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LESSON LEARNED

Africa can avoid repeating its Covid-19 mistakes with a new malaria vaccine

Biomedical engineers pack a consignment of AstraZeneca/Oxford vaccines from COVAX in Nairobi in March.
Reuters/Monicah Mwangi
Biomedical engineers pack a consignment of AstraZeneca/Oxford vaccines from COVAX in Nairobi in March.
Published

A global group of researchers recently released a preliminary study reporting that their malaria vaccine showed up to 77% efficacy in a one-year preliminary clinical trial involving 450 children in Burkina Faso.

The vaccine has been heralded as a breakthrough, particularly given its safety profile, the fact that it is cheap to produce, and that it can be stored in a fridge. If a peer review confirms the results, it would have exceeded the 75% effectiveness target for vaccines set by the World Health Organization (WHO).

This is a huge step in the fight to eradicate malaria, a disease that is particularly prevalent and deadly in Africa. An estimated 409,000 people died from malaria in 2019, according to WHO, with sub-Saharan Africa accounting for 94% of cases and deaths. By comparison, an estimated 122,600 have died of Covid-19 in Africa since the beginning of the pandemic. Even accounting for the fact that the complete impact of Covid-19 might be underestimated, the historic and persistent threat of malaria makes it a disease requiring urgent attention.

 

The preliminary report has raised hopes that doctors might have a highly effective and safe malaria vaccine in their hands in the near future. But African governments must make early plans to access doses of the potential malaria vaccine and avoid repeating the mistakes they made with Covid-19 vaccines.

The challenge of accessing the Covid-19 vaccine has shown that African governments need to be proactive and directly involved in vaccine procurement. The dangers of not doing so are mostly recently illustrated by the continent’s dependence on the Covax vaccine-sharing initiative, which was distributing vaccines to countries supplied by the Serum Institute of India until the country decided to tamp down on exports. Efforts to negotiate deals and secure a diverse portfolio of Covid-19 vaccines with different manufacturers have come too late, negatively impacting access to the vaccines in the continent.

For decades, African governments have depended for vaccines on organizations such as WHO, UNICEF, and Gavi, an international organization created to improve access to vaccines for people living in the world’s poorest countries. As these organizations helped African people access billions of vaccines over the years, many governments stepped back to play a passive role. This approach has not been effective, as it effectively pushes Africans to the back of the vaccine queue in a crisis, as developed countries jostle to meet their needs. This was observed during the 2009 H1N1 pandemic and is currently being observed with the Covid-19 pandemic.

“Currently, approximately 40 of the 54 African countries rely on Gavi/Unicef for their vaccines completely or in part,” said Patrick Tippoo, the head of Science and Innovation at South African vaccine company Biovac. Tippoo is also executive director of the African Vaccine Manufacturing Initiative (AVMI), a consortium of organizations and individuals advocating for the establishment of vaccine development and manufacturing in Africa. “These African countries have very little influence over where these vaccines are sourced from, and [this arrangement] is not an enabler of building sustainable vaccine manufacturing capacity on the continent.”

Tippoo explained that to avoid the failures experienced with Covid-19 vaccines access, a new approach needs to be co-created: “African countries can either advance purchase vaccine doses from potential manufacturers and/or establish and support local vaccine manufacturing capacity to produce the malaria vaccine, should its efficacy be confirmed in larger clinical trials.”

While indicating that securing large potential vaccine doses early during trials carries financial risk (there is the possibility that a large clinical trial down the line may show a poor result), Tippoo maintained that an early pre-order could at least guarantee access. The longer African countries wait to pre-order, the greater the risk of being relegated to the back of the supply line.

Analysis of the time Covid-19 vaccine deals were made with the numbers of doses that have been administered in countries across the world shows that the how and when the deals were made between countries and vaccine developers largely affected a countries’ access to doses. For example, the US and the UK made their first Covid-19 procurement deals with pharmaceutical companies as early as May 2020, when the vaccines were still in the clinical trial. The African Union made its first vaccine deal eight months later.

The countries that made early deals got the front of the vaccine line and account for the majority of the doses that have been administered worldwide. Morocco, which made the first vaccine deal in Africa in September 2020, was able to secure a total of 53.5 million doses of Astrazeneca and Sinopharm by November the same year. As a result, it has administered the highest number of Covid-19 vaccine doses in the continents—over 9.3 million doses.

However, experts emphasized that urgent investment in local vaccine development and manufacturing capacity remains a more sustainable solution to the vaccine access problem in Africa.

“We need to have our own vaccine development and manufacturing systems,” said professor Gideon Awandare, the director of the West African Center for Cell Biology of Infectious Pathogens. “Sitting down and waiting for others to produce vaccines and give us what is left after they have taken care of their people is not a sustainable strategy.”

Awandare warned that investing in the rapid mass production of a malaria vaccine, like we saw with Covid-19 vaccines will not be a priority for Western countries, as malaria is not endemic in these countries. It is going to be on Africans and people in other parts of the world where malaria has caused the most pain and suffering to carry the burden.

“This is the time for African governments to start building capacity to make vaccines locally so that when the malaria vaccine is made if we have the systems in place and the intellectual property on it is waived we can start making it locally. Waiting for others to produce it for us to order is not a good strategy,” he said.

Tippoo advised that the Africa Union should work with African governments to make good on the vision for African vaccine manufacturing. “To ensure Africa has timely access to vaccines to protect public health security, by establishing a sustainable vaccine development and manufacturing ecosystem in Africa.”

During this pandemic, organizations such as the African Union and African CDC, with funding facilitated by the Afeximbank, collaborated in unprecedented ways on a scheme that successfully made advance procurement deals with vaccine developers for Covid-19 vaccines. A similar approach can be improved upon with support from the global community to pool resources for the building of local vaccine research and manufacturing capacity or to make early advance procurement deals with vaccine developers.

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