Vaccine Commodification and Ramifications for Countries in the Global South

By Rawlings Magede

The Covid-19 pandemic has exposed inequalities between countries in the Global North and those in Global South. While governments across the world have responded differently to contain the spread of the virus, vaccine hoarding and use of patent laws has crippled vaccine access and distribution in the Global South. Patent laws such as Intellectual Laws by pharmaceutical companies in the Global North makes it difficult for countries in the Global South to manufacture and distribute vaccines to their populations. The ring fencing of vaccine patents has created monopolies driven by profit and capitalism. The Covax scheme that was designed to bypass this has been plagued by inequity, funding shortfalls and a severe supply crunch. Its initial targets for the year 2021 were missed, partly as a result of the poor health infrastructure in many of the recipient country and partly because of vaccine hesitancy. Cultural and religious beliefs in most countries in the Global South have dealt a heavy blow to the attainment of herd immunity. Waiving of patents across the globe will culminate into better access of vaccines by countries in the Global South.

https://www.africaopl.org/publications/vaccine-commodification-and-ramifications-for-countries-in-the-global-south

Mary Chiwenga Illness: Why the nation needs answers

 By Rawlings Magede

Early this week, Mary Mubaiwa, former wife to Zimbabwe’s Vice President, Constantine Chiwenga appeared in court facing several charges ranging from attempting to kill VP Chiwenga when he was battling for his life at a South African in hospital. She has been on routine  remand for 15 months now with the court failing to put her on trial.Everytime,she has appeared in court, images of her swollen legs and hands have gone viral with many netizens expressing shock as to what could be eating up the former wife of one of Zimbabwe’s powerful politicians. To this end, very little information is known about the cause of the disease that is eating her up.

The lack of such information has made discussion around the health of public officials futile. During the tenure of former President Robert Mugabe, there were rumours to the effect that the he had prostate cancer. Even in his death, the cause of death remains secretive. That information is only known by a selective few in foreign countries where he frequented for medical reviews and checkups. These medical professionals are up to this day still bound by the non-disclosure and confidentiality clause. Secrecy over ill health allows public figures to avoid the stigma associated with certain ailments and maintain their image as heroic and invincible. Unfortunately, it also reinforces a culture of hiding illnesses and perpetuating the stigma, guilt, disdain, and shame often associated with poor health. In the interest of the public, disclosure of an ailment allows for research, awareness and addresses issues of stigma.

A useful example if that of former American President, Ronald Reagan who was diagnosed with colon cancer in 1985.In that instance, Reagan’s diagnosis and treatment was formally disclosed in detail  to the public ,generating widespread media coverage and dispassionate public discussions. Later in the years, researchers later found that the disclosure birthed a public discourse on dietary habits and an increase in awareness around the importance of health monitoring. In the years that followed after the disclosure there was a sharp drop in advanced colon cancer cases likely due to early detection  and public disclosure.

In the past, even VP Chiwenga was down with an undisclosed ailment that saw him even seeking medical attention in China where he was kept for several months while recuperating. While even rumours of his imagined death made the rounds during his stay in hospital, the details of the cause of the ailment still remained top secret. In 2019, President Emmerson Mnangagwa while giving an update to the nation on the condition of the VP, only highlighted that his “condition remained remarkably stable”. Sadly years later, after a messy divorce, Mary Chiwenga cannot have the privilege of seeking medical attention abroad. In a turn of events, unlike his want-away husband whose sickness was secretive, she has had live with the “shame and embarrassment” of coming face to face with the media during routine remand. People who have interacted with her recent pictures have expressed shock and disdain over her deteriorating condition. Attempts by her lawyers to remove her off routine remand have all been struck down by the courts. Given the sensitivities around her dilemma, all the public can do for now is to shed sympathy and tears and watch from a distance as a mysterious ailment eats her away. What a sorry sight! In a normal country where issues of public health are prioritised, her sickness is not supposed to be a top guarded secret. The general public must be given a sneak preview of the ailment that to some is still mysterious. Revealing one’s condition can open up opportunities for even the general public or other health practititioners to lend a helping hand. Watching her come for routine remand is disturbing. At one point she was brought to court by an ambulance. All this proves her deteriorating condition and the stigma attached.

Recent researches around COVID 19 have revealed the high predominance of illness-related stigmatization and discrimination in Africa. Guilt and shame is more common when conditions are infectious, terminal or are deemed to have some moral or spiritual connotations. In such circumstances, patients often report to health facilities only when their symptoms are too advanced for meaningful intervention. This often leads to poorer treatment outcomes, higher care burdens and higher mortality rates, which further perpetuates fears and contributes to a general lack of knowledge about many illnesses. The resulting stigma can become so entrenched that it tarnishes the image of the deceased and their family.

In the final analysis, the Mary Chiwenga must come out of her shell and speak openly about her ailment. She has lost all there is in this world and is only left with her life to preserve. Going public about issues around her ailment will help the public to learn more about the disease  and in some cases even proffer solutions that can assist her.

Rawlings Magede is a Development Practitioner who writes here in his personal capacity. Feedback on vamagede@gmail.com

 

 

 

Vaccine hesitancy in Africa and the impact of misinformation on the COVID 19 Vaccine

 By Rawlings Magede

In 2019, the World Health Organisation (WHO) listed “vaccine hesitancy” as one of the ten greatest threats to global health. More than one and half years later, the world is fighting against a pandemic that has threatened to wipe up the human race. COVID 19 has claimed the lives of more than two million people globally since its outbreak in 2020.Countries such as India and Brazil are among the countries with the highest casualties. In Africa, statistics of COVID 19 related deaths are sketchy owing to the poorly developed public health infrastructure and testing. What however is undisputable is that the pandemic has claimed the lives of many people. In the absence of an effective health infrastructure, people particularly in rural areas continue to die quietly from the virus. In Africa, the fight against the pandemic has also been weakened by misinformation and religion. Ever since reports of the discovery of the COVID 19 vaccine began to filter in, there was a floodgate of conspiracy theories by religious leaders on the vaccine. Reasons for reservations on taking the vaccine varied with some religious leaders suggesting that once one is vaccinated they automatically join Satanism. However, WHO has noted that vaccine hesitancy is influenced by factors such as complacency, convenience and confidence.

In my search for answers, this past week, I conducted an online survey (Whatsapp) that probed reasons why people in Zimbabwe would consider not taking the COVID 19 vaccine. The  majority of respondents (60%) highlighted that their reason for not taking the vaccine were that they did not know much about the COVID 19 vaccine, while 30% highlighted that they do not trust the vaccine while a remaining 10% singled out their religious belief as the major factor for them not taking the COVID 19 vaccine. In my view, if this is representative of Zimbabwean society, it will fall short in achieving population immunity which experts say would require between 80-90% of the population to be immune. If results of the survey are anything to go by, then government needs to share widely information around the vaccine.

Share information on the COVID 19 Vaccine

Among urgent issues that governments across Africa must deal with is sharing widely on the vaccine. Little has been said about this vaccine, what happens after vaccination, ,side effects etc. Recently there were reports that twenty-nine people in the United States developed some reactions after being vaccinated against COVID 19 since the rollout began. All this information is fuelling the anti-vaccination movement that is being led by various individuals, mostly from various religions. The pronouncement by WHO on the threat posed by vaccine hesitancy in achieving global health even before the outbreak of the pandemic in 2019 was informed by past experiences of societies that refused vaccinations. For example Polio vaccinations were boycotted in East Africa in the 1990s and in northern Nigeria in the 2000s.More recently, In South Africa in July 2020, people took to the streets of Johannesburg to register their concerns against human trials for a potential corona virus vaccine. This was after the University of Witwatersrand in partnership with Oxford University rolled out South Africa’s first clinical trial, which would consist of two thousand volunteers. This incident demonstrates concerns among some on the continent over vaccines that people know very little about.

Among issues that African governments must tackle is the need to deal with vaccine hesitancy that is inherent in most African societies due to lack of adequate information and religious beliefs. This will greatly help increase confidence .Misinformation on vaccine safety has eroded trust in our health care systems. Rebuilding this trust is a herculean task but will take concerted and multi-faceted efforts. Closely linked to this, is the need for governments to communicate effectively and transparently regarding the full benefits and risks of vaccinations going forward. There is no doubt that more pandemics will visit us in the near future. Health personnel especially those in remote districts must be trained to ensure that they give relevant and comprehensive information in a respective and culturally sensitive manner. To effectively do this, key stakeholders that can help easily propagate this message such as religious, political and other leaders must be identified and equipped with skills to effectively  disseminate   key information to their followers. The assumption that radio and social media has a wider reach has  negatively impacted access to key information by some sections of society. Added to this, well thought strategies must also be devised to target marginalized communities that may have less access to healthcare services.

In the final analysis, COVID 19 has demonstrated the urgent need for collaboration between government and other stakeholders. Collaborations require strong institutions that embrace transparency and accountability over use of funds. Going forward, the challenge for our leaders and policy makers would be to craft and design effective vaccination policies and bolster population immunity that will help the continent combat future epidemics.

Rawlings Magede is a Communication for Development expert who writes here in his personal capacity. Feedback on vamagede@gmail.com

State and citizens must join forces to help contain COVID 19

By Rawlings Magede

Zimbabwe risks losing the fight against the COVID 19 pandemic if the laxity in the enforcement of COVID 19 restrictions is anything to go by. The 31 December event in Mbare organised by DJ’s Fantan and Levels all but exposed the lack of appreciation by citizens on the severity of COVID 19 in Zimbabwe. How the police allowed this event that was attended by hundreds of people is shocking given the surge in cases of COVID 19 over the festive season.

This past week, the sentencing of DJ’s Fantan and Levels dominated discussions on social media with a majority of netizens arguing that the sentencing was harsh given that other elite clubs such as Dreams owned by the late flamboyant Genius Kadungure have continued to open its doors to large numbers of patrons. While such a debate is necessary, there has been a somewhat limited conversation on the complicit role played by police officers who gave the green light for the event. That senior police officers received bribe  money from the organizers is not a secret but rather serves to confirm the high levels of corruption within  law enforcement agents.

In a country confronted by a pandemic that has the potential of dishing out untold fatal blows, there is need to confront the pandemic on two levels. The first level is at the level of the state, that has an obligation of acting on behalf of citizens by ensuring that resources such as social protection is provided for vulnerable groups. At this level, government must do more and go beyond cheap politicking by ensuring that such vulnerable groups are cushioned. The other level is at the level of everyday life in which individuals and communities mobilize each other thereby helping in changing their behaviors to help reduce the risk of transmission. At this level sadly we have failed. This has been demonstrated by the failure to observe social distancing, wearing of face masks and adhering to other COVID 19 preventative measures.

These two levels must complement each other. Public health remains a social good that is a product of both the state and its citizens. The fight against epidemics such as HIV/AIDS and Ebola brought with it several lessons. One such lesson is the importance of partnerships between civil society and government. In dealing with COVID 19, we need a similar social contract between the state and citizens, collaborating in solidarity to keep the vulnerable safe and take care of the sick. One of the unfortunate blunders by government is the failure to consider the disastrous effects of the lockdown on a sizeable chunk of our population which belongs to the informal sector. Cash payouts for vulnerable groups that help mitigate against the impact of COVID 19 that have been channeled through the Ministry of Public Service, Labour and Social Welfare remain shrouded in a lot of mystery. What we have seen are just headlines mostly in the state controlled press but there have been lack of publicity around the criteria being used to help such groups. Social protection measures have been inadequate, poorly implemented and hard to access. The fight against COVID 19 has also been dealt a major blow by acts of corruption within law enforcement agents.

Of hungry law enforcement agents and poverty

The 31 December event organised by the jailed DJ’s eroded whatever was left of the confidence that citizens had in the police in as far as enforcement of COVID 19 lockdown is concerned. The several roadblocks bear testament to this. At some roadblocks citizens without exemption letters are made to pay money to gain access into town.

Also the  manner in which the lockdown is being implemented makes citizens by standers in the fight against COVID 19.The default frame of thinking about state-society relations has been disciplinary and coercive. The emphasis has been on the top-down controls via a series of sometimes bizarre regulations. In my view during the lockdown period law enforcement agents assume the role of front line workers which means that in enforcing the lockdown, they must not only enforce the law with brutality as before but ensure that they also join the crusade on awareness raising on COVID 19.As highlighted before, there is need for stronger ties between the state and civil society built on mutual trust and respect. As part of this partnership, civil society organisations can train law enforcement agents on COVID 19 preventative measures and have collaborative programmes such as awareness raising on COVID 19 in suburbs. We need to do much more thinking about public health movements and pick up lessons from past epidemics. The last great European cholera epidemic, for example was not simply eradicated by medical science. What made a big difference in Hamburg at the end of the 19^th century was a workers’ public health movement led by socialist parties in poor neighbourhoods, teaching people about hygience, washing of hands and boiling water before drinking. Closer to home,HIV/AIDS in South Africa was not only contained by the roll-out of antiretrovirals.It was the Treatment Action Campaign that shook things up. This organisation created a democratic, gender-aware and rights-based social movement that destigmatised the disease and supported profound changes in sexual behavior. It built a movement for health that linked a campaign for access to medicine to a broader call for social justice.

In the final analysis, both the state and citizens need to change their approach on tackling COVID 19.At a time when governments across the world are struggling to control the spread of COVID 19, there is need for the state to change its approach and treat its citizens as active participants in the fight against COVID 19.Without participation by the citizens, the fight against COVID 19 will be a lost battle.

Rawlings Magede is a Communication for Development expert who writes here in his personal capacity. Feedback on vamagede@gmail.com

 

Never mind about “exporting patients” Minister, all we want is basic health care

By Rawlings Magede

Recently, new Health Minister Constantine Chiwenga during a press conference announced that government will no longer “export” its patients to neighbouring countries for treatment. In his address the new Health Minister bemoaned the high cost of the export bill that has in the past seen government footing bills for officials who get treatment overseas.

Exporting patients especially government officials to foreign countries for medical attention is not a phenomenon, during former President’s Robert Mugabe tenure of office, senior government officials made a beeline as they even sought medical attention even for minor ailments that our local health institutions could deal with . At the turn of the millennium as age took a toll on the former president, he made Singapore his second home as from time to time he frequented the Southeast Asian country for check-ups and treatment. The export bill during his time even ballooned to astronomical figures and set precedence for his cronies in government to snub local health facilities. Such a culture led to a neglect of our health infrastructure. The subsequent years that followed saw government crushing by every means necessary industrial action by health workers who would from time to time take to the streets to highlight the poor state of affairs within the sector. Coincidentally, it is the new Health Minister who fired striking nurses in April 2018 describing their industrial action as politically motivated and refused to entertain any of their concerns. Surprisingly, the new Minister this time has made another huge turn by singling out “exporting of patients” by government as the major cause for the poor health infrastructure.

Over the years, communicable diseases such as Cholera have wrecked havoc especially in our overcrowded high density suburbs. Public hospitals and clinics which in most cases do not have basic medication have failed to cope during times of great need. This has been made worse by governments’ decision to privatise health which has seen private surgeries mushrooming across the country. Services at these surgeries remain beyond the reach of many. The situation is worse in rural areas.

Access to health care is even worse in rural areas

Ensuring the well-being of its citizens is the primary goal of any government. Zimbabwe’s constitution in Section 76 provides for basic health care which must be enjoyed by every citizen without discrimination. In rural areas however, this right has evaded many over the years. In most cases, health care centres are far away from those they are supposed to serve, leaving people to travel long distances. Access has also been further impeded by a lack of infrastructure, such as roads that are not well maintained, resulting in poor road conditions and potholes that make it difficult for transportation of critical drugs .Due to years of neglect and derelict, bridges that have either collapsed or have not been constructed hinder travelling of patients during critical times and negatively affects the timely delivery of medical drugs and medical supplies to health centres. The situation is even difficult for women. According to a recent survey by the Zimbabwe Demographic Health Survey (ZDHS), institutional deliveries stood at an average of 77 percent. This means that about 20 percent of Zimbabwean birth over the past five years occurred at home, statistics which medical experts describe as unacceptably high. It is my view that in the wake of the COVID 19 induced lockdown, the percentage of home deliveries could be high.

Minister’s call welcome but…

In light of the structural reforms that Minister Chiwenga wants to usher in within the Health Ministry, the first stop must be in ensuring that the public health system is revamped, health workers are motivated to do their jobs by remunerating them in line with other professionals in the region and ensure that in this era of COVID 19,they have adequate Personal Protective Equipment ( PPEs).In respect to access to health care in rural areas, it is important to shorten distance travelled by people to access health care by at least building more health institutions and providing mobile clinics that can be used to visit certain areas on particular days. Mobile clinics can help scale up access to primary healthcare quickly and effectively because they are cheaper to operate and come with less costs to rural communities.

To help reduce “exportation of patients”, government must create a comprehensive referral system that ensures that even government officials get treatment locally to save resources. In cases where one seeks specialised health care abroad, it should only be after the referral system has recommended or in instances where one will use personal resources. This can help save resources that can be channeled towards resuscitating our public health care infrastructure. Closely linked to this is to close errant medical aid companies and private surgeries that continue to privatise health care by charging exorbitant amounts thereby making basic health care a luxuary. What citizens really want is quality health care services for their families at public health institutions. The privatization of social services only serve to benefit a few elites who over the years have abdicated their role of ensuring that inalienable rights such as the right to health care in enjoyed by all.

Rawlings Magede is a Communication for Development expert who writes here in his personal capacity. Feedback on vamagede@gmail.com