Vaccine Inequities

*Cross-posted from Elizabeth Vibert's blog at https://www.womensfarm.org/south-africa/vaccine-inequities/

The early view that the continent of Africa had been “spared,” relative to the Global North, in the coronavirus pandemic appears to be debunked by emerging data. While known infection rates and death rates are lower, many countries – including South Africa – have entered a third wave, and with global inequities in vaccine access deeply entrenched, ongoing impacts are likely to be felt for a long time to come.*

Source: New Scientist

The growth and spread of new variants of COVID-19 in the absence of vaccination is a major concern across the continent, and by extension the world. As the World Health Organization’s Regional Director for Africa, Matshidiso Moeti, recently said, “It is crucial that we swiftly get vaccines into the arms of Africans at high risk of falling seriously ill and dying.” Troublesome Beta and Delta variants are circulating in many African countries, and in light of low testing levels in some regions, the emergence of other variants may go undetected until they become widespread.

A wide range of statistics paint a grim picture of global vaccine inequity. Only 0.3% of the more than 800 million doses administered by the end of April went to people in lower-income countries. While the US gives 3 million jabs per day, fewer than 40 million had been administered by May, in total, across 100 countries of the Global South. G7 countries outpace low-income countries in vaccination 73:1. While nearly two-thirds of Canadians are at least partially vaccinated, less than 1% of the population of low-income countries have received a dose. Canada has been widely seen as a “hoarder,” reserving up to five times as many doses as we need, while COVAX – the global mechanism for equitable vaccine access – is grossly undersupplied.

Two weeks ago COVAX put out an urgent call to rich-country governments, noting that it faces a second-quarter shortfall of nearly 200 million doses – mainly because of the need in recent months to prioritize delivery to South Asia as the catastrophe unfolds there. Donor nations must prioritize access to vaccines before such devastating surges occur. COVAX calls on the G7 and other wealthy nations to “urgently unlock new sources of doses, with deliveries starting in June, and funding so we can deliver.” COVAX has the infrastructure and expertise to manage this global effort. It needs the vaccines.

My friend Mixo M, a nurse from N’wamitwa who works at Chris Hani Baragwanath Hospital in Johannesburg – the largest hospital in the Southern Hemisphere, and the inner-city hospital at the epicentre of Gauteng Province’s rising third wave – has not yet received her jab. Mixo’s situation as a worker truly on the frontline of South Africa’s pandemic is emblematic of inhumane, and dangerous, global supply inequities. (The country, which has vaccinated only 0.5%, has faced an array of local hurdles, including a dominant variant that didn't respond well to the Astra Zeneca vaccine the government initially prioritized and then sold off.) As Dr. Keitumetsi Sothoane of the same hospital puts it, “Our biggest worry as health care workers [is] the impact of the virus on our already understaffed, overburdened, overwhelmed, and resource-limited public health care system.” The longer the country waits to be vaccinated, the greater the strain on that system. Beyond public health, it is hard to fathom the potential long-term economic and social impacts of a protracted pandemic in a country that already ranks as the most unequal on earth.

Zapiro cartoon, Daily Maverick

This week’s G7 summit in England failed to take the resolute action needed to improve global vaccine access, mainly due to an unwillingness to confront the interests of Big Pharma. Oxfam UK issued a sharp rebuke at the close of the summit:

“[G7 leaders] say they want to vaccinate the world by the end of next year [2022], but their actions show they care more about protecting the monopolies and patents of pharmaceutical giants.” Sharing a billion vaccines, as G7 nations have pledged to do, is an important step -- but the WHO says it needs 11 billion to reach its (lofty) goal of 70% global vaccination by this time next year. The G7 donations pledge “will only get us so far," Oxfam says. "[W]e need all G7 nations to follow the lead of the US, France and over 100 other nations in backing a waiver on intellectual property. By holding vaccine recipes hostage, the virus will continue raging out of control in developing countries and put millions of lives at risk.”

“Wanting” to vaccinate the world by the end of 2022, without action, is pretty words: most projections are that poor nations will wait until 2024 for full vaccination. Pharmaceutical companies hold the lucrative patents, blocking the ability of countries like South Africa to undertake their own, local production of vaccines and other medicines needed for the COVID response, or even to direct their own import programs. Much of the research that grounds vaccine development was publicly funded over many years, and governments transferred more than US$110 billion to pharmaceutical firms to finance urgent research and roll out of COVID vaccines. Yet the powerful companies – enabled by patents – monopolize production, keep prices high, and keep out-size profits flowing.

Financial Times: Pfizer profits soar

Pharmaceutical companies claim that Global South countries don’t have the skill or latest technologies needed to produce their own COVID-19 vaccine, a colonialist view that is simply wrong (as both India and South Africa have demonstrated). South Africa and India first requested a waiver of certain World Trade Organization intellectual property rights in October 2020, to enable countries to direct their own vaccine programs. More than two-thirds of World Trade Organization members have signed on to the waiver proposal. Canada has not signed on to this important step in removing barriers to wider, more equitable vaccine production and access.

Economist Joseph Stiglitz calls the patent waiver “a critical first step” to ensure optimal global access to vaccines and other therapeutics for COVID-19 – for the sake of both public health and economies. “There is no way to beat COVID-19,” he emphasizes, “without increasing vaccine production capacity. And some production must be in the Global South for a host of reasons, including that prompt suppression of new variants is how we avoid more deaths and quarantines.”

For Southern Africans, glaring inequities in access to life-saving medical therapies raise disturbing memories. The world watched (or, more aptly, turned a blind eye) while HIV/AIDS completely overwhelmed the healthcare systems of countries across Southern Africa and ravaged a generation. The pandemic of HIV/AIDS peaked in Southern Africa in 2005-06, fully a decade after most Americans, Canadians, and others in the North had access to anti-retroviral medications that transformed HIV from a death sentence to a manageable chronic disease. The speed of developing the new medications (which was impressive, though laggardly when compared to the lightning speed of COVID vaccine development) “was not matched by a similar speed in ensuring everyone could get access to the [medications], with treatment out of the reach of the global poor,” says Deborah Gold of the UK's National AIDS Trust. Pharmaceutical patents were a hurdle then too. It took dogged activism by civil society groups in Southern Africa – groups like South Africa’s Treatment Action Committee -- to finally prick the conscience of wealthy nations and institutions. These groups' voices, and the voices of African grandmothers who played such a central role in the AIDS response at community and household level, were amplified by Stephen Lewis, then-UN Special Envoy for HIV/AIDS and himself one of the most dogged figures working to marshal local and global resources in the struggle against HIV/AIDS.

Source: Women Deliver. HIV/AIDS activism, South Africa

Still today, grotesque inequities in access to HIV treatments persist. This is a mark of a major failure in global political will and resource provision.**

Deborah Gold speaks of striking parallels in official responses to HIV and to Sars-CoV-2. A nation-by-nation approach fuels vaccine nationalism and more inequity, and can hardly succeed against a virus coursing through the veins of the world. Among the similarities in response: “governments being too slow to respond; a marked impact on minority communities and a failure to understand why; a governmental response which has veered into overpolicing and victim-blaming, rather than taking every conceivable measure to help people stay safe and healthy.” The history of the global response to HIV teaches myriad lessons, many of them simple: the more people treated quickly, the better people’s health, the fewer who are able to pass on the virus, and the fewer who fall ill and become a burden on health care systems.

The coronavirus pandemic is an opportunity for the global community to act like a community, considering the interests of all before (or at least alongside) the interests of each. Instead we seem to be treating vaccination like “a league table,” as Gold puts it, a competition to see which country gives the most jabs first, which company rakes in the biggest profits. Once again, the former colonies in the Global South are stuck in the waiting room.

___________

 

*Africa, the continent, sits at just over 130,000 recorded COVID-19 deaths thus far, putting the continent sixth for death toll behind the US, Brazil, India, Mexico, and Peru. Numbers of dead are known to be underestimates in many countries, including these five.

**HIV/AIDS is far from a thing of the past. 38 million people currently live with HIV worldwide (35 million have died since the start). While new infections have fallen dramatically due to medical treatments, in 2020 1.5 million new cases of HIV were recorded, nearly 900,000 of them in Africa - where adolescent girls are hardest hit. Access to life-saving medication, which also suppresses transmission, continues to be a struggle for millions of poor and marginalized people worldwide, and pandemic shutdowns have deepened the challenge in ways that are not yet clear.

Sources include –

Chakrabarty, Dipesh. Provincializing Europe. Princeton University Press, 2000.

COVAX Joint Statement. “Call to Action to Equip COVAX to Deliver 2 Billion Doses in 2021.” World Health Organization, 27 May 2021.

Gold, Deborah. “’Vaccine Nationalism’ Echoes the Disastrous Mistakes Made with HIV.” The Guardian 2 Feb. 2021.

Grandmothers Advocacy Network [Canada]. COVID-19: Resources. grandmothersadvocacy.org/issue/covid-19-vaccines-testing-and-treatments

Johns Hopkins Coronavirus Resource Centre. COVID-10 Map [13 June 2021] coronavirus.jhu.edu/map.html

Oxfam UK. “Reaction to G7 Communique.” 13 June 2021. www.oxfam.org.uk/media/press-releases/reaction-to-g-communique/7

Stiglitz, Joseph and Lori Wallach. “Preserving Intellectual Property Barriers to COVID-19 Vaccines is Morally Wrong and Foolish.” Washington Post 26 April, 2021.

Trade Justice Network. “Canada, Global Vaccine Inequality, and TRIPS Waiver.” 10 May 2021.

UN AIDS. Global HIV and AIDS Statistics [2020]. https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf

Documentary: The Thinking Garden

A film telling the inspiring story of South African women seeking food justice

This is a film about resilience – three generations of older women in a village in South Africa who came together in the dying days of apartheid to create a community garden. In the midst of severe drought and political turmoil, older women with limited access to land and little political voice joined together, beyond the household, beyond their kin, to make something new. They named their garden Hleketani – “thinking” in the local xiTsonga language – a place where women gather to think about how to effect change. The garden provides affordable vegetables to local people, nourishes those living with HIV/AIDS, and offers land, community, and opportunity for women. In short, the garden has helped restore the lives of people pushed to the edge. Filmed against the backdrop of a new drought gripping southern Africa, The Thinking Garden tells the remarkable story of what can happen when older women take matters into their own hands, and shows how local action in food production can give even the most vulnerable people a measure of control over their food and their futures.

More information on the Hleketani Garden can be found at Dr. Elizabeth Vibert's website, https://www.womensfarm.org/.

Dr. Elizabeth Vibert: “Apartheid, Dispossession and Legacies in Jopi Village, South Africa”

As part of a lecture series on Decolonizing Settler Societies, Dr. Vibert gives a presentation on the history of apartheid and dispossession in Jopi Village, South Africa and the lasting legacies from that history.

*This lecture was originally presented to an undergraduate seminar class in the History Department at the University of Victoria

Social Impacts of COVID-19 in Rural South Africa

South Africa’s already extreme inequality, along racialised axes of income, wealth, and opportunity, has been exacerbated by the global pandemic. The vulnerability of many people’s livelihoods, and the food insecurity that is a key marker of that vulnerability, have been brought into sharp relief.

As Tessa Dooms of Global Governance Futures observes, South Africa’s five-stage lockdown was delivered in ways suited to “middle-class suburbia.” Measures appropriate in well-resourced communities are neither feasible nor humane in informal settlements and poor rural communities. Now more than ever, she argues, the state needs to make targeted practical interventions “that govern the two sides of South Africa.”

South Africa’s strictest lockdown measures (Level 5) were in place from late March to early May; having “flattened the curve,” the country moved to Level 4 (still sharp restrictions) through May and Level 3 in June. The country is now at Level 1 “alert,” while remaining in the top 10 countries in the world for confirmed cases and top 15 for COVID deaths. The country’s national economy will likely contract by 8 percent this year and take at least four years to recover. The UN Development Program estimates that one-third of middle-class households will slip from that status, and that “women, particularly in the poorest female-headed households, disproportionately bear the brunt of the impact of COVID-19.”

Kliptown, Soweto. Hard to social distance. Quartz

Social impacts of the lockdown at household level are illustrated by conversations with a range of community members in the villages of N’wamitwa, Limpopo Province, in May and June, when the country continued in lockdown.*

Family and neighbourly support networks have always been crucial to local wellbeing in these communities. Those networks are “destroyed” by pandemic lockdown, in the words of Josephine M of Jopi village. “We can’t check on our relatives, we can’t go to church, people lost their jobs because their companies have closed. … This thing has destroyed things at my home, my community, my relatives, and my country.”

Gotfrey R of Nkambako says he understands and respects the lockdown for public health reasons. But it comes at a very high cost.

“This is the village. If you don’t have food, [normally] you could go to the neighbours and ask, or to your relatives. That is not happening because rules were set for the country. We are not able to share the little that we have as family, relatives and neighbours. A person has to stay at home and mind their own food. And when it’s finished, the kids look at you, and you get hurt and cry.”

Traditional Authority board member M. C. Baloyi also highlights the impacts on crucial mutuality networks. “In our communities, rural areas, we are used to supporting one another. ... The spirit of UBUNTU is always there. But you now cannot see that happening because people are prohibited from supporting one another.” One of the casualties is stockvels, the savings, credit, and purchasing clubs that so many rely on to grow their savings and stretch their limited funds. “Most of our communities are used to stockvel .. and those meetings are not held anymore. Most families are relying on that to earn a living.” Now people are unable to save to pay their costs and grow their meagre funds. “That becomes a very serious headache for those who do not have income” and rely on these social and investment circles for material support.

Grocery club, Nkambako. 2018

Rose N’s household in Nkambako has been kept afloat by her adult son, whose job continues. He has helped her buy maize meal to feed her school-age children. “If my son wasn’t helping because he is still working, I don’t where will I be.”

Rose describes the narrowing of the diet that came with her loss of income (she is a bartender and stitches for a craft cooperative). Rose curbed her tea drinking because “I feel like when I drink tea I am eating the bread for my children.” She limited her own meals to “pap and sauce” (maize porridge and sauce) to protect some diversity in the children’s meals. “Now I’m just cooking beans. We are not used to this way of eating. We are suffering.”

Rose registered her family for food parcels from the municipality, but they never materialized. “They keep saying we will get [a parcel] on a certain date. But since lockdown the only other help I got was from church; they gave me a food parcel because they could see that I am poor.”

Mthavini M in Nkambako, 80, describes the downward spiral in her household’s food supplies. She stopped going shopping for food in town when health workers warned about contagion, and when runs on urban shops during restricted hours made shopping impossible. “We are not able to get enough food because we are not able to go to the shops. You eat twice a day because if you say you want to eat three times a day, where will you get the food?  Maize meal [gets] finished at the local shops quickly.”

At first her farm income was hit because some were continuing to shop in town while others were reluctant to leave their homes for fear of “this monster” (COVID-19). As more people in the village observed lockdown, at times harshly enforced by police, “they want spinach … and now there’s nothing left because everyone runs to the farm.” Farmers were given permits to leave their homes for work, because “if we farmers say we are afraid to come out of our houses [to the farm], people were going to die of hunger.”

Bus driver Jackson Matsimbi describes the shift from being able to “control the situation around food” to food poverty under lockdown. “If you don’t have money [to shop], you stay at home. … You have to eat pap in the morning and evening, instead of breakfast, lunch and supper. Pap.” Two meals instead of three, pap with few accompaniments. Children stuck at home from school create added strain, since they would normally eat a hot meal at school at midday, and again at after-school care.

Another father,  Gotfrey R, notes that “we have started to respect food. What pains me the most is not me, but my kids. My kids are used to a certain way of eating … but when this situation arrived, things became heavy to a point where I wasn’t coping” because his children could not eat as usual. “We have to reduce the amount eaten [during the day] and save for evening.”

At the time of the interview Gotfrey had not received the government assistance he applied for, nor any food parcels. “I hear that people are getting them [food parcels], but I personally did not get any help so far.”

Traditional Authority board member M. C. Baloyi notes the special challenges for the poorest people. Government emergency funds, added to the social grants that support so many unemployed and low-income households, were difficult to access for those who did not have cellphones or the ability to purchase data. Those who did manage to apply generally found delivery very slow.

Major structural reforms are clearly needed to address deepening inequalities and vulnerabilities in South Africa, vulnerabilities laid bare by the pandemic. Land reform is one structural intervention that could have major impacts in these rural areas. As Ben Cousins argues, land reform is essential “to help address inherited historical injustices, especially those resulting from land dispossession of the black majority.” Pro-poor land reform will restore land to individuals and communities who lost their homes and land due to colonial and apartheid-era forced removals. It will create secure rights to land held by the black majority, helping to create viable and dignified livelihoods in rural areas. Cousins continues, “When South Africa eventually emerges from the fog of the COVID-19 crisis, structural reform, including land reform, will be high on the political agenda as never before.”

Rose agrees. While lockdown has been difficult, she worries about what comes next. “After lockdown, who is going to give us food? There are no jobs, where are we going to work? … You can see how our economy is. Where are we going to start and end? Where? It can never be the same.”

 

***All interviews were conducted by Basani Ngobeni in the villages of N’wamitwa, in person where permitted and otherwise by telephone. Basani administered a food security questionnaire prepared by the Four Stories About Food Sovereignty research team.

Other sources include

Ben Cousins, “Study Shows Land Redistribution Can Create New Jobs in Agriculture in South Africa.” The Conversation 3 June 2020.

“Beyond ‘Stay Safe’: Covid-19 and Inequality in South Africa.” A Conversation with Tessa Dooms. Global Policy 8 July 2020.

South African History Online. "The Natives Land Act of 1913."

United Nations Development Programme. “South Africa’s GDP could plunge 8  percent this year.” 31 August 2020.

Children of climate crisis

Ayakha Melithafa is not as famous as Greta Thunberg, but she may soon be. Ayakha is one of sixteen youth from around the world, including Greta, bringing a complaint before the UN Committee for the Rights of the Child. Their claim: climate change is a crisis for children’s rights.

The Committee monitors implementation of the UN Convention on the Rights of the Child. If the Committee finds that signatories have infringed those rights by “knowingly causing and perpetuating the climate crisis,” as the youth petition charges, then signatory states will be urged to act to protect children’s rights. The petition specifically names Brazil, Germany, France, Argentina, and Turkey, but South Africa, Canada, and every other state that has ratified the Convention may feel a moral obligation to respond. (The U.S. signed but did not ratify the Convention.)

Ayakha, 17, goes to school in Cape Town while her mother and siblings live in the Eastern Cape. Her mother is a small-scale farmer and, like the women at Hleketani Garden, has been living the impacts of climate change for several years. Drought set in in the Eastern Cape in 2014. More recently, international headlines blared as the city of Cape Town counted down toward “Day Zero,” when urban reservoirs would run dry. Rural regions, where thousands of small farmers grow food for their households and local communities, got few headlines.

Small farm, Eastern Cape (Desmond Latham/IPS)

Ayakha, who told her story to The Mail and Guardian, says her mother and other small farmers “really don’t know when the rains will come. … My mom knows when to plant which vegetable. She knows how the weather will be.” Not anymore.

Her mother’s livestock have also been hard hit. “I saw all these animals die,” Ayakha recounted. “A full-grown cow is about R16,000 [$1,450 CAD]. I saw my family lose all that money. My mom is supporting five children; she’s the only one working.”

With this hit to the family’s finances, Ayakha’s mother, along with so many other rural farmers, will struggle to provide for her children’s school needs. Such immediate impacts are obvious and keenly felt. Less obvious, but perhaps even more devastating, is the impact on the dream to send one’s children to university.

In Limpopo Province, at the other end of the country, January Mathebula speaks hauntingly of the declining fortunes of the vegetable farm he tends alongside his wife Lydia. The farm used to thrive and paid for their children to go to university, he explains. At the moment, it barely provides enough for the costs of their youngest daughter's subsistence, textbooks, and travel home from the University of Cape Town, where she is studying mathematics on a scholarship.

“We are waiting for the rain, then we can farm,” January says. “But what about now? What about now?”

Now, January and Lydia need money from the farm to support their daughter in Cape Town. Without rain, however, they don’t know whether or when that money will arrive. “Our children grow up on the money from the farm. What can we do?” Until recently they were also supporting their infant grandson, whose parents work in Johannesburg. Income from the farm’s cabbages and leafy greens is the family’s livelihood, and the food is the source of their health.

Moonrise over January and Lydia's farm

Farmers like January, Lydia, and Ayakha’s mother face an uncertain future as Southern Africa is wracked by drought, intense storms, growing pest pressures, and unpredictable seasons. Farmers in this region know how to innovate and adapt to drought in the short term – it has long been a regular feature of farming here. But droughts that last years, in combination with these additional pressures, are a new kind of crisis.

As Ayakha and her peers insist, it is a crisis with deep consequences for children.