In their Brookings essay, “Did Africa turn a corner in 2020 or did it just dodge a bullet?” Indermit Gill and his co-author Kenan Karakullah take issues with three assertions made by Vera Songwe of UNECA and Brookings AGI during the launch of AGI’s Foresight Africa 2021 at which she was a panellist.
Tanzania: Magufuli not keen on Covid shots, but without vaccines many would be dying of smallpox
Tanzania’s President John Magufuli does not, it seems, trust vaccinations.
Magufuli has told the health ministry not to rush to adopt Covid-19 vaccines, saying they may not be safe or effective. He says the country is free of Covid-19, and his government does not track infections or deaths.
There is no scientific reason why Tanzania would be able to avoid what all of its neighbours are going through, and Magufuli has been a Covid-19 sceptic since the early days out the outbreak.
“If the white man was able to come up with vaccinations, then vaccinations for AIDS would have been brought, tuberculosis would be a thing of the past, vaccines for malaria and cancer would have been found,” Magufuli said in a speech on 26 January.
The existence of an illness does not in itself create a vaccine, or mean that it is easy to make one. We are fortunate in that Covid-19 does not seem to present any particular difficulties in vaccine development: the global emergency means that vaccines have been developed in record time.
The example of smallpox
Less fortunate were millions of Africans who until the late 1960s were infected with smallpox without access to a vaccine.
Tanzania in the 1950s and early 1960s had about 1,000 cases of smallpox each year, climbing to 3,000 in 1966. The country suffered from a particularly severe strain of smallpox which had fatality rates of between 5% and 7%.
Then as now, political will was essential to fight the disease. The World Health Organisation (WHO) purposely refrained from proposing mass smallpox vaccine campaigns in East Africa.
Tanzania requested the programme itself and, according to the WHO, was the only East African country to view smallpox as a serious problem. In 1965 and 1966, six million vaccinations were carried out in Tanzania.
The plan in action
In 1968, Tanzania’s government and the WHO undertook to eliminate smallpox from the country within three years.
- The plan was for the attack phase of systematic mass vaccination, where areas with more than five cases per 100,000 people were to be prioritised.
- This was followed by the consolidation phase for areas with less than five cases per 100,000 people.
- The maintenance phase was rolled out once the disease had been eliminated. The efficacy of the system rested on prompt and accurate reporting of all cases.
The WHO provided Tanzania and other African governments with vaccines, advisers and logistical support. In Tanzania, Rwanda and Kenya, it was possible to administer the smallpox vaccine in conjunction with anti-tuberculosis vaccines.
Slower smallpox transmission
Of course, not all the vaccinations that were given worked. Some doses were not strong enough and refrigeration was a problem, as it is today. The campaign kept going despite the obstacles. The result was that transmission of the disease had largely ended in East Africa by 1970.
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The same approach was being carried out across Africa. In September 1968, surveillance of smallpox transmission was started in all areas of West Africa with known or suspected cases of smallpox. By May 1970, all 20 West African countries targeted were free of smallpox.
The world’s last known case of smallpox was reported in Somalia in November 1977. In 1979, the world officially became free of smallpox, estimated to have killed 300 million people in the twentieth century alone.
Medical authorities fighting smallpox had an advantage compared with today in that the disease spread with relative slowness. It was possible to identify the areas that were most at risk of infection and get there to give vaccinations even if it took days to get there.
Covid-19 is much more contagious, and we live in a world which is much more interconnected and urbanised than in the 1960s. The urgency for vaccination, therefore, is much greater.
Playing politics with Covid-19 will cost lives.