Big Pharma and its rich government allies have tried to attribute low inoculation rates in poor countries to vaccine hesitancy, but a new transnational survey published Friday documents how low-income nations have been forsaken during the global response to the ongoing coronavirus pandemic, with numerous barriers still preventing billions of people from obtaining lifesaving jabs, tests, and treatments.

“People in the Global South have been abandoned. Their lives have been treated as an afterthought.”

Leading public health researchers have spent the past several months studying access to Covid-19 vaccines, diagnostics, and therapeutics across 14 low- and middle-income countries and territories: Bangladesh, Democratic Republic of the Congo (DRC), Haiti, Jamaica, Liberia, Madagascar, Nepal, Nigeria, Peru, Senegal, Somalia, Somaliland, Uganda, and Ukraine.

As detailed in a report compiled by Matahari Global Solutions, the People’s Vaccine Alliance, and the International Treatment Preparedness Coalition (ITPC), they found that “a combination of undersupply of vaccines and treatments, underfunding of health systems, undervaluing of health workers, and poor adaptation to local needs were the key drivers behind low vaccination rates,” a summary states.

Key findings include:

• Testing and vaccination sites have been inaccessible, meaning true infection and death rates are likely to be far higher than official figures. PCR test results can take anywhere from 8-12 hours in Bangladesh to more than two weeks in rural DRC. People cannot leave work at short notice, travel long distances to a vaccination/testing site, and then wait for a long unpredictable period of time. For rural populations and nomadic people in countries like Somalia, this problem is particularly acute. Mobile vaccination and testing are not widespread enough.
• Vaccine supply is still a major problem. Vaccines have been delivered inconsistently and in insufficient numbers, leading to stock fluctuations at vaccination sites. Doses arrive with little or no notice or information about what kind of vaccine will be delivered or whether they are suitable to conditions in a country. Dr. Saeed Mohamood from Somaliland’s Ministry of Health said, “Sometimes we will find out that the Somaliland shipment is on a plane in the air, en route, and we do not know when it’s going to expire and how much resources we will have.”
• Access to antiviral treatments is nonexistent in most countries surveyed. Health workers on the ground in some countries are not even aware that treatments like Paxlovid exist. Some countries will have access to doses through generic licensing agreements, but that is unlikely to happen this year, meaning the grave inequities experienced with the global vaccine rollout will be repeated with treatments. Peru, among other middle-income countries, is considering overriding patents to secure access.
• People cannot access accurate information in a format that is accessible to them, reducing the likelihood of vaccine uptake. Information campaigns are often in the “official language” of former colonizers (e.g. English, French, Spanish), instead of local languages, and use technical terms that are hard to understand. Richard Musisi, executive director of MADIPHA in Uganda, said: “When the key vaccinations started, the fact [was] that people could not find access to such information, most of the information was communicated in English, it was not put into local languages.”
• A history of colonial oppression and racist medical experimentation means that people in some areas distrust Western medical products delivered by white doctors and Western aid programs. This has compounded with access issues and a broader distrust in government in certain areas. Building more pharmaceutical manufacturing in lower-income countries could help tackle these perceptions, campaigners say.
• Oxygen supply planning and financing have been poor. A public health officer at WHO Nigeria told researchers, “The Oxygen plant breaks down whenever there’s high demand and it needs upgrading in other wards and further installation of another one with regular maintenance.” Governments need multiyear oxygen supply and infrastructure plans that include national inventories on oxygen infrastructure and technical support, and modified donor requirements that include medical oxygen.
• Essential community health workers often go unpaid. Vuyiseka Dubula, former head of the Treatment Action Campaign, described the erratic and sometimes non-existent payment as “a form of modern-day slavery.” In DRC, nurses in North Kivu earn just $80 per month, and some reported not having been paid since the beginning of the pandemic. A clinician in Haiti, Dr. Marie Delcarme Petit-Homme, told researchers: “Sometimes doctors and nurses can go 6 months, a year without receiving remuneration. Lower bands have it worse, they don’t really have access to remuneration. Sometimes we are forced to leave the country if we want a better pay.”

Pfizer CEO Albert Bourla—whose monopolization of publicly funded knowledge and technology has enabled the pharmaceutical giant to reap billions in private profits while more than 15 million people died—has repeatedly tried to downplay his role in perpetuating unequal access to Covid-19 medical tools, blaming poor countries for having “way, way higher” levels of vaccine hesitancy.

“Our report finds this allegation to be false,” Dr. Fifa A Rahman, principal consultant at Matahari Global Solutions, said in a statement. “These are issues of equity.”

“This report shows that communities have repeatedly been let down by a system geared towards protecting people in wealthy countries,” said Maaza Seyoum, Global South convenor of the People’s Vaccine Alliance. “People in the Global South have been abandoned. Their lives have been treated as an afterthought.”

“Local populations are expected to shoulder blame and be grateful for what vaccines they do receive, when there has been little effort to meet their needs,” Seyoum added. “It is yet more evidence of the systemic racism that has plagued the global response to Covid-19.”

Thanks to dose hoarding by wealthy governments and knowledge hoarding by pharmaceutical corporations, less than 21% of people in low-income countries have received at least one Covid-19 shot, compared with 79% of people in high-income nations—prolonging the circulation of the virus and increasing the chances of a vaccine-resistant variant emerging.

COVAX, the United Nations-backed initiative to encourage vaccine donations to poor governments, has fallen far short of its own targets, leading critics to declare the charity model a failure.

Nadia Rafifi, head of advocacy at ITPC, said Friday that “governments, pharmaceutical companies (including domestic manufacturers), and international agencies must meaningfully address the real issues that prevent people from accessing vaccines and treatments.”

“Investing in more pharmaceutical manufacturing in lower-income countries and maximizing the use of the existing public health safeguards such as the [Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement] flexibilities, could improve reliability of access to vaccines and treatments,” said Rafifi.

A widely supported campaign to push the World Trade Organization to suspend coronavirus-related patents for the duration of the pandemic, which would allow drugmakers to produce generic jabs, diagnostics, and therapeutics without fear of legal retribution, recently suffered a major defeat at the hands of a few rich governments. The fight for a temporary TRIPS waiver limited to tests and treatments continues, however.

When it comes to expanding generic vaccine manufacturing, several other initiatives are underway, including the World Health Organization’s mRNA Vaccine Technology Transfer Hub, which seeks to facilitate the sharing of knowledge and increase local production capacity in low- and middle-income countries.

The first consortium—based at Afrigen Biologics in Cape Town, South Africa—has successfully replicated the mRNA Covid-19 vaccine co-developed by Moderna and the U.S. National Institutes of Health despite Big Pharma’s best efforts to undermine their work.

As of April, 15 manufacturers in low- and middle-income countries have been named as “spokes,” or recipients of mRNA technology and training from the Afrigen hub. In addition, the WHO has partnered with South Korea to establish a global teaching facility that will popularize lessons learned by researchers involved in the South African project.

Moreover, U.S. government scientists agreed last month to share technical know-how related to the development of next-generation mRNA vaccines and treatments with Afrigen in an effort to not only combat the current pandemic but also to beat back other infectious diseases and cancer.

Such efforts to broaden the geography of vaccine production, said Rafifi, could contribute “to countering the distrust of Western medical products that exists in some parts due to phama greed, health nationalism, and a legacy of colonial oppression and racist medical experiments.”

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