Geopolitics

The Rush To Reverse Africa's Dismal Vaccination Rate

As many parts of the continent face a brutal third wave, the urgency to vaccinate is growing. But the obstacles are many, including a stubborn strain of vaccine hesitancy.

Preparing a vaccine dose in Nairobi, Kenya
Claudia Lafrance and Olivier Marbot*

Vaccination against COVID-19 remains a challenge in Africa. The Delta variant is spreading on the continent and the third wave of the pandemic is causing fears of more sudden and concentrated arrivals of severely affected patients in hospitals. The situation is all the more worrisome given the lack of capacity to care for them. Some facilities are already saturated. The situation is particularly problematic in South Africa, where it's winter now, in North Africa (especially Tunisia), and in Uganda, so much so that the specter of an "Indian-style" scenario is increasingly being raised.

So far, just over 6 million cases and 155,000 deaths have been recorded on the continent. But these figures could be underestimated, as the data is fragmented. In all, 51 countries on the continent (including the Maghreb) have received roughly 70 million doses from various sources, and 18 million people are now protected by two jabs. That means that less than 2% of the African population has been vaccinated, numbers that are simply "unacceptable," the World Bank's director of operations, Axel van Trotsenburg, recently said.

"The Covax system was supposed to provide us with doses, but we can see that it not functioning very well," laments Dr. Moumouni Kinda, executive director of the NGO Alima, which has just launched a vaccination support and awareness campaign in six countries.

"The situation is very disparate. In some countries, there is a shortage of doses, in others people have received the first dose but are unable to get the second," he adds. "We must change our methods, otherwise the third wave that is hitting southern Africa will also arrive in West Africa and this will be a failure for everyone. We must opt for active vaccination, that is to say, we must sensitize the populations and go to them, not wait for them to come to the centers."

Complicating matters is the fact that a large part of the African population is also reluctant to be vaccinated. This mistrust is even fueled by some leaders. In addition to legitimate questions, there are prejudices and conspiracy theories about alleged attempts at poisoning or even disguised sterilization. Last December, only a quarter of respondents of a survey conducted by the African Union's Center for Disease Control (CDC) in 18 countries across the continent believed that coronavirus vaccines were safe. At the same time, 79% of respondents said they would accept an injection if it was proven safe.

We must stop thinking that in Africa, we do not vaccinate properly!

"Too much fake news is circulating, especially on social networks," says Dr. Amavi Edinam Agbenu, who works with the WHO's Africa division. "Citizens don't necessarily have all the data to analyze it and we are working to bring them information as soon as we can."

Media campaigns, creating informational videos, and support for state communication are now among the organization's priorities on the continent.

"Resistance to the vaccine has many sources: confusion in communication, lack of clear information, the reputation of AstraZeneca, which some European countries have suspended for a while," Alima's Dr. Kinda explains. "So we use community networks, people who are able to explain things to people. But we also need to be transparent about the side effects of vaccines, document them and inform seriously, to reassure people."

Complicating matters is the fact that a large part of the African population is reluctant to be vaccinated — Photo: Robert Bonet/NurPhoto/ZUMA

The NGO director also deplores what he calls "contradictory messages," explaining that some people who send doses to Africa refuse to allow nationals of our countries, even though they have been vaccinated, to enter their country. "This is very regrettable and does not reassure people," he says. "The suspicion must stop. We have a good experience with mass vaccinations. If necessary we are able to go to villages, to go door to door… We know how to do it. We must stop thinking that in Africa, we do not vaccinate properly!"

Amavi Edinam Adgbenu, a pharmacy doctor and expert in immunology, agrees. "African countries may have a limited income, but their health systems are often well trained and able to carry out large-scale vaccination campaigns," he says. "They are used to vaccinating more than 10 million people in one week against yellow fever, meningitis, or polio, for example."

In addition to the Covax package, which announced 31.5 million Pfizer doses for Africa by the end of August, the African Union has secured 400 million doses of the Johnson & Johnson vaccine, which requires only one injection. The shipments are expected to arrive in the third quarter of 2021. According to Dr. Matshidiso Moeti, WHO's regional director for the continent, the number of available doses are expected to be much higher in July and August. The WHO says that 25 million will be sent from the United States in the next few weeks and another 3.5 million from Norway, Sweden, France and the United Kingdom.

The rate of the use of vaccines received varies considerably from one region to another

The World Bank and several African leaders met earlier this month to discuss the development aid expected for the next three years, especially to fight the pandemic. But NGOs are concerned that donated doses will expire too quickly for countries to have time to roll out their campaigns.

Paradoxically, despite the shortage, batches of the vaccine have recently expired in the DRC, Health Minister Jean-Jacques Mbungani announced on July 14. And this is not an isolated case. Other countries are failing to administer them in time. In May, Malawi destroyed nearly 20,000 expired doses. The DRC, South Sudan and South Africa have also sent back doses, either because they were about to expire or because they refused the AstraZeneca vaccine, which did not work against the South African variant. Cameroon, seeing the deadline for its doses approaching, stepped up its vaccination campaigns last week. In all, some 20 sub-Saharan countries are still at risk, with some doses expiring by the end of the summer.

The WHO and CDC centers in Africa have been supporting governments for months in organizing their vaccination campaigns. Regular monitoring of stocks and their expiration dates has been put in place. "In some countries, the use of certain brands of vaccine has been frozen to clear priority uses," says Edinam Agbenu. Vaccination has also been opened earlier than planned to non-priority targets.

But the rate of the use of vaccines received varies considerably from one region to another. According to the latest figures available to WHO, Morocco, Angola and Rwanda have administered all their doses, followed closely by Nigeria, Malawi, Kenya, Tunisia, Ghana, Uganda and South Sudan, which have exceeded 90% use. Sudan, Côte d'Ivoire, Gambia, and Eswatini are at around 80%

Some 30 countries have been less quick to develop their vaccine campaigns and have used between 30% and 80% of their doses, while seven others are really lagging behind. Some started their campaigns late. And it is possible that not all data has been reported.


*This article was translated with permission from its authors.

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Economy

Merkel's Legacy: The Rise And Stall Of The German Economy

How have 16 years of Chancellor Angela Merkel changed Germany? The Chancellor accompanied the country's rise to near economic superpower status — and then progress stalled. On technology and beyond, Germany needs real reforms under Merkel's successor.

Chancellor Angela Merkel looks at the presentation of the current 2 Euro commemorative coin ''Brandenburg''

Daniel Eckert

BERLIN — Germans are doing better than ever. By many standards, the economy broke records during the reign of outgoing Chancellor Angela Merkel: private households' financial assets have climbed to a peak; the number of jobs recorded a historic high before the pandemic hit at the beginning of 2020; the GDP — the sum of all goods and services produced in a period — also reached an all-time high.

And still, while the economic balance sheet of Merkel's 16 years is outstanding if taken at face value, on closer inspection one thing catches the eye: against the backdrop of globalization, Europe's largest economy no longer has the clout it had at the beginning of the century. Germany has fallen behind in key sectors that will shape the future of the world, and even the competitiveness of its manufacturing industries shows unmistakable signs of fatigue.

In 2004, a year before Merkel was first elected Chancellor, the British magazine The Economist branded Germany the "sick man of Europe." Ironically, the previous government, a coalition of center-left and green parties, had already laid the foundations for recovery with some reforms. Facing the threat of high unemployment, unions had held back on wage demands.

"Up until the Covid-19 crisis, Germany had achieved strong economic growth with both high and low unemployment," says Michael Holstein, chief economist at DZ Bank. However, it never made important decisions for its future.

Another economist, Jens Südekum of Heinrich Heine University in Düsseldorf, offers a different perspective: "Angela Merkel profited greatly from the preparatory work of her predecessor. This is particularly true regarding the extreme wage restraint practiced in Germany in the early 2000s."

Above all, Germany was helped in the first half of the Merkel era by global economic upheaval. Between the turn of the millennium and the 2011-2012 debt crisis, emerging countries, led by China, experienced unprecedented growth. With many German companies specializing in manufacturing industrial machines and systems, the rise of rapidly industrializing countries was a boon for the country's economy.

Germany dismissed Google as an over-hyped tech company.

Digital competitiveness, on the other hand, was not a big problem in 2005 when Merkel became chancellor. Google went public the year before, but was dismissed as an over-hyped tech company in Germany. Apple's iPhone was not due to hit the market until 2007, then quickly achieved cult status and ushered in a new phase of the global economy.

Germany struggled with the digital economy, partly because of the slow expansion of internet infrastructure in the country. Regulation, lengthy start-up processes and in some cases high taxation contributed to how the former economic wonderland became marginalized in some of the most innovative sectors of the 21st century.

Volkswagen's press plant in Zwickau, Germany — Photo: Jan Woitas/dpa/ZUMA

"When it comes to digitization today, Germany has a lot of catching up to do with the relevant infrastructure, such as the expansion of fiber optics, but also with digital administration," says Stefan Kooths, Director of the Economic and Growth Research Center at the Kiel Institute for the World Economy (IfW Kiel).

For a long time now, the country has made no adjustments to its pension system to ward off the imminent demographic problems caused by an increasingly aging population. "The social security system is not future-proof," says Kooths. The most recent changes have come at the expense of future generations and taxpayers, the economist says.

Low euro exchange rates favored German exports

Nevertheless, things seemed to go well for the German economy at the start of the Merkel era. In part, this can be explained by the economic downturn caused by the euro debt crisis of 2011-2012. Unlike in the previous decade, the low euro exchange rate favored German exports and made money flow into German coffers. And since then-European Central Bank president Mario Draghi's decision to save the euro "whatever it takes" in 2012, this money has become cheaper and cheaper.

In the long run, these factors inflated the prices of real estate and other sectors but failed to contribute to the future viability of the country. "With the financial crisis and the national debt crisis that followed, economic policy got into crisis mode, and it never emerged from it again," says DZ chief economist Holstein. Policy, he explains, was geared towards countering crises and maintaining the status quo. "The goal of remaining competitive fell to the background, as did issues concerning the future."

In the traditional field of manufacturing, the situation deteriorated significantly. The Institut der Deutschen Wirtschaft (IW), which regularly measures and compares the competitiveness of industries in different countries, recently concluded that German companies have lost many of the advantages they had gained. The high level of productivity, which used to be one of the country's strengths, faltered in the years before the pandemic.

Kooths, of IfW Kiel, points out that private investment in the German economy has declined in recent years, while the "government quota" in the economy, which describes the amount of government expenditure against the GDP, grew significantly during Merkel's tenure, from 43.5% in 2005 to 46.5% in 2019. Kooths concludes that: "Overall, the state's influence on economic activity has increased significantly."

Another very crucial aspect of competitiveness, at least from the point of view of skilled workers and companies, has been neglected by German politics for years: taxes and social contributions. The country has among the highest taxes on income in Europe, and corporate taxes are also hardly as high as in Germany anywhere in the industrialized world. "In the long run, high tax rates always come at the expense of economic dynamism and can even prevent new companies from being set up," warns Kooths.

Startups can renew an economy and lay the foundation for future prosperity. Between the year 2000 and the Covid-19 crisis, fewer and fewer new companies were created every year. Economists from left to right are unanimous: Angela Merkel is leaving behind a country with considerable need for reform.

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