The emergence and rapid domination of the Omicron variant is the sharp reminder that Covid-19 remains a global threat, and that vaccinating the whole world is the only way forward. Yet the Global North continues to accept reality of vaccine apartheid, while the rest of the world, particularly Africa, pays the price.

Vaccines have been and remain in short supply in Africa after countries in the Global North hoarded all initial orders from pharmaceutical companies and refused to waiver vaccine patents. As a result, African countries have struggled to secure enough vaccines to roll out mass immunisation campaigns. Many are reliant on donations from global vaccine scheme COVAX, co-led by the WHO and partners, including the Gavi vaccine alliance.

Despite deliveries of vaccines to Africa increasing in recent months, there have been claims that weak healthcare systems and limited infrastructure are holding back rollouts once they arrive. Another, related issue has emerged, too: vaccine wastage.

Vaccine wastage is defined as any vialled vaccine that goes unused, and to some extent, it’s expected. Given the scale of the Covid-19 vaccination programmes, including booster campaigns, some vaccine wastage has been unavoidable for a variety of reasons, including the characteristics of the vaccine, logistical issues with cold chain supply, storage failure, vial size, and specific clinical contexts. But the volume is heavily dependent on vaccination rollout programmes, equipment, and immunisation workers’ practice.

The World Health Organisation (WHO) differentiates between two types of vaccine waste: closed vial wastage, and open vial wastage. Closed vial wastage occurs when there is physical damage to vials, when the vaccines expire before they are opened, or when vials are not kept at the necessary temperature during storage or transportation, rendering them unusable. Open vial wastage generally occurs because of spillage, physical damage, expiry, or because unused doses from multi-dose vials are thrown away.

The main vaccines approved and used in the UK, including Pfizer/BioNTech, AstraZeneca/Oxford, and Moderna, come manufactured in multi-dose vials. They’re more cost-efficient and require fewer resources (i.e. the amount of glass vials). Once a multi-dose vial has been opened, it has a shelf life of about six hours. Wastage rates tend to increase as the number of doses per vial increases.

The extra vaccine in each vial is called overfill. While excess vaccine is perfectly safe to use, excess doses from multiple vials cannot be pooled into one vial and then used. Similarly, leftover AstraZeneca vaccine cannot be combined with leftover Pfizer vaccine, and vice versa.

In the early stages of the mass vaccination at the start of the year, there was a lack of ‘official’ guidance, and so after administering doses to the government’s priority groups, vaccine wastage was unavoidable—there was far more supply than there was demand. Once they had all been vaccinated, health professionals working at vaccination sites used their discretion and turned to other key workers including firefighters, taxi drivers, teachers, supermarket staff, and family and friends, often in exchange for their silence. However, even when this was done to avoid wasting vaccine doses, they faced criticism from politicians and senior NHS management—as if throwing away perfectly usable vaccine doses when millions of people were still at risk of catching Covid and passing it on was more ethical.

In January 2021, vaccines minister Nadhim Zahawi said NHS England had forecast vaccine wastage to be around ten percent, but that the actual wastage rate was ‘well below that’. However, it was reported in November 2021 that the UK threw away more than 600,000 doses of the AstraZeneca vaccine after the life-saving jabs were allowed to pass their expiry date. These doses were discarded after the decision was made in May to stop offering the AstraZeneca vaccine to younger age groups because of concerns over rare blood clotting.

Unsurprisingly, the government failed to donate the doses to eligible recipients in poorer countries struggling to access Covid vaccines—despite previous promises to redistribute supplies that were deemed surplus to requirements. It’s estimated that this amount is set to increase even further to around 800 million wasted doses by mid-2022.

In the United States, pharmacies and state governments have thrown away at least 15.1 million doses of Covid-19 vaccines since 1 March, according to government data obtained by NBC News—a far larger number than previously known and still probably an undercount. But the UK, the US, and other Global North countries where vaccine coverage is high are not the only countries experiencing these issues.

In July this year, the World Health Organisation reported that 450,000 donated doses across eight African countries had expired before they could be administered. This is a familiar story across the continent; over the course of this year Malawi has had to burn 20,000 doses, South Sudan discarded close to 60,000 doses, and the Democratic Republic of Congo had to return 1.3 million jabs to COVAX, all as a result of ill-thought-out donations.

Currently, the vaccines being donated to Africa fail to consider Africans themselves. The decisions taken by African leaders and health professionals to discard vaccines have not been made in silos, but due to the growing cases of donations with carelessly short shelf lives, as well as last-minute donations that have left countries with little time to prepare for their vaccine campaigns. What use are the vaccines for Africans if they are simply dumped on them for use, without accounting for the time needed to transport, clear, distribute, and deliver to the public?

Africa is not a dumping ground, and countries on the continent shouldn’t have to wait until our doses are about to expire to vaccinate their populations. Some African countries are capable of safely manufacturing their own vaccines, if only the Global North would waive intellectual property rights so doses can be produced patent-free for the communities that need them most.

There’s been a recent rise in media coverage of Covid vaccination wastage in African countries. This coverage often suggests that supply isn’t the main issue in vaccinating African citizens, instead constructing the idea that wastage is happening because people don’t really want the vaccine. What this coverage fails to do is make the case against wealthy Global North countries donating near-expired vaccines—and accepting the resulting and avoidable loss of life—and for the improvement of delivery logistics instead.

Of course, there are also internal factors that slow the vaccination of all Africans—for example, class divides. In Kenya, relative elites in the capital quickly got themselves vaccinated but stopped pushing for everyone else. But that doesn’t shift the responsibility rich countries shoulder to enable vaccine justice. Their short-sighted vaccine nationalism and the free pass handed to big pharmaceutical giants to profit as much as they like from these publicly funded vaccines is prolonging the pandemic, and costing lives.

With one billion doses of Covid vaccines expected to arrive in Africa in the coming months, concern has shifted to the shortage of equipment required to deliver them, like syringes, as well as insufficient planning in some countries that could create bottlenecks in the rollout. Reducing vaccine waste should be a key aim of all programmes, to ensure this precious liquid ends up in the arms of as many individuals as possible—and not in the bin.