Give Africa what Africa really wants

Pfizer says it wants to help Africa. With BioNTech, its partner in mRNA vaccines, Pfizer is offering to ship millions of doses of covid-19 vaccine to Africa for final production and distribution. Africa’s need is great. Vaccination rates are barely 15%, and a very real concern is that the next SARS-Cov-2 variant will evolve unnoticed in Africa’s large population of people with HIV (doi:10.1136/bmj-2021-069807).1 As much of the world considers its pandemic exit, enjoying the benefits of a “hoard and boost” vaccination strategy, the logic of supporting Africa’s vaccination efforts has never been clearer.

Yet, Pfizer and BioNTech’s solution isn’t one that Africa wants. Africa wanted technology transfer from global pharmaceutical companies to become self-sufficient in vaccine production. Africa wanted intellectual property waivers and manufacturing support. In this, Africa spoke for South Asia and South America. But Pfizer and Moderna, in particular, didn’t agree. The financial reward from today’s mRNA vaccines and any future mRNA products is simply too great. Pharmaceutical companies can be generous to Africa, help end the pandemic, and continue to please their shareholders, but they choose not to.

Instead, Africa, with support from the World Health Organization and others, wants to develop its own vaccines, piecing together knowledge that isn’t protected by commercial patents. Pfizer and BioNTech see this self-sufficiency—this ability to save lives without help—as a threat. Africa’s technological independence doesn’t fit their business plans. Why else, as our investigation reveals (doi:10.1136/bmj.o304),2 is the kENUP Foundation, a consultancy hired by BioNTech, undermining Africa’s efforts to manufacture covid vaccines?

Pfizer and BioNTech aren’t alone in overselling solutions that perpetuate inequalities and negatively affect health and wellbeing. The UK’s new “food on prescription” policy is a flawed gesture that will not tackle the root causes of poverty and disadvantage (doi:10.1136/bmj.o318; doi:10.1136/bmj.o324)34; neither will a new government strategy paper to achieve its soundbite ambition of levelling up society (doi:10.1136/bmj.o303; doi:10.1136/bmj.o356).56 The effects of inequalities begin early and can last a lifetime (doi:10.1136/bmj.o278; doi:10.1136/bmj.n2608).78 A “resilient and equitable” recovery from covid requires a genuine commitment and a multisectoral response (doi:10.1136/bmj.o311).9 If a government can squander £9bn on wasted personal protective equipment (doi:10.1136/bmj.o330),10 why does it struggle to spend 10% of that sum on food poverty?

Loneliness is one possible outcome of inequality, and new research suggests that it is experienced by a “substantial proportion of the population in many countries” (doi:10.1136/bmj-2021-067068).11 A public health approach calls for us to tackle the wider determinants of health and demands political commitment (doi:10.1136/bmj.o280).12 The same is true of mental health, in this case of prisoners (doi:10.1136/bmj-2021-069776),13 and of racism (doi:10.1136/bmj.o289; doi:10.1136/bmj.o293),1415 but progress on these fronts has stagnated and reversed. Patients will hope that the UK’s new “elective recovery plan” isn’t another such exercise in electoral soundbites (doi:10.1136/bmj.o343).16

In these circumstances, we grasp for the crumbs of hope on offer: a new “traditional” covid vaccine (doi:10.1136/bmj.o309),17 a successful attempt at HIV self-testing (doi:10.1136/bmj.n2633),18 sound advice on supporting patients during Ramadan (doi:10.1136/bmj-2020-063613),19 and an unexpected Valentine’s card in your inbox (doi:10.1136/bmj.o261).20 But perhaps the greatest hope lies in emerging from the deepest gloom, whether it is the personal story of a doctor who recognised that “we are not, and never were, superhuman” (doi:10.1136/bmj.o331)21 or the powerful realisation that a historically oppressed continent is combating political and corporate exploitation to shape its own destiny. It’s time for Africa to get what Africa wants.