As a highly infectious new strain of COVID-19 spreads through southern Africa, health workers in Mozambique, Eswatini and Malawi are struggling to treat escalating numbers of patients with little prospect of being vaccinated to protect them from the virus. Médecins Sans Frontières (MSF) urges for COVID-19 vaccines to be distributed equitably, prioritising and protecting frontline health workers and people at highest risk of severe illness and death from COVID-19 in all countries, including in Africa.

“We are appalled by the inequitable distribution of COVID-19 vaccines across the world,” says Christine Jamet, MSF director of operations. “While many wealthy countries started vaccinating their health workers and other groups nearly two months ago, countries such as Eswatini Malawi and Mozambique, which are struggling to respond to this pandemic, have not received a single dose of vaccine to protect the most at-risk people, including frontline health staff.”

In Eswatini, a country of 1.1 million people, 200 new cases are being reported each day and deaths are around four times higher than in the first wave of the pandemic, with health workers saying that patients are becoming more severely sick this time around. With health facilities overwhelmed, MSF teams have set up tented wards at Nhlangano health centre and brought in extra doctors and nurses to care for critically ill COVID-19 patients.

In Mozambique, case numbers are currently almost seven times higher than at the peak of the first wave.

“Health workers are getting sick and those still at work are exhausted,” says Natalia Tamayo Antabak, MSF head of mission, whose teams are helping implement infection and prevention control measures at government COVID-19 treatment centres in Maputo to minimise infections in health staff working there.

In Malawi, the number of new cases increased exponentially in January, doubling every four to five days. Queen Elizabeth Central Hospital, the main facility offering COVID-19 care in Blantyre, is close to full capacity for patients needing oxygen support. MSF has sent in extra staff and is ready to open an additional 40-bed ward for COVID-19 patients.

“The priority right now is protecting frontline health workers,” says Marion Pechayre, MSF head of mission. “If Malawi had 40,000 doses of vaccine, we could at least start by vaccinating health staff in the country’s main hotspots. Without this, the situation will soon be untenable.”

So far, 1,298 frontline health workers in Malawi have tested positive for COVID-19 and nine have died.

“People in the poorest countries seem to be at the back of the queue to access this crucial vaccine,” says Jamet. “There is an urgent need for vaccination in countries in southern Africa that are struggling to respond to the aggressive spread of the new virus strain, which is overwhelming their health systems.”

While Mozambique, Eswatini and Malawi go without vaccines, wealthier nations are hoarding vaccines with the intention to vaccinate beyond the priority groups.

“It would be indefensible if some countries started to vaccinate their lower-risk citizens while many countries in Africa are still waiting to vaccinate their very first frontline health workers,” says Jamet. “This totally goes against the World Health Organization’s equitable allocation framework. Not only will it prolong the pandemic, but it will put even more lives at risk.”

“We urge governments who have secured more doses than they need for vaccinating their high-risk groups to urgently share their doses, so that other countries can start vaccinating,” continues Jamet. “This is a global pandemic that requires a global spirit of solidarity if we truly hope to bring it under control.”

“MSF calls on vaccine manufacturers to ensure that priority is given to those countries that are in urgent need of protecting their healthcare staff,” says Isabelle Defourny, MSF Director of Operations. “MSF stands ready to provide logistical support to high priority countries that were denied access to the Pfizer/BioNTech vaccine through COVAX because of their limited cold chain management capacity.”