Medical Colonialism: Pandemic Impacts and Vaccine Delivery

Debating Ideas is a new section that aims to reflect the values and editorial ethos of the African Arguments book series, publishing engaged, often radical, scholarship, original and activist writing from within the African continent and beyond. It will offer debates and engagements, contexts and controversies, and reviews and responses flowing from the African Arguments books.

The past months have seen the Covid debate shift decisively to the question of vaccines. The inequality of access to vaccines has been truly staggering.[1] Rich nations have virtually required younger citizens to be vaccinated against a disease of which very few young people are at risk, thereby hoarding vaccines and preventing equal access in poor countries. And yet what is also staggering is the way in which the Covid debate is framed entirely through the medical eyes of rich countries.

In an African Arguments piece in April, I pointed out that it was essential that the priority of Covid vaccination did not upend other vital public health goals on the continent.[2] Balance is required: ensuring that vulnerable and elderly people in Africa are provided with Covid vaccines, while not hampering other vital healthcare initiatives.

The importance of this perspective has become ever clearer since then. The 2021 WHO Malaria report suggests that there were 47,000 additional deaths from malaria in 2020 – the vast majority children under 5.[3] This was caused by a variety of supply chain factors – including the diversion of resources from malaria rapid tests to Covid rapid tests[4] – and supply shortages brought on by lockdowns and the diversion of pharmaceutical companies into Covid work. Beyond this, the impact of the narrow focus on Covid-19 on other childhood vaccination programmes has been enormous. A June 2020 report by Collateral Global found that 13 of 15 African countries with available data had seen declines in monthly vaccination rates: in Ethiopia the average decline in regular immunisations were of the order of 12.5%, while there were also significant drops in measles vaccinations in Senegal, to give just two examples.[5]

It is therefore vital to take account of all vaccination and associated medical programmes, and not just Covid-19, when looking at inequalities related to vaccination. And yet Western media sources have failed to offer this perspective – leaving this task to African medical practitioners, who have spoken out about the realities where able to.

Doctors and scholars of medical history from Africa have been quick to highlight this perspective. The Angolan doctor João Blasques de Oliveira wrote about this in detail in July, noting that: “The lockdowns added layers of difficulty to routine medical services for a variety of reasons … anecdotal evidence from many primary care health care facilities in Angola describes a sharp decline in outpatient and emergency visits across the region and for various conditions … preventive child health services were affected, and vaccination was frequently postponed. For example, nationwide polio and measles vaccination were cancelled or delayed, and restrictions on movement presented barriers to access to the locations where routine vaccinations were provided.”[6]

Meanwhile in Mozambique, a doctor wrote that “Covid-19 has not been a major health crisis when compared to other endemic diseases … there is currently more attention and publicity on the vaccination campaign for Covid-19, while the focus on normal – life-saving — vaccination campaigns for children are being minimised. This is a serious concern in a country with a high prevalence of malnutrition and infectious diseases in early childhood. In Mozambique, malnutrition is a significant trigger for death caused by vaccine-preventable illnesses, and those vaccination campaigns have stalled.”[7]

Politicians and senior figures have begun to speak out about the impacts of this ongoing situation. In an article in the Financial Times on December 8, Ayoade Alakija, co-chair of the African Union, Africa Vaccine Delivery Alliance, noted that “countries such as Uganda and Mozambique are suffering rising rates of poverty and inequality, with the last 20 years of development gains wiped out by the virus”.[8] The noted philosopher Kwame Anthony Appiah wrote in the Guardian on November 23 of the “second-order” damages caused by Coronavirus.[9]

These are important interventions. And yet there is a reticence to be as bald and bold as is needed, doubtless out of wariness of the reaction of Western liberals who are comforted by their go-to myth that all this destruction is “caused by the virus”.[10] These are not “second-order” effects of coronavirus, and development gains have not been wiped out by “the virus”. At the time of writing (December 12), data shows that Covid-19 has killed around 225,000 people on the African continent in almost two years,[11] whereas roughly 9 million people die in Africa every year.[12] 172,500 of these deaths have occurred in just 6 countries: South Africa, Morocco, Tunisia, Libya, Egypt and Algeria. Thus, the total recorded Covid-deaths in the rest of the continent are less than 55,000.

Many claim these figures are a large underestimate. The Stanford University Professor of Medicine John Ioannides has estimate that they represent between 30% and 80% of the true figure, that is, roughly half the true total.[13] But let us be more drastic, and say the true figure is four times that recorded – or roughly 200,000 deaths in the rest of the continent. How can it be the case that this level of mortality has had all the destructive effects that are noted?

Let us take the case of Nigeria. Less than 3,000 people have been recorded as dying from Covid-19 in Nigeria – but let us be ultra-cautious, and say that the true figure is 20,000. Roughly 1.8 million people die annually in Nigeria.[14] This 1% increase in the level of mortality (even with this cautious estimate of Covid mortality) cannot be responsible for the loss of 20% of formal employment,[15] the collapse in schooling which means that only 11 out of 60 schools in a recent survey were able to keep over half of their children in education,[16] or the huge increase in child marriage.[17] These impacts derive not from the virus, but from the response to the virus as championed by global institutions, with strong pressure then brought to bear on African politicians. The pressure for lockdowns in African settings is all the more surprising, since they were trialled in Sierra Leone and Liberia during the Ebola epidemic and determined not to have been effective.[18]

It is important therefore to be clear. What we are really witnessing is a new version of medical colonialism – reproducing very similar patterns to the historical ones highlighted in an African Arguments essay by Florence Bernault last year.[19] In this pattern, the public health needs and requirements of the African continent are subordinated to those of wealthy nations. This has become abundantly obvious in the pressure to “vaccinate the whole of Africa” in response to the Omicron variant – where this policy is openly said by leaders such as Tony Blair as being grounded in the desire not to have further variants affecting older populations in rich countries.[20] But this is not an African public health decision – and moreover, African countries are being forced to take out World Bank loans in order to fund some of these vaccines.[21]

Moreover there is no logic to the current vaccine drive. On the one hand Western populations are told that boosters are needed to protect them against the new variants;[22] and yet on the other, we are told that the whole of Africa must be vaccinated with the first round of Covid vaccines. Of course, for elderly people and the vulnerable these may still offer some form of protection. But for the rest of the population, if the original vaccines no longer provide strong protection, it is hard to understand the rush to push the whole medical system of the continent into delivering vaccines no longer deemed effective for the rest of the world?

Of course, effective Covid vaccines should be available for the older and vulnerable people who need them in African countries. But for the rest of the population, as this article has shown, there are many more pressing needs. As the Ghanaian historian of medicine Samuel Adu-Gyamfi wrote on December 6, “It should be up to African countries to determine their own public health goals, and Covid-19 is far from the most serious public health concern in Africa today.”[23] Unless political leaders are willing to state this truth as boldly as some of the doctors and social scientists on the continent, the fallout from this catastrophe will only continue.