Nearly two years into the Covid-19 pandemic, the world is still suffering from the absence of political will to fight inequality. The failure to distribute vaccines equally across the world, alongside the lack of vaccine production and distribution capacity in African countries, is the subject of growing concern in the wake of the emergence of the Omicron variant in recent weeks.

The number of cases reported among all African countries comes, at time of writing, to a total of 8.5 million, and throughout the course of the pandemic there are believed to have been more than 218,000 deaths. South Africa, with 2.9 million cases and around 90,000 deaths, is the worst affected country on the continent; Morocco has recorded more than 945,000 cases, and Tunisia is not far behind with more than 710,000. However, the true extent of the pandemic in many African countries is unknown, as testing infrastructure is limited, leaving testing rates low. Data collection has also not been standardised.

In October 2021, around fifty million Covid vaccines were shipped to Africa, almost double the figure in September 2021. COVAX, the global platform to ensure equitable access to vaccines, has delivered almost 90 percent of this month’s vaccines, accelerating its shipments since July. Despite commitments made by G7 countries, though, Africa still faced a 275 million dose shortfall against its year-end target of fully vaccinating 40 percent of the population. There is no sign that this shortage will be overcome before mid-2022.

Only 77 million people on the African continent are vaccinated at time of writing: just six percent of the population. In comparison, over 70 percent of high-income countries have already fully vaccinated more than 40 percent of their citizens. First-dose vaccination rates in Africa also lag far behind other countries who are already boasting of successful booster jab programmes. More than 44 percent of Israel’s population have received a booster vaccination, for example—more than five times the proportion of Africa’s population to have received their first dose.

Africa is the world’s least vaccinated continent, but there also remain large disparities intra-continentally, too, which further exasperate the extent of the global vaccine apartheid. More than 80 percent of the population of the Seychelles have received at least one dose, compared with just 0.1 percent of the population of the Democratic Republic of the Congo. Only five African countries—the Seychelles, Mauritius, Morocco, Cape Verde, and Tunisia, less than 10 percent of Africa’s fifty-four nations—were projected to hit the 2021 year-end target of fully vaccinating 40 percent of their people. This target was set back in May 2021 by the World Health Assembly, the world’s highest health policy-setting body.

It seems the answer would be to provide more vaccines, but it’s not that simple —and even that is proving a challenge. Much of the blame for low vaccination rates has been shifted onto individuals, whose cultural and religious beliefs are being weaponised as a source of vaccine hesitancy: this, according to some, is the main reason Africans aren’t being vaccinated.

But more of the issues with vaccinating the continent stem from persisting logistical difficulties with delivery and problems with healthcare infrastructure. The region has limited access to crucial items like syringes, which slows the vaccine rollout: UNICEF has reported an imminent shortfall of up to 2.2 billion auto-disable syringes for Covid vaccinations and routine immunisations in 2022. So what good would a theoretical outpouring of vaccine doses into the continent be when the scarcity of other basic healthcare necessities could paralyse any progress?

Africa’s shortage of vaccine manufacturing capacity also contrasts it with developing countries like India, which has extensive pharmaceutical production capability, and Brazil. In Africa, only Tunisia, Senegal, Egypt, Ethiopia, and South Africa have capabilities to produce and fill or finish vaccines, and those capabilities vary widely. Mounting pressures on drug companies to extend vaccine coverage to Africa has led BioNTech to announce investment in vaccine manufacturing facilities in Rwanda and Senegal, which could be a game-changer—but this has only come years into the pandemic, after many thousands of deaths.

It has been said that the facility will be managed and operated by BioNTech staff, but the ownership and expertise will be transferred over time to local operations. Based on the example of Biovac in South Africa, that structure could more than ten years to develop.

In that time, Covid-19 vaccines could have more easily been supplied directly from BioNTech’s facilities in Germany and elsewhere in the world—raising questions about whether the rationale for this deal is based on maintaining a high pricing structure for African countries. The priority for drug companies, after all, is to protect their high-value markets in order to keep drug prices high and their margins fat.

Any product can be distributed under ‘access pricing’, a mechanism whereby countries in the Global South can purchase equivalent products at significantly reduced prices, but problems arise when the product becomes available in lucrative markets because of parallel importation. Parallel imports can be avoided by using geographically separate manufacturing sites, operating under different regulatory frameworks.

For example, products like the Covid-19 vaccine, manufactured in Rwanda, and approved by a Rwandan regulatory authority, would not be accepted in the Global North. This model has been created deliberately by pharmaceutical companies, who saw an opportunity to kill two birds with one stone: they can protect their PR by meeting the criticisms of the global community in terms of accessibility, while also protecting their profit margins in the most lucrative segments.

The failures of the vaccine rollout in Africa is not an accident—it’s the system working as it was designed. The vaccine apartheid we currently face is symptomatic of how global healthcare markets have often rendered African citizens expendable. In more recent news, for example, Israeli company Oravax’s oral Covid vaccine is being greenlit for clinical trial in South Africa. As ever, the continent is great for experiments, but not for protection.

As the Omicron variant catapults the pandemic back into the Global North’s imagination, we must remember the structural conditions that contributed to its emergence. The old adage still stands: no one is safe until everyone is safe.