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Tackling Corruption for Effective Vaccination for a Healthy Africa

Sonja Dobson and Denisse Rudich, G7 Research Group
June 15, 2021

Corruption poses a high risk and threat to public health safety and more needs to be done to tackle corruption in Africa to support vaccination efforts. The continent of Africa has approximately 50 countries and more than 1 billion people, yet with one eighth of the world's population, less than 2 per cent of its people have been vaccinated against COVID-19. Only 0.6 per cent of Africans have received both doses for full protection. While countries in North America and Europe are competing to have the highest daily and cumulative vaccination rates, African countries have received few vaccines. Global vaccine inequity is evident with developed countries – which have also had their fair share of COVID-19 corruption scandals – able to vaccinate their populations at significantly higher rates than developing countries. Moreover, Africa has little production and distribution capacity. Vaccines are produced in only 10 countries globally, with factories mainly located in high and middle income countries.

As part of the COVID-19 Vaccines Global Access (COVAX) facility, several African countries qualify for vaccines, as they are unable to pay for or produce their own. Unfortunately, COVAX has clearly not been enough. Ghana and Cote d'Ivoire were the first African countries to receive COVAX vaccines doing so in February 2021. Within a month, distribution to Africa stalled. In South Africa, the delivery of 2 million Johnson & Johnson one-shot vaccines was delayed due to contamination. At Cornwall, President Cyril Ramaphosa said that Johnson & Johnson would be able to recommence production in the coming days but also stressed that "If we are to save lives and end the pandemic, we need to expand and diversify manufacturing and get medical products to treat, combat and prevent the pandemic to as many people as quickly as possible." For these efforts to be effective, there needs to be a commitment to transparency and managing conflicts of interests in the allocation of contracts.

Several factors, not just a lack of vaccines, have contributed to the low vaccination rates in Africa. These include untrained vaccine administrators, inadequate storage facilities and vaccine skepticism. There are also numerous vaccine corruption scandals, including politicians and those with money able to gain access to their vaccines before those in need. Indeed, widespread corruption has invoked vaccine hesitancy. Crisis and conflict have also affected the vaccination campaigns in many African countries.

Unfortunately, according to some surveys, there is little trust in formal institutions and widespread misinformation across Africa. Consequently, public health measures falter. In countries such as Liberia and the Democratic Republic of the Congo, vaccine confidence and uptake "rest on a fragile continuum of trust/mistrust and information/misinformation."

One prevalent conspiracy theory in African countries is that "vaccines are a way for governments to control their growing populations, and that they are a way for corrupt government elites to make money. After all, 4 out of 10 Africans believe that most, or all government officials are corrupt."

The G7 supports equitable vaccine access, especially in Africa, but many people in African countries believe vaccines are just another way for governments to profit. In order to reach the World Health Organization's targets of 10 per cent of people vaccinated in every country by September 2021 and 70 per cent by the next G7 summit, to be held in Germany in summer 2022, G7 members must combat the conspiracy- and corruption-fuelled views of African citizens. After the summit, President Ramaphosa told reporters, "We need much more support because the need is huge."

One mechanism in place to fight that challenge, which the G7 leaders should recognize and support, is the United Nations Convention Against Corruption. Transparency is key to tackling corruption in health care. This includes disclosures of beneficial ownership and a commitment to transparency in public tendering and procurement processes as well as the allocation of contracts linked to health infrastructure including the publication of terms, fees, and risk and impact assessments. Building accountability and reporting mechanisms are also important, as is using technology to allow people to confirm that the suppliers used, including pharmacies and clinics, are regulated and that they are not receiving counterfeit vaccines, personal protective equipment and treatments. Where bribery and corruption have been identified, countries must take enforcement action but also inform their people of the risks and dangers of corrupt and fraudulent practices in what is an essential public good.

At the G7 summit in Cornwall, G7 leaders committed to donating an additional 1 billion vaccines over the next year as part of the Carbis Bay Health Declaration. They further pledged to create the appropriate frameworks to increase and coordinate global manufacturing capacity on all continents and support scientists to develop safe and effective vaccines in 100 days. Leaders promised to "lead the way in building a resilient, integrated and inclusive global health system." The G7 reaffirmed its commitment to the International Health Regulations (IHR), including by enhancing implementation and compliance and determining to improve accountability and transparency. Leaders also pledged to support vulnerable countries in enhancing "implementation of the IHR and strengthen health systems, including through coordination of G7 financial investments, promotion of country ownership, and collaboration with regional public health institutions and leadership networks in Africa, Asia and beyond." As health responsiveness frameworks are further developed and improved, the G7 must make tackling corruption and promoting effective communication a priority. No one is safe until everyone is safe.

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