Global Health Security for Whom? Africans Reduced to Pawns in Geo-strategic Rivalry

The Covid-19 pandemic – like the HIV/AIDS pandemic before it – threatens to become an endemic disease because important lessons were not learned.

A crisis should never go to waste. Consequently, the 1990s should have taught Africa a lesson about how the world works. The HIV/AIDS pandemic was wreaking havoc across the globe and, like the Coronavirus, didn’t seem to discriminate between (economically) rich and poor countries. Hollywood stars in California were getting infected and dying in equal measure as farmers in rural Africa. However, it didn’t take long for the West to find a solution for the pandemic through the manufacturing of life-saving anti-retroviral (ARVs) drugs that are able to boost the immune system of the infected.

While HIV/AIDS stopped being an epidemic in rich countries that could afford the drugs, it became endemic in poor countries. For approximately two decades, activists pleaded with rich countries to persuade their drug manufacturers to lift patent rights. By the time the pharmaceutical industry accepted to allow the production of generic ARVs in India, Brazil, and South Africa, at least 30 million lives had been lost globally, with Africans accounting for over 20 million deaths.

A similar pattern is developing today with regard to Covid-19: the rich countries have found a solution that has allowed them to enter what they are calling “a post-Covid” situation. At the same time, they have colluded to hoard more vaccines than they need, placing export restrictions on pharmaceutical companies, and resisting calls to wave patent rights for these life-saving vaccines, a situation that places Africa under their benevolence. In other words, the Covid-19 pandemic – like the HIV/AIDS pandemic before it – threatens to become an endemic disease for some, precisely because important lessons were not learned.

Pawns in geo-strategic rivalry

The global response and sustainable solution to the coronavirus pandemic has been the manufacturing of Covid-19 vaccines. In this, Africa’s agency has been missing. Africa’s health security has been placed in the hands of “benevolent” actors who, abandoning any semblance to live up to their professed values, decided to grab as much as four to five times more vaccines than they needed for their own people – and to donate whatever is left to Africans.

Africans are observing with incredulity as their lives take the backstage in the geopolitical rivalries among the powerful countries that produce the Covid-19 vaccines, with some openly talking about the need to donate unused vaccines (to Africa) before they expire. They have watched as the western media talks casually about what vaccines – Sino, Pfizer, Astra Zeneca, Sputnik – should be allowed in which sphere of influence. Who knew that vaccines would turn out to be tools for geo-strategic competition in which Africans are mere pawns?

Only 2.5 per cent of Africa’s population has been fully vaccinated, according to Africa CDC. Consequently, Africans are shocked that the liberal rules of free trade have been kicked to the curb in favour of vaccine nationalism. In some instances, even those countries that had accepted payments from some countries (chiefly from Africa) refused to deliver the vaccines as the death rates began to rise at home. This shouldn’t come as a surprise, considering that, in the initial days of the pandemic, Americans were intercepting masks destined to other countries and redirecting them to the U.S to cover for their shortages.

These geo-strategic games and their more sophisticated term of “vaccine diplomacy” have gone on even as Africans are clamouring that, unlike during the HIV pandemic, this time they have the money to buy the vaccines. The competition for control and influence has turned out to be more important to these countries than the money Africans were willing and ready to pay. A clip of Strive Masiyiwa – appointed in April 2020 along with Dr Donald Kaberuka, Dr Ngozi Okonjo-Iweala, Tidjane Thiam and Trevor Manuel as AU Special Envoys to mobilise international economic support for the continental fight against COVID-19 – pleading with the western countries to do the right thing made the rounds on social media this September,

“As AVAT and the African Union, we are not asking for donations. You can donate to us if you so wish, but our basis is not a donation. We want to buy vaccines. That means we want access to purchase. We call on those countries that have put restrictions on exports of vaccines to lift them. That will give us vaccines immediately,” Masiyiwa pleaded.

Earlier in June 2021, Masiyiwa had made a similar plea to the western world to “do something” to prevent deaths: “They told us that they had created this thing called COVAX. I met with them, with my colleagues, the African leadership, in January. And we said, okay what can you do for us? They said we can deliver up to 20%. We said but 20% cannot deal with our problem. You yourself have said that the Europeans and the Americans have set a target of 70% of the population, why should Africa have to deal with this permanently? They said, well, we can only do 20%, you have to go to the donors. We said okay, meet us half way. You do 30%, we do 30%, and set a target of 60%. And they said okay. And we said can you give us a schedule of what you can deliver? They told us 700 million doses. I have it in writing. We met in January, they said by February you will start to receive vaccines. Up to 27% of your population [will be vaccinated] by December. I have it in writing. But we have only received less than 30 million of that projected target. Meanwhile, we could not buy any. So how can I say that science has been a miracle to my people who are dying? We are going through the third wave now. Our people are dying. We have grandmothers that are dying. You can watch the Euro finals without a mask on. It’s happening now. But we can’t. And I cannot be here and not tell you we are not disappointed. So, I cannot sit here and say this was a moral failure. It was deliberate. Those with the resources pushed their way to the front of the queue.”

Undoubtedly there was a Masiyiwa of his time making similar pleas when the HIV/AIDs pandemic was claiming 20 million African lives in the 1990s. Consequently, the lesson that Africans should have learned more than two decades ago is that any solution to future pandemics that does not involve outsourcing African agency to external benevolence (should) run(s) through domestic manufacturing capacity.

Some countries like South Africa, Egypt, Senegal and Rwanda are spearheading this push, only twenty years too late – since the previous pandemic that claimed tens of millions of Africans. However, even when Africans create the pharmaceutical industries they need, they will remain vulnerable; they will remain dependent on the R&D and patents of the very countries that have played them as pawns for vaccines. In other words, just like the manufacturing capacity, the thinking around the health security of Africans cannot be outsourced. Consequently, the hardware of manufacturing must be accompanied by the software of research and innovation, if true lessons will have been learned from these two pandemics.

Africans surely can’t wait for another pandemic to learn these lessons. The truism is now clear to all that when the stakes are high, everyone is in it for themselves. We don’t need to lose another 20 million Africans to do what needs to be done.

How do we build resilient societies?

Outsourcing thinking around a scientific solution for epidemics correlates with underspending in the area of health. While all African countries lacked the capacity to be part of the scientific solution to Covid-19, some have managed this pandemic better than others – in other words, there has been variation, as follows.

First, countries with greater health equity were able to accommodate patients who contracted the virus and to offer them urgent remedial care. Countries without this capacity left their people to fend themselves, often retreating to herbal concoctions without the proven capacity to treat the virus. The lesson should be that health equity is a prerequisite to a healthy society since those who can afford healthcare will remain vulnerable as long as there are people around them who cannot afford it.

Secondly, countries with greater economic inclusion could afford prolonged economic restrictions as the welfare packages mitigated the resultant shocks to people’s livelihoods. An inclusive economy with adequate social protections overcomes shocks in unprecedented times. In Africa, Covid-19 proved that almost everyone is economically vulnerable, albeit to varying degrees. Therefore, we shouldn’t wait for catastrophes to remember that we are in this together – we should build adequate, inclusive economies, already.

Thirdly, the political leadership and the capacity of the state to be responsive to the people proved to be key. In light of what was happening elsewhere in China, Europe and America, effective and people-centred leadership immediately understood that saving lives took precedence over any other consideration; the economy had to be sacrificed.

However, for economic restrictions to be effectively implemented, trust is essential. The capacity of the state to deliver essential services during good times allows it to build social capital and to remain in control during bad times. Accordingly, where there is greater trust and confidence in the leadership, the people acquiesced to measures, however stringent, put in place to contain the spread of the virus. Trust determined who obeyed and disobeyed and allowed for the benefit of the doubt towards authorities at different levels of state administration. In other words, the reach of the state was tested, its authority affirmed or rejected.

Moreover, when vaccines were made available, this social capital moderated issues of vaccine acceptance and hesitancy. In countries where the trust in leadership is low, authorities have struggled to convince their people that they are acting in good faith, that the vaccines are safe, and that the risks of Covid-19 are worse than those associated with the vaccination.

Furthermore, trust in leadership highly correlates with social cohesion. Where there is greater trust in the leadership, there’s often high levels of social cohesion. Accordingly, in societies with greater social cohesion, it was easier for the authorities to leverage social solidarity in support of the needful on the basis of “We are in it together.” In such circumstances, the mobilisation of communities with the aim of delivering essential goods/services for the most vulnerable members of society took a communal approach, making it difficult for corruption to manifest and divert support.

Therefore, although exogenous vulnerabilities were shared by all African countries due to the outsourcing of scientific solutions (as evidenced by the absence of African agency in it), these were compounded, to varying degrees, by internal vulnerabilities in African societies mainly revolving around the ability of the political leadership to take decisive decisions, especially where there’s no social cohesion and trust.

This article was extracted from Africa’s Health and Education magazine.

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