The Human Cost of Vaccines under-investment in Africa

BY OLUWAFUNKE ISHOLA

Africa’s debt crisis is having a devastating impact on vaccination efforts, leaving millions of people vulnerable to preventable diseases.

With debt-to-GDP ratios exceeding 65 per cent across sub-Saharan Africa, governments are struggling to balance debt servicing with essential health spending, including vaccination programmes.

In Kenya, for instance, vaccine procurement has been reduced by 22 per cent since 2024, creating immunity gaps that put lives at risk.

Vaccine-preventable diseases claim thousands of lives in Africa each year, with the continent losing an estimated $13 billion annually due to these diseases.

Every $1 billion funding shortfall translates to approximately four million unvaccinated children and an estimated 200,000 preventable deaths.

As of 2024, 23 African countries were experiencing financial distress, and three had either defaulted or sought formal debt restructuring; together, African countries owe more than $1.8 trillion.

The reduction in vaccine procurement is particularly concerning, given that vaccine preventable diseases such as measles, meningitis, and diphtheria can have devastating consequences, especially for children under five.

“We must ask ourselves what truly constitutes sustainable debt,” said Togo’s President Faure Gnassingbé.

“Many African countries face competing pressures, servicing debt while addressing health, education, and security needs. Without peace, there can be no development.”

The Abuja Declaration of 2001, a pivotal commitment made by African Union (AU) member states, aimed to reverse this trend by pledging to allocate at least 15 per cent of national budgets to the health sector.

However, more than two decades later, only three countries—Rwanda, Botswana, and Cabo Verde—have consistently met or exceeded this target, according to WHO.

Recurring outbreaks of Mpox, Ebola, cholera, measles, alongside effects of climate change and humanitarian crises in Eastern DRC, the Sahel, and Sudan, are overwhelming systems stretched by chronic underfunding.

Despite the proven power of vaccines to save lives, over 500,000 children under five in Africa continue to die each year from preventable diseases, including measles, diphtheria, tetanus, polio, and whooping cough—diseases that have been nearly eradicated in much of the world.

Providing effective protection against these illnesses should be straightforward, yet across the continent, vaccination remains out of reach for millions.

Limited domestic health funding, low trust in vaccines, political instability, and the challenge of accessing remote communities all contribute to the problem.

Dr Adedeji Adeniran, Director of Research, Centre for the Study of the Economies of Africa (CSEA), noted that debt servicing reduces room for government health budgets and spending and pushes costs onto households.

Adeniran also pointed out that low government spending on health results in heavy reliance on external funding, foreign aid, and humanitarian assistance to address the country’s health needs.

“This heavy reliance on donor and external financing makes African health systems vulnerable when fiscal pressures mount.

“Debt distress and tighter global financing conditions like the elimination of the USAIDs, often complicate governments’ ability to meet counterpart or co-financing obligations for critical programmes such as immunisation, HIV, TB, and malaria.

“When treasuries are cash-strapped, these obligations are either delayed or unmet, raising the risk of service interruptions and threatening hard-won health gains,” Adeniran said.

Recommending countries to mitigate this negative impact by protecting health with programme-level spending floors; raising better domestic revenues (especially well-designed health taxes); tapping innovative instruments (debt-for-health, special drawing rights (SDRs) re-channelling via AfDB).

He further advised pooling procurement; and accelerating pre-payment social health insurance with primary healthcare at the core while tightening public financial management and efficiency inside the health sector.

Data from Africa CDC revealed that one in five children in Africa still lacks access to even a single routine vaccine, as a result, millions of children remain vulnerable to preventable diseases.