africa Vaccine Delivery Alliance, noted that “countries like Uganda and Mozambique are suffering from increasing rates of poverty and inequality, with the last 20 years of development gains wiped out by the virus “. Renowned philosopher Kwame Anthony Appiah wrote in the Guardian on November 23 about the “second-rate” damage caused by the coronavirus.
These are important interventions. And yet there is a reluctance to be as bald and daring as it takes, no doubt out of mistrust of the reaction of Western liberals who are comforted by their myth that all this destruction is “caused by the virus.” These are not “second order” effects of the coronavirus, and the development gains have not been wiped out by “the virus”. At the time of writing (December 12), data shows that Covid-19 has killed around 225,000 people on the African continent in almost two years, while around 9 million people die in Africa each year. 172,500 of these deaths occurred in just 6 countries: South Africa, Morocco, Tunisia, Libya, Egypt and Algeria. Thus, the total of deaths due to Covid recorded in the rest of the continent is less than 55,000.
Many claim that these numbers are grossly underestimated. Stanford University professor of medicine John Ioannides estimated that they are between 30 and 80 percent of the actual figure, or about half of the actual total. But let’s be more drastic and say the real number is four times that recorded – or roughly 200,000 deaths across the rest of the continent. How is it that this level of mortality had all the destructive effects that we see?
Take the case of Nigeria. Fewer than 3,000 people have been recorded as having died from Covid-19 in Nigeria – but let’s be extra careful and say the true figure is 20,000. About 1.8 million people die each year in Nigeria. This 1% increase in the level of mortality (even with this conservative estimate of Covid mortality) cannot be responsible for the 20% loss of formal employment, the collapse of school enrollment which means that only 11 out of 60 schools in a recent survey were able to keep more than half of their children in education, or the huge increase in child marriage. These impacts do not come from the virus, but from the response to the virus as advocated by global institutions, with strong pressure then exerted on African politicians. The pressure for lockdowns in African contexts is all the more surprising given that they were tested in Sierra Leone and Liberia during the Ebola outbreak and determined not to have been effective.
It is therefore important to be clear. What we are really seeing is a new version of medical colonialism – reproducing models very similar to the historical models highlighted in an essay on African arguments by Florence Bernault last year. In this diagram, the public health needs and demands of the African continent are subordinated to those of the rich nations. This has become abundantly evident in the push to ‘vaccinate all of Africa’ in response to the Omicron variant – where this policy is openly stated by leaders such as Tony Blair as being based on the desire not to have to. ‘other variants affecting older populations in wealthy countries. But this is not an African public health decision – and furthermore, African countries are being forced to take World Bank loans to finance some of these vaccines.
In addition, there is no logic in the current vaccination campaign. On the one hand, Western populations are told that boosters are needed to protect them against the new variants; and yet on the other, we are told that all of Africa must be vaccinated with the first round of Covid vaccines. Of course, for the elderly and the vulnerable, these may still offer some form of protection. But for the rest of the population, if the original vaccines no longer provide strong protection, is it difficult to understand the rush to push the entire medical system on the continent to deliver vaccines deemed to be more effective for the rest of the world?
Of course, effective Covid vaccines should be available to the elderly and vulnerable in need in African countries. But for the rest of the population, as this article has shown, the needs are much more pressing. As Ghanaian medical historian Samuel Adu-Gyamfi wrote on December 6: “It should be up to African countries to determine their own public health goals, and Covid-19 is far from being the public health problem. most serious in Africa today. “ Unless political leaders are prepared to assert this truth as boldly as some of the continent’s doctors and sociologists, the fallout from this catastrophe will only continue.
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Toby Green is Professor of African History at King’s College London and author of The Covid Consensus: The New Politics of Global Inequality (Hurst). He is a member of the Scientific Advisory Board of Collateral Global (https://collateralglobal.org)