The challenges African countries face to get hold of the Covid-19 vaccine

A volunteer receives an injection from a medical worker during South Africa’s first human clinical trial for a potential Covid-19 vaccine June 24, 2020.
A volunteer receives an injection from a medical worker during South Africa’s first human clinical trial for a potential Covid-19 vaccine June 24, 2020.
Image: REUTERS/Siphiwe Sibeko
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This week there was much excitement around the world when Pfizer announced that an interim analysis showed its vaccine candidate is 90% effective in protecting people from Covid-19.

The Pfizer/BioNTech candidate is one of the few currently in the last phase of human trials before approval. While the news has raised hopes the current pandemic may be ending soon, there are concerns that the Pfizer vaccine may not be accessible in many parts of the world including countries in Africa.

There have been prior concerns that many low-income countries may not be able to access successful vaccines due to multiple challenges beginning with the lack of funding. In the last few months, wealthy countries have spent billions of dollars hoarding and securing future supplies of vaccine candidates for their citizens while low-income countries are being pushed to the back of the queue.

GAVI, the global vaccine alliance, has been securing vaccine candidates alongside wealthy countries to make the vaccine equally accessible to low-income countries and cover 20% of their population. However, the countries may be required to share some of the costs of the vaccines and delivery which is up to $1.60 to $2 per dose.  But the economies of most African countries have been badly hit by the pandemic and may not be able to afford the vaccine delivery.

However, Dr. Nicaise Ndembi, senior science advisor for Africa Centers for Disease Control (CDC) said $5 billion has recently been secured from the African Export-Import Bank to purchase Covid-19 vaccines with the hope to cover an additional 40% population in Africa to reach herd immunity on the continent.

Ndembi added that between 1.3 billion to 1.4 billion doses of the vaccine will be needed to reach herd immunity. “We need $12 billion to cover everything. Now we are working towards getting the remaining $7 billion to top up then we are good to go and Africans will have their mechanism to support vaccinating at least 60% of the population.”

Good job

It is now  more widely acknowledged African countries have broadly handled the pandemic well by bop executives of  global health organizations and observers including Matshidiso Moeti, WHO Africa Director and Sema Sgaier, the director of the Surgo Foundation, which produced a Covid-19 vulnerability index for each region.

So far Africa with a population of about 1.3 billion there have been just under 2 million Covid-19 cases recorded so far and much fewer deaths (about 46,626) compared to Europe (about 325,899) or the North Americas (about 252,235). Some scientists have attributed the lower death rate to Africa’s younger demographics and a lower comorbidity overall.

But there are still worries that several African countries are not testing enough people to be able to confidently assert the low case load numbers as truly reflecting the ongoing situation. This is why focus has turned to the efficacy and availability of potential Covid-19 vaccines like elsewhere in the world.

There are also concerns African countries lack the capacity to manufacture the vaccines they need and depending on importation for vaccine access is not feasible especially if there is a need for cold storage. The vaccine manufacturing industry in the continent is nascent with Covid-19 vaccine manufacturing capacity potential in Tunisia, Ethiopia Senegal, Egypt, and South Africa.

Getting measles vaccine and other supplies to people in Mongala province in the Democratic Republic of Congo Feb. 27, 2020.
Getting measles vaccine and other supplies to people in Mongala province in the Democratic Republic of Congo Feb. 27, 2020.

This month South African company Aspen Pharmacare announced an agreement with Johnson & Johnson, US pharmaceutical giant to manufacture its Covid-19 vaccine candidate. Earlier in July Egypt announced an agreement with China to manufacture a Chinese Covid-19 vaccine.

While Dr. Ndembi says the Africa CDC is working to see if vaccines can be produced in more African countries, a spokesperson for the Gates Foundation an organization that has invested billions in vaccination in low-income countries said “in countries that do not already have a track record of manufacturing quality-assured vaccines, local vaccine production can be both difficult and expensive in the near term and drive limited health impact.”

Staying cool

Poor vaccine cold chain system has been a common and major challenge of vaccination in Africa. Most vaccines must be stored at temperatures between 36°F to 46°F (2°C and 8°C) but in many parts of the continent the cold chain infrastructures are inadequate and electricity is often unavailable or reliable.

Adding to this challenge, some of the Covid-19 candidate vaccines in development such as Pfizer’s and also from Moderna (another mRNA technology vaccine expected to be as effective as Pfizer) requires storage and transport facilities that can maintain extremely cold temperature: about -112°F (-80°C)—colder than a regular deep freezer. There is the additional logistical complication that the Pfizer vaccine requires two doses taken three weeks apart to be fully effective while the Moderna vaccine requires two doses taken four weeks apart.

The Gates foundation says these challenges are surmountable saying it has given grants to organizations to help develop early-stage vaccine candidates that could overcome some of the delivery challenges, “such as those that only require one dose, have greater temperature stability, or are less expensive to manufacture.”

“Gavi has supported more than 495 vaccine introductions in the last two decades, including a successful effort to vaccinate over 300,000 people against Ebola with a new vaccine that had to be stored at a similar temperature profile as some of the expected early Covid-19 vaccines.”

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