A Covid-19 vaccine has not yet been licensed. However, all indications from experts indicate that the licensing of one of the top three candidates for Covid-19 vaccine is imminent. It is expected that by the end of 2020, or extremely early in 2021, an approved licensed vaccine will be available for mass production and mass vaccination.
The delivery of the first vaccine marketed to the public will face many challenges that policymakers and industry and international organizations must plan to reduce the risks and use the vaccine optimally and effectively. My briefing on global health discussed the issue of public trust and confidence in a newly licensed Covid-19 vaccine.
This article addresses the potential barriers that African countries may face in their future efforts to deliver vaccines to the mainland. A public discussion on what plans and contingencies, governments, public health experts, policymakers and partners are in place to deliver vaccine across the region is needed. Policymakers need to wander on the side of caution by preparing too much and planning too much to minimize possible disruption.
Plan for the same supply challenges seen early in the pandemic
The challenges that African countries are likely to face when delivering Covid-19 vaccine are likely to reflect those that countries have experienced worldwide since the onset of the pandemic. In particular, many low- and middle-income countries (LMICs), including those in Africa, have faced major challenges in their ability to buy PPE and IPC products at all. Other countries could not get the supplies they bought because the world did not produce enough products compared to what was needed. The global demand for products for the prevention and infection of infections, such as test kits, masks, medicines and ventilators, has far exceeded the available supply.
Some countries have blocked their borders to prevent essential products needed for the national effort to leave their borders. The Swiss Global Trade Alert project has estimated that more than 90 countries place restrictions on the export of protective equipment and medical products. There was diplomatic tension when some countries did not allow products destined for other countries to be transported through their countries territory. Once the Covid-19 vaccine is available, countries should plan for similar barriers in their efforts to distribute Covid-19 vaccine. The best way to use the vaccine is to ensure that the places that are worst affected are prioritized. It will best serve global public health. However, the most likely scenario is that rich countries will first get the vaccine regardless of the international health requirements. Production will not be enough, so taking vaccine to people outside of affluent countries will take time.
The global challenge of producing and distributing enough vaccine
In a more optimistic way, having enough vaccine to protect all Covid-19 susceptible populations around the world will help to know how much vaccine is needed and to best deploy the available production infrastructure to this target. . The absolute amount of vaccine needed to stop the pandemic depends on whether individuals should be vaccinated with one, two or three shots of the vaccine. If each person needs more than one injection to obtain adequate immune protection, more vaccine must be produced. The amount of time it takes to get the vaccine to the largest number of people, including the most vulnerable outside rich countries, will be even greater. The leading vaccine candidate, the Oxford-AstraZeneca vaccine, is currently being given in two doses, according to Professor Sarah Gilbert, the lead scientist on the subject. vaccine.
Africa will face greater challenges in the supply chain
The production and distribution of enough vaccine to meet global demand is a challenge facing the global community. Global production capacity will not be enough to meet this unprecedented demand. Existing scientific data from testing for Covid-19 antibodies in individuals exposed to the virus suggests that an estimated 90% of people (7.2 billion people worldwide) are susceptible to Covid-19. According to data models, protective immunity within communities should require that approximately 70% of people be exposed to the virus through vaccination or natural infection. That equates to about 5.6 billion people worldwide and 910 million in Africa who need to be vaccinated or, of course, exposed to SARS-Cov-2. Unless enough people within any population have immune protection to interrupt the chain of transmission, viral transmission will not stop. The harsh reality is that some people will have to do without enough vaccines.
The concern about whether Africa and other LMICs can get vaccines at all is very real. Africa is currently pursuing a dual strategy to Covax facility, the global vaccine allocation plan that accelerates the development and manufacture of Covid-19 vaccines to ensure fair and equitable access for every country in the world. At the same time, it also seeks bilateral negotiations with China, Canada and others to secure additional vaccine supplies. Africa CDC has indicated plans to immunize 60% of the population, an effort that would require up to $ 35 billion to secure 3 billion doses. Covax aims to buy two billion doses of approved vaccine by 2021, of which 20% (230 million doses) will be reserved for Africa’s frontline workers and vulnerable groups. This is a small amount compared to what Africa needs. However, the Act-Accelerator, a global collaboration to accelerate the development, production and access to tests, treatments and vaccines, lacks no funds. The company currently needs $ 35 billion to meet its promise of 2 billion vaccine doses, 245 million treatments and 500 million tests. Of the $ 15 billion it needs immediately, $ 3 billion is available. Although funding the Act-Accelerator would completely shorten the pandemic and enable faster economic recovery, it faces steep challenges in raising these funds amid the pandemic as all countries look inward.
In the past, manufacturers and affluent countries have made promises to donate vaccines for pandemic vaccine such as the 2009 H1N1 pandemic. However, these promises were not linked to any specific delivery timelines. They would probably be met too late to be of great benefit to recipient countries. In fact, the US promised at the time to donate 10% of its H1N1 vaccine purchases to the WHO, but US Secretary of Health and Human Services Kathleen Sebelius subsequently withdrew it. The US will only donate the promised amount after all Americans at risk have been vaccinated. The US faced a production problem that caused shortages and any donations were postponed until national needs were met. Canada resisted joining other affluent countries and promised to donate vaccines because it was so experience shortages at that point. Fearing that other governments are likely to prevent the export of vaccine to Canada due to their own national vaccine shortages, Canada has decided to award the vaccine contract to a local company. The Australian Government has also instructed its local producers that they have previously had an obligation to meet local needs any vaccine can be exported to the US.
As the 2009 H1N1 pandemic progressed, affluent countries finally decided to donate vaccine. However, it was only after they realized that they had bought the vaccine too much, because they expected that they would need two doses to vaccinate adults. It turns out that adults can be adequately protected with a single shot. So they suddenly saddled up with excess vaccine stock from which they had to deliver themselves. Furthermore, scientific data at the time also showed that the 2009 H1N1 pandemic virus appears to be lighter than previously thought and a less global public health threat. The concerns of donors during the 2009 H1N1 pandemic are very similar to the Covid-19 pandemic. The lesson of history here is that donations in African countries are not a reliable source of vaccine, and that more viable avenues for vaccine are needed, including mainland production.
Political rhetoric with priority over Covid-19 vaccine
According to the WHO and good public health principles, vaccines and other medicines should be available in countries where they are most needed. Access priority must always be given to the populations most affected. This is the best way to prevent worldwide spread. At the national level, this means prioritizing the leading health professionals in healthcare settings, the elderly over 50, people with pre-existing conditions that increase their vulnerability to Covid-19, such as those with diabetes, high blood pressure and other health conditions. Globally, this means providing vaccines to those most in need of public health – large affected populations with poor infrastructure that can hardly control a serious outbreak. However, it rarely works this way because the rich countries are able to harness poorer countries and give up. During the 2009 H1N1 pandemic, affluent countries are used advance purchase contracts to buy virtually all the available stock of vaccine produced by manufacturers at the time. Poorer countries with cases of 2009 H1N1 that shared virus samples with the global surveillance network that led to the development of a vaccine could not buy any vaccine with their own money. Pharmaceutical companies have prioritized the highest bidders such as the US, France and the UK who are willing to pay significantly more to secure vaccines, as has already been seen with Covid-19 vaccines.
The countries of Africa, like other LMICs, have little geopolitical leverage to influence richer countries to save a vaccine for it. They will receive numerous empty words about the importance of equity, social justice and global solidarity, which are of little value and essence if vaccine is not available to protect the vulnerable people of Africa. African countries will have to stand together resolutely and take great offense in all areas to have any hope of securing any vaccine. To avoid the chance for Africa to get the vaccine on time and improve further barriers in the expected second and third pandemic waves, a well-thought-out strategy and contingency will be needed to navigate the current geopolitical environment to vaccinate the region to ensure successful.