Well, just looking through a number of news articles over the past couple years to see what the issues were, it looks like it effectively comes down to too many cooks in the kitchen.

It's not like insulin, where the creators sold the patent to a university for everyone to be able to use anywhere in the world. The Covid vaccines has multiple companies and multiple countries all having an interest in the product. Add in that a company can patent one part of the system that could render the rest of it useless. For instance, I use Flonase Sensimist, which is now over-the-counter. However, it doesn't have any generics because Glaxxo-Smith-Kline patented the delivery system, so anyone coming out with a generic would have to come up with a new delivery system. (This also was an issue during the whole Epipen debacle and the competing company had to come up with a different delivery system from what epipen's system is). If you have a vaccine, but can't delivery it to the person because you can't get the delivery system, it's essentially worthless.

I'm not saying it's right or wrong or whatever (I, for one, would love having a generic of Sensimist to use), just that's basically the answer to your questions. Too many cooks and the ability to patent pieces of the full package.

Waving patents means western companies losing money, can't put the needs of humanity above making profits.

Or many African countries were taken advantage of for centuries by white Europeans and put into a crappy social/financial position and are still trying to recover from it decades later. How could they afford to outbid the richer countries that took advantage of them?

I remember during the pandemic richer countries that had left over Covid vaccines nearing the end then gave the vaccines to the poorer countries. So yes, they were treated like beggars.

I think it's more accurate to say every country cares about the citizens of it's own country more than the citizens of other countries.

Cyril Ramaphosa is arguing on behalf of the people of his own country, as he should.

Note that he's not making arguments in favour of vaccine distribution prioritizing parts of the world that were are the highest risk. No regard to where there were the highest death rates (which were urban areas). Simply arguing that his country should have higher priority without any regard as to which areas of the world were seeing the highest numbers of deaths.

So he's not exactly doing anything different from any other country. And sure that's fair, a country's leader should be advocating for their own citizens. But he's just another player in the same game as everyone else.