Africa: Is Africa Ready To Roll Out A Covid-19 Vaccine?

27 November 2020

Cape Town — Representatives from the World Health Organization (WHO), University of the Witwatersrand in South Africa and the University of Nairobi in Kenya have met in a webinar to discuss Africa's Covid-19 vaccine readiness.

Moderator Tsepiso Makwetla welcomed the panel before Dr Matshidiso Moeti, WHO Regional Director for Africa, spoke on what the status of development was on several Covid-19 vaccine candidates and where Africa stands. "With three Covid-19 candidates demonstrating high levels of efficacy, many countries are keen and determined to get the vaccine on time. We know that African countries are concerned and hoping that pre-ordering millions of doses of vaccines by wealthy countries will not disadvantage," Moeti said.

She said vaccination in combination with tried and tested public health measures would help end the pandemic. "As the Covid-19 vaccine is rolled out in phases, it will turn into the biggest vaccination drive in the history of the continent and, indeed, the history of the world," said Moeti.

Moeti explained that the work of the WHO has seen the global health body work with partners to prepare for this unprecedented initiative, adding that 40 of the 47 countries in the African region that received readiness assessment tools have shared data on their preparedness of a Covid-19 vaccine rollout.

"What we see is that, so far, the average readiness score is 33% which is well below the desired benchmark of 80%. We are doubling down on planning and preparation because this will make or break this unprecedented endeavour," Moeti said. "In our region we are assisting countries to develop their Covid-19 vaccine introduction plans by leveraging our vast network of polio, immunisation and other public health staff on the ground under the leadership of WHO representatives."

Moeti spoke on the role communities have played in stopping the spread of Covid-19 and that they would be central in the rollout of vaccines. "It is critical that authorities reach out to communities, listen to their concerns and give people a voice in implementing the delivery strategies," Moeti said. She added that it was critical to counter anti-vaccine information, pleading to colleagues and journalists to ensure that the vaccine narrative continually emphasises equity over the coming months.

Moeti said Africa has seen an uptick in the rate of Covid-19 infections across the continent, which she said was cause for concern. "The curve is once again trending upwards a little bit as we head into the holiday season when people will travel. It's vital, therefore, that we continue practicing the preventive measures and that scaled up, proactive public health capacities are in place to flatten the rise in cases," Moeti said.

Makwetla opened the floor to Professor Helen Rees, Wits Reproductive Health and HIV Institute at the University of the Witwatersrand, who was asked to discuss the pros and cons of different vaccines and what had to be considered in their distribution across Africa. "I think it;s clear that the first thing you need to have is an effective and safe vaccine, and the good news is that early results from three candidates are that they all started to show really promising results," Rees said.

Rees asked what it was about the vaccines that needed to be mainly considered after approval. "Well we need to ask- how many doses do we have to give? The thing that actually gained a lot of attention recently has been what's called the ultra cold chain with the RNA vaccines," said Rees. The ultra cold chain refers to ultra cold freezers required to store the vaccines, which have recently seen a surge in demand. Rees said the rollout of the vaccine in Africa with that kind of consideration needed to be taken into account will be difficult.

Rees then discussed the potential effectiveness of the vaccines. "We heard that the overall effectiveness of the AstraZeneca vaccine was 62% but after they looked at a lower first dose and larger boost dose taken later, it went up to 90%. The efficacy and safety from these trials is going to be very important," she said.

Rees said another consideration that needed to be made was whether these vaccines worked in particular groups. "Given that people over 60 are at higher risk, how effective is any one vaccine against another in that age group?," Ress said, saying that the efficacy of vaccines diminishes among older people. Rees pointed out that this would be a greater concern for nations that have older populations and less so for the African region where most nations have a younger demographic.

Rees then brought up the issue of cost. "The newer mRNA vaccines are much more expensive when we compare it to, say, the AstraZeneca vaccine which is a more established type of vaccine platform," said Rees. She added that for countries doing bilateral negotiations, cost would be a major factor, even for those using the COVAX facility. According to Gavi, COVAX is one of three pillars of the Access to Covid-19 Tools (ACT) Accelerator, which was launched in April by the WHO, the European Commission and France in response to this pandemic. Bringing together governments, global health organisations, manufacturers, scientists, private sector, civil society and philanthropy, with the aim of providing innovative and equitable access to Covid-19 diagnostics, treatments and vaccines.

Rees briefly mentioned vaccine hesitancy, something, she said, was gaining a lot of attention due to the spread of misinformation. "For the African region we had a problem right at the beginning of the pandemic where, unfortunately, two French doctors had a conversation that went viral where they appeared to be saying it was a good idea to come to Africa to do clinical trial research. That was perceived as, perhaps, the African region being looked at as guinea pigs," Rees said, adding that it created a negative dialogue.

Professor Pontiano Kaleebu, Director Uganda Virus Research Institute, was then given the opportunity to address the panel and speak on Covid-19 vaccine trials in Africa. "Approximately 35 vaccine candidates have entered the human trial phase and I'm happy to say Africa is making a contribution, especially South Africa," Kaleebu said.

Kenya, Kaleebu said, recently joined the Oxford vaccine trial while in Uganda a phase 1 trial is being readied though it has been delayed. "We've had some preparatory studies and gone out to communities to understand what knowledge they have of vaccines and we're excited to see that there'a a lot of interest in vaccine trials," he said.

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