MUCH has been written about the vaccine nationalism debate surrounding the various COVID-19 vaccines. By now the outlines of the story are familiar. Wealthy countries and alliances like Canada, the US and the EU are hoarding COVID-19 vaccines and refusing to support a motion at the World Trade Organisation, brought by South Africa and India, to waive intellectual property rights that will allow poorer nations to manufacture generic versions of the vaccines. Aanu Adeoye Even the Covax Alliance, the World Health Organisation’s initiative to distribute vaccines to developing nations, is not safe from the meddling of wealthy countries: either they have been slow to support it; or in Canada’s case, have actively undermined it by signing up for 1,9 million doses, despite having already purchased enough vaccines for each of its citizens to be vaccinated six times over. But what’s missing from this discussion is the culpability of African leaders in leaving us once again dependent on the mercy of Western nations. In more than a year of reporting on the pandemic, I have been fortunate enough to speak to two of the leading figures in Africa’s fight against the virus. Both of them, in carefully diplomatic language, have made it clear that the biggest challenge in Africa’s response to the pandemic has been the preparedness — or lack thereof — of Africa’s health systems. Chikwe Ihekweazu, the director-general of the Nigeria Centre for Disease Control, told me last April: “We haven’t invested enough as a country in building enough molecular labs to help us with this [testing] across Nigeria.” Last month, John Nkengasong, director of the Africa Centres for Disease Control and Prevention, while praising the efforts of African leaders to secure additional vaccines for the continent, pointedly observed: “We need a new public health order for our security… “We have to be very deliberate in our public health workforce development. We need 6 000 epidemiologists. We only have 1 900 on a continent of 1,2 billion people. That’s like going to a gunfight with a knife. “We need 25 000 frontline responders; we only have about 5 000. That’s not acceptable.” Both of these men are public health experts with decades of experience behind them. It’s not hard to see why they are underwhelmed by Africa’s state of readiness when it comes to public health threats. In 2001, members of the African Union agreed to spend 15% of their national budgets on health. By 2018, only two countries had met this lofty goal. Nigeria’s biggest increase in five years in 2020 saw it rise only to 4%. Doctors in Nigeria are routinely underpaid and work in deplorable conditions. This is a country where it is not uncommon for surgeries to be carried out by lamp and candlelight in the absence of reliable electricity. Amid a crushing pandemic, South Africa went the other way — it cut its own health budget in the most recent budget presented to the nation.These are Africa’s two biggest economies. The situation is even starker in smaller countries. Take the tiny nation of Equatori