Vaccination is an essential tool to stop the spread of infectious diseases. Yet, as the Delta variant of SARS-COV-2 spreads across the world, Africa, with a covid-19 vaccination rate of less than 2%, faces a high risk of surges in infection and deaths. Various initiatives such as COVAX and the African Vaccine Acquisition Task Team (AVATT) negotiate with pharmaceutical companies and high-income countries (HICs) to secure covid-19 vaccines for Africa, but the world can’t avail itself of enough doses to rapidly respond to the demand. This presents a threat to Africa’s development as the reorientation of resources to fight the pandemic is having a negative impact on economies, as well as the provision of education and health services. This is why many African countries are fighting to start manufacturing the much needed covid-19 vaccines in order to avoid being the last to be served as always.

The response of many African countries early in the pandemic was hailed for its focus on strict implementation of prevention measures backed by science under the leadership of Africa Centres for Disease Control and Prevention. This contributed to a low rate of covid-19 infections and mortality. However, the implementation of public health measures can only hold off a major catastrophe and ensure recovery for so long. Vaccines are critical, especially with the emergence of more infectious and deadlier variants.

Public health measures have largely relied on the ability of governments to implement them, with external support for testing and personal protective equipment (PPE) as Africa did not produce enough of these tools. However, the continent has to look outwards to secure covid-19 vaccines. The continent currently accounts for 25% of the global demand for all types of vaccines, but only produces 1% of the vaccines consumed. This makes Africa’s health security heavily reliant on the availability of surplus vaccines beyond the needs of HICs, and the willingness of pharmaceutical companies and their governments to extend an arm and supply Africa with these vaccines. 

The story of how Africa got here is not news to many. Centuries of slavery, followed by colonialism, have enriched Europe while depriving Africa of its wealth and the capacity to build the necessary health and industrial systems to innovate medical interventions. Colonial powers created extractive, resource-based economies rather than building health, education, and other systems needed for Africa’s sustainable development.

In the 1960s, newly independent African countries that were economically deprived and lacked qualified human resources, looked to the colonizers of yesterday for support. Under the façade of helping Africa, the new partnerships and multilateral organizations left little room for system building. Instead, Europe further entrenched colonial-time power dynamics and continued to divert African wealth from the continent, resulting in shockingly very little reduction in poverty, despite the abundance of natural resources on the continent. A few decades later, structural adjustment programmes (SAPs) from the World Bank and the International Monetary Fund (IMF) required disinvestment in public programmes focused on building systems for human development, favoring tax-based private investments. History proved them wrong, as countries with the best public health systems are among those with the best population health outcomes. Note that better health outcomes also contribute to higher levels of economic growth. Despite this proof, HICs and these international organizations expressed no regrets. No one was held accountable for HICs’ misconduct and no reparations were provided to compensate for their wrong advice. On the contrary, HICs still essentially blame African countries for the current situation. 

Colonialism and its legacy continue to handicap Africa, leaving it to provide rudimentary health services needed to keep populations alive instead of developing new interventions. Brain drain, which is estimated to result in a loss of $2billion annually, contributes substantially to the continent’s poverty. Furthermore, despite the common narrative of large aid flows into Africa, the extraction of resources from Africa continues, with an estimated net value of $41.3billion flowing out of Africa to rich countries in 2017. This further leads to inadequate investment in research and the limited number of vaccine manufacturers that currently prevent Africa from meeting the demand for vaccines on the continent. Today the continent has built a strong momentum for vaccine manufacturing in the context of covid-19, but for it to succeed, each step of the process requires leaders to fight the colonial legacies that undermine the real narrative and undercut Africa’s progress. 

The world needs to understand that if Africa reaches out to HICs for the resources needed to bolster vaccine manufacturing, it is because the disastrous impacts of centuries of enslavement, colonialism, and its continued legacy force Africa to look outwards. Supporting this request is not a question of compassion or beneficence, but rather one of overdue reparations to payback for centuries of injustice that diverted wealth from Africa. By doing so, Africa will be more autonomous in its efforts to protect the health of its population, while pharmaceutical firms in HICs will continue to make high profits through licensing.

Agnes Binagwaho, vice chancellor of the University of Global Health Equity in Rwanda. She previously worked as the Executive Secretary of Rwanda’s National AIDS Control Commission, as Permanent Secretary of the Ministry of Health, and as the Minister of Health.

Kedest Mathewos, research associate at University of Global Health Equity

Competing interests: None declared.