Why much of the world is facing a Covid-19 vaccine famine

The Covax Facility and richer countries unfortunately conflate fundraising with distribution, and the countries that provide the funds are not subject to the same distributive system
There must be a stronger focus on ensuring vaccines are manufactured in countries beyond rich nations, so each can practise vaccine nationalism

Hannah Wanjie Ryder

Published: 5:45am, 22 Jun, 2021

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The recent G7 summit agreement to donate 1 billion Covid-19 vaccine doses to poor countries has elicited disappointment from many development organisations and leaders, for two reasons. The first is moral: poor countries need help, charity or solidarity from first-world countries and even emerging economies. The second argument is about self-interest – that no one is safe until everyone is safe, given the risk of outbreaks and mutations crossing borders.

However, there is another reason for disappointment – if we realise that most countries in the world are facing a vaccine famine. Africa’s 55 countries, for instance, have so far received vaccines, both purchased and free – vaccines that could protect at best 2 per cent of the region’s population.

Characterising a lack of vaccine access as a famine is important because it illuminates a key point that Amartya Sen, the Nobel-Prize-winning development economist, explained in his seminal 1981 book Poverty and Famines: famines imply starvation, but starvation does not imply famine. When people are hungry, it is not necessarily because of food shortages. It could be because the distribution of the food or the money to buy food is not working.

This is important when it comes to vaccines. The fact is, there is not – yet – a global vaccine shortage. The World Health Organization has suggested that 11 billion vaccine doses would be sufficient for the world to achieve herd immunity, while current projections suggest 12 billion doses can be produced by the end of 2021.

Indeed, G7 countries are enjoying a relative feast – on average they have fully vaccinated 33 per cent of their population and there are internal debates about when children, the least vulnerable to Covid-19, should receive jabs.

So why are other countries facing a vaccine famine? As mentioned above, Sen’s argument is that famine arises from poor distribution. This has two key implications for the handling of pandemics, and other global problems.

The first is that there must be a stronger focus on ensuring the manufacturing of vaccines in countries beyond the G7 and other rich nations, so that, in some way, every country or region can practise vaccine nationalism, or – in Sen’s analogy – has more autonomy to avoid local famines.

In many ways, this is what China and India have achieved. Furthermore, pressure is mounting for vaccine manufacturers – including in the G7 – to share intellectual property, which acts as a barrier to diffusing production. New investment is also being made in local manufacturing in Africa and beyond.

This is welcome progress, but the second implication of Sen’s analysis is more fundamental. It implies a reordering of the multilateral system.

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Early on in the Covid-19 crisis, the WHO and other groups created the Covax Facility – a scheme to centrally procure and distribute vaccines “equitably” internationally. But it had one huge problem: it enabled several countries – the rich countries – to opt out. As a result, the system was subjected to famine. The excluded richer countries were able to reach out directly to manufacturers – often based in their countries, procure doses at high prices, hoard them, and effectively create famines for those who couldn’t pay as much.

To use another analogy, it was as if, when Covid-19 started, rich people lived near a supermarket and decided to pop in and buy most of the toilet paper while everyone else living further away was walking to the store. The rich people then left a few rolls for a charity to hand out “equitably”, and only later realised they had a few rolls at home they could donate to the charity to be distributed again.

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In the case of the actual toilet paper crisis, this kind of hoarding was addressed through regulation in some neighbourhoods. Supermarkets set purchase quotas, while allowing health workers to come in earlier than other patrons. Toilet roll famines ended.

So why is the multilateral system different? Why, for instance, isn’t Covax managing a truly global system of vaccine delivery for 20 per cent of populations in all countries, from Britain and China to Kenya and Jamaica?

The reason is that Covax and richer countries in particular conflate fundraising with distribution. Those who provide funds are never subjected to their distributive systems because international organisations like the WHO are expected to just focus on the poorest countries.

Yet, being able to finance the multilateral system should not mean a country is exempt from the implications. It’s hypocritical, and in an emergency like a pandemic both circumvents and disrupts the system.

Development experts across the world, including myself, are currently working on a concept called “Global Public Investment”, as coined by the author Jonathan Glennie. A key principle is a separation of funding, production and allocation mechanisms. This principle is linked to another enshrined in the UN’s 2015 Sustainable Development Goals – universality. This recognises that poverty is not confined to poor countries and mandates truly global work on issues that affect all, such as pandemics and climate change.

It should never have been up to the G7 to decide how many vaccine doses to donate. The role of plurilateral groups like the G7 or international tools like Covax is not to enable charity, solidarity or self-interest. This not only embeds in our imaginations an indefinite “rich world versus poor world” concept, but Sen’s analysis also shows it will lead to famine – the vaccine famine we are experiencing now.

It’s time to recast the international system and, as Sen suggested 40 years ago, to distribute entitlements to health, environment and other global public goods equally.

Hannah Wanjie Ryder is CEO of Development Reimagined, an African-owned international development consultancy with headquarters in China, and offices in Kenya and the UK. She was formerly head of policy and partnerships for UNDP in China