Targeting the vulnerable: A healthcare worker rests in the hall where people 60 years and old are getting vaccinated with Pfizer vaccines, at Bertha Gxowa Hospital in Germiston. The developing world won’t reach herd immunity any time soon. (Photo: Michele Spatari/AFP)
It has been over a year since the World Health Organisation (WHO) declared the Covid-19 pandemic, which has for all intents and purposes, turned the world up-side down — especially for the marginalised and vulnerable.
But vaccines, hailed by many as the solution to the pandemic, cannot, by themselves, be the only answer. The problems with the turn to the silver bullet of vaccination are not just in the already visible failures of equitable distribution and access, nor the decimation of public health structures in most nations capable of inspiring trust through ethical and transparent practice.
The problem is more basic: vaccination was never meant to be the only practice to control a novel pandemic. To know the coronavirus as it mutates in place and over time, to understand the variation in population impacts and effects, requires testing: sustained, efficient and equitable testing.
Workplaces and markets have been shut, borders and airports cordoned off. Wearing masks and physical distancing have become second nature to many of us. Yet all these tactics, and many more, including vaccination campaigns at a scale only a few months ago thought unimaginable, have not been decisive in bringing the pandemic under control. Even the vaccination programme, initially thought to be the solution, is bringing more questions by the day as the virus continues to mutate further out of reach.
In May, the WHO announced that a measly 0.3% of the global production of vaccines have made their way to low-income countries. Surely this is not sustainable. For people who have lost livelihoods, and who have been worst affected by the socioeconomic consequences of the pandemic, respite remains elusive.
Challenges with vaccines
The roll-out of vaccines has been met with myriad challenges and the initial optimism and euphoria is quickly dying away as access to vaccines continues to be a challenge for most of the world. Countries such as Brazil, Yemen and India continue to see more peaks well after vaccines have been approved. Some estimates suggest that it will only be at the end of 2023 at the earliest that enough people will be vaccinated to bring about population immunity.
Unless something changes drastically in terms of production capacity, vaccines are still a pipe dream for many people, especially in the global south and in lower income countries not able to compete at the global stage of tiered pricing, where prices are protected by non-disclosure agreements. While the profit-driven method of working of big pharmaceutical companies who are hell-bent on maximising profits in the face of millions dying may be shocking for many, those who have been campaigning for access to affordable medicines know that this has been the same for ARVs, pneumonia vaccines and cancer treatment among many others. Sadly, this is nothing new.
Vaccine campaigns have also been beset by conspiracy theories and suspicion across the geographical divide. But vaccine hesitancy is also nothing new. Healthcare workers who work in parts of Nigeria, for example, know the reality of vaccine hesitancy even for “old” diseases, including cholera and polio.
The net effect of vaccine hesitancy is that even as access to vaccines continues to increase, many people remain sceptical about being vaccinated. And yet the fight for access to vaccines is a noble one that must go on. It cannot be that vaccines are still only available to a chosen few who happen to be, by sheer accident of birth, born or resident in richer countries.
The measures initially taken by authorities to control the Covid-19 outbreak have not only shown to be of limited success, but they have also come at a great socioeconomic cost. Many economies in the global south were already underperforming before the pandemic and these have brought devastating impact on the little that sustained communities. Governments are looking likely to implement even harsher austerity measures as they try to appease the IMF and the World Bank. Indeed, many governments are between a rock and a hard place.
For many lower-income countries, patients must pay for healthcare because governments do not set aside sufficient funds to deliver it. During the pandemic, paying user fees and paying for consumables has often been the difference between whether someone can be diagnosed and access care or not. Testing services remain by and large available at a high price, especially for asymptomatic people. Since we already know that asymptomatic patients can also transmit the virus, it potentially means many people have been infected and unwittingly spread the virus to many others.
In May 2021, the medical humanitarian organisation, Médecins Sans Frontières (Doctors Without Borders) decried the lack of oxygen therapy, which they described as “the single most important medicine for severe and critical Covid-19 patients”. The pursuit of vaccines has blinded many to the value and usefulness of diagnostics as well as therapy for those who are sick with Covid-19.
Which way forward?
It would be remiss to fail to acknowledge the challenges that authorities face as they try to control the pandemic. It has been undoubtedly frustrating to see once again how pharmaceutical companies continue to overprice and maximise on profits for diagnostics and vaccines. It would indeed be discouraging to note how some rich countries continue to support enforcement of intellectual rights claimed by drug companies in the face of untold devastation.
And yet we cannot afford to slumber. We cannot afford to be complacent or let the virus go unchecked, no matter how exhausting the last months have been. It is becoming clear that the virus will continue to seek to exist alongside us, and we are reminded repeatedly that if some people are not safe from the virus, then we are all collectively at risk.
As we prepare for this future, full of uncertainty and knee-jerk learning, it is important once again to remind ourselves that the tools for controlling epidemics are already within our midst. While vaccines may bring some glimmer of hope and continue to be a useful tool to control the outbreak, this is by no means the only tool that we have. The capacity to test people and isolate the infected remains the most developed pillar of epidemic response so far, and it would be a huge failure to not utilise the full potential of this tool. Testing needs to be scaled up and made accessible to the socially excluded.
Truck drivers, commercial sex workers and traders who sell their wares in informal markets require access to testing so that they can continue to protect the people they interact with. It is unconscionable that 12 months after the pandemic was declared, testing within the public health system of many countries is still inaccessible.
People still pay over $70 to get a test in many African countries, especially if they are asymptomatic. In some countries, residence status is still a built-in administrative hurdle to access testing within the public health system. In some countries, people still travel over 200km to get to a testing site. We continue to see the unfairness of a response that tries to champion equality instead of equity.
It is through accessible testing that is available on demand that even the risk of mutations can be controlled. Without widespread testing, it is impossible to identify new mutations of the virus and isolate them. In this regard even the success of vaccination campaigns rely on robust testing services. We have seen in South Africa that some vaccines have markedly reduced efficacy against new variants of the virus. It would be a waste and a breach of public confidence if the vaccines that were used turn out to be ineffective, especially as there are already high levels of vaccine hesitancy.
If anything, the pandemic has once again reminded us of the limitations of an approach that is overly reliant on biomedical science, at the expense of social and human science. This probably makes sense for higher-income countries that can pay whatever is demanded by drug companies to access vaccines — but for most of the world, this remains a pipe dream.
Without taking communities into our confidence, we continue to deny ourselves of willing and able agents against Covid-19. As the renowned pan-Africanist and anti-imperialist Amilcar Cabral once stated: “Hide nothing from the masses of our people. Tell no lies. Expose lies whenever they are told. Mask no difficulties, mistakes, failures. Claim no easy victories …”
Karsten Noko is a lawyer from Zimbabwe, who has worked in the health and humanitarian sectors in sub-Saharan Africa for more than a decade. Veena Pillai is a Malaysian medical doctor and researcher in the humanitarian sector. Both write in their personal capacities