Universal access to Covid-19 vaccines must remain a critical goal if we are to win the battle against the disease. However, despite laudable calls for an equitable global rollout, vaccine nationalism appears to have the upper hand for the moment. While it is hoped that an eventual “course correction” will cause a return to a co-ordinated global effort aimed at a fairer rollout, from a global health perspective it is important to assess where individual countries stand in terms of their Covid-19 vaccination plans, especially those in Africa.

Research led by a Columbia University/Brenthurst Foundation team as part of the Futures Forum on Preparedness (organised by Schmidt Futures) and released last week includes an analysis of five large countries on the continent, namely Egypt, Ethiopia, Kenya, Nigeria and SA. Together, these countries represent about 40% of the continent’s population and more than half of its GDP.

A combination of early efforts to secure vaccine doses and pre-existing manufacturing capacity (in the form of Vacsera, one of only a few vaccine manufacturers on the continent) has placed Egypt in a favourable position. Agreement was reached in 2020 regarding future access to Russia’s Sputnik V vaccine, and more recent negotiations may result in the acquisition of doses of both the Pfizer/BioNTech and Oxford/AstraZeneca vaccines.

In September 2020, agreement was reached between Vacsera and Sinopharm to conduct vaccine trials in Egypt. Egypt reportedly received its first batch of 50,000 doses of the Sinopharm vaccine in December, and is in line for an additional 40-million doses. After approval by the Egyptian Drug Authority, the Sinopharm vaccine will start to be rolled out as part of a phased plan later in January, according to Egyptian health & population minister Hala Zayed.

Ethiopia appears to be in more difficult position. Political instability, including the Tigray conflict, has placed the country under substantial strain, which will undoubtedly weaken its health system.

A combination of early efforts to secure vaccine doses and pre-existing manufacturing capacity has placed Egypt in a favourable position

Ethiopia’s participation in the Covax equitable access initiative is crucial; it was found in an analysis undertaken by the Duke Global Health Innovation Centre that the country may have to rely on Covax for vaccine coverage of 20% of its population.

Ethiopia does appear to have a degree of readiness with regarding distribution. It was recently able to complete a measles campaign that reached 15-million children despite the Covid-19 pandemic, and proactive steps have been taken by a range of stakeholders in the country, including private sector networks, regarding future Covid-19 vaccination logistics.

Kenya’s participation in vaccine trials may, like Egypt, prove to be an important factor. It actively participated in trials related to the Oxford/AstraZeneca candidate vaccine, with support provided in-country via the KEMRI/Wellcome Trust Research Programme.

The Kenyan government recently announced it had ordered 24-million doses of the Oxford/AstraZeneca vaccine, which could arrive in February. If this transpires and distribution takes place without too many hitches, it would cover a considerable proportion the country’s population of about 54-million. Additional doses of vaccines could also be acquired through the country’s participation in Covax.

The government has indicated that it is developing  vaccination guidelines, including a prioritisation strategy, but these are not yet publicly available.

In Nigeria, the federal government responded proactively to the pandemic through the establishment of the presidential task force on Covid-19.

Considerable capacity is also available in terms of existing government agencies — the National Agency for Food & Drug Administration & Control is prepared to fast-track regulatory assessment processes related to Covid-19 vaccines; the National Primary Health Care Development has successfully conducted large-scale programmes for other vaccine-preventable diseases in the past; and the Nigeria Centre for Disease Control, under the exceptional leadership of Dr Chikwe Ihekweazu, has substantial institutional memory that can be leveraged for Covid-19 vaccine rollout planning.

There are two vaccine manufacturers in the country, Biovaccines Nigeria and Innovative Biotech Nigeria, both of which could boost vaccine production.

Challenging path

Despite these advantages, Nigeria has had problems regarding vaccine access. It appears largely reliant on Covax for what, in the first instance, could only be enough doses for 20-million people, enough to cover just fewer than 10% of its population. Early discussions under way between the Nigerian government and vaccine producers in Russia, China and the UK may result in access to much-needed additional doses.

SA’s efforts in terms of vaccine acquisition and rollout planning have followed a challenging path. The establishment of the ministerial advisory committee on coronavirus vaccines in September was a good first step, creating the potential for co-ordinated planning guided by experts.

SA also has pre-existing vaccine manufacturing capability in the form of the Biovac Institute, a public-private partnership, and possible future manufacturing capacity through an agreement entered into between Johnson & Johnson and SA-based Aspen that could translate into greater access for the country.

Despite these encouraging developments, there have been significant setbacks. This includes apparent early difficulties providing a down payment to Covax to secure future doses for 6-million people, about 10% of the population (the payment was eventually made) as well as sharp criticisms over the initial lack of a clear Covid-19 vaccination plan.

Inequality of access

Recent positive steps have bolstered the country’s efforts, including the release of a Covid-19 vaccine rollout strategy on January 3 and an announcement that the country would obtain 1.5-million doses of the Oxford/AstraZeneca vaccine, due to arrive before the end of January. Furthermore, during an address on January 11, President Cyril Ramaphosa announced that SA had secured 20-million vaccine doses for distribution mainly in the first half of 2021.

The ability of these five countries to acquire Covid-19 vaccines, and their respective readiness in terms of vaccine rollouts, is varied. The common obstacle faced by all relates to the underlying inequity of access to vaccines. A renewed commitment to a fairer global rollout by, for example, rallying around the People’s Vaccine initiative and advocacy of Covid-19 vaccines as a global public good, is perhaps what is most urgently needed, not just for these countries but the continent and global community as a whole.

There is also the further challenge of vaccine resistance to overcome. The Wellcome Trust Monitor established in 2019, before Covid-19 descended on the world, reports that as much as three-quarters of Africans believe vaccines are safe and effective, a much better figure than in the US, for example.

Covid-19 is certain to have affected attitudes, both positively and negatively, if one carefully examines the social media traffic. Hard work therefore lies ahead in persuading citizens, more in some countries than others, that taking vaccines will accelerate our journey to achieving herd immunity and a return to normal life for all.

• Dr Volmink is a Johannesburg-based public health medicine specialist and Dr James a senior research scholar at Columbia University in New York.


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