For Covid-19 Vaccines, Some Are Too Rich — and Too Poor

CAPE TOWN — A few months from now, a factory in South Africa is expected to begin churning out a million doses of Covid-19 vaccine each day in the African country hardest-hit by the pandemic.

But those vials will probably be shipped to a distribution center in Europe and then rushed to Western countries that have pre-ordered them by the hundreds of millions. None have been set aside for South Africa.

The country, which will help manufacture the vaccine and whose citizens have enrolled in clinical trials, does not expect to see the first trickle of doses until around the middle of next year. By then, the United States, Britain and Canada may already have vaccinated more than 100 million people.

The first year of the Covid-19 pandemic revealed that a country’s wealth would not spare it from the virus. Overconfidence, poor planning and ignored warnings felled some of the world’s richest nations. But now, money is translating into undeniable advantages.

Over the past few months, rich nations like the United States and Britain have cut deals with multiple drug manufacturers and secured enough doses to vaccinate their citizens multiple times over. China and Russia have conducted their own trials and begun mass vaccination programs.

Yet countries like South Africa are in a singular bind because they cannot hold out hope for charity. Although its government is nearly insolvent and half of its citizens live in poverty, South Africa is considered too rich to qualify for cut-rate vaccines from international aid organizations.

Poor and middle-income nations, largely unable to compete in the open market, rely on a complex vaccine sharing scheme called Covax. A collaboration of international health organizations, Covax was designed to avoid the inequities of a free-market free-for-all. But its deals come with strings attached, and health advocates are questioning its transparency and accountability.  ...