As new COVID-19 variants cause spikes in COVID cases across the continent with cases and deaths increasing by almost 40% in the past week – the acute imbalance in vaccine access across the world is on full display. Thankfully, governments and funders are responding. The WHO announced this week it was setting up a manufacturing hub to make COVID-19 vaccines in South Africa, the continent’s first COVID-19 vaccine production facility. This is an important step towards the urgent investments needed in Africa’s capacity to design, manufacture and develop vaccines.
A key piece of this capacity, which must be at the center of these investments, is Africa’s ability to conduct vaccine clinical trials in the region.
Africa’s relative exclusion from global clinical vaccine trials is not new, but COVID-19 has brought it into sharp focus. Globally, less than 6% of clinical vaccine trials are carried out in Africa and this ratio applies equally to trials of COVID-19 vaccines – so far only 17 of 301 trials are in Africa.
This glaring gap in the global vaccine research and development model could limit the availability of effective COVID-19 vaccines to some populations and insert additional risk into the global health ecosystem. It contributes to vaccine scepticism, increases the risk of new variants developing, especially where vaccination coverage is low, and is a clear symptom of the weakness of Africa’s health systems. Together all these factors are contributing to the tragic reality that most poor countries will have to wait much longer for COVID-19 vaccines than rich ones.
There is no time to waste. India’s recent battle with the Delta variant, and the emergence of “Delta plus” shows just how rapidly situations can change and how devastating the impact can be. In Africa, we’re seeing surges in parts of Uganda, South Africa and Kenya as more contagious variants – including ones we may not know about yet – spread In order to identify variants of viruses, scientists carry out genome sequencing but this capacity is limited in most African countries. This means we cannot know the level of spread of variants across the region and their potential impact on the efficacy of different vaccines.
There has been some progress on vaccine testing in Africa, such as the clinical trials of Oxford/AstraZeneca and Novavax vaccines in South Africa, which provided early evidence of the impact of the vaccine on the variant first discovered there. Without this action, the world may have been blind to what was coming. Other investments are being made in Africa’s clinical trial capacity and there are a number of world-class research institutions on the continent. But without sufficient (or representative) vaccine trials, manufacturers and policy makers cannot respond as effectively to variants that will inevitably spread globally.
In an atmosphere of vaccine hesitancy and skepticism, driven in part by the inequity surrounding COVID-19 vaccine development, conducting more clinical trials in Africa could also boost vaccine confidence. There is no current evidence that different ethnic groups react to the COVID-19 vaccine in different ways, but the level of trust in COVID vaccination in African countries is very variable. Clinical vaccine testing at scale in Africa, as well as tackling misinformation, could help to reassure vaccine hesitant groups.
In addition, investment in clinical trial capacity in Africa would be a significant contribution to “building back better”. It would strengthen local laboratories, boost African research and development and health worker capacities, and improve preparedness for future pandemics and treatment of many other diseases. We saw lasting benefits of investment in the Ebola vaccine trial in Sierra Leone between 2015-2016 with laboratories renovated and health workers trained. Boosting clinical vaccine trial capacity for COVID could do the same for the whole continent.
African governments need to take the lead. It is no longer sufficient for African governments to rely on rich countries and western capital to shoulder the cost of vaccine development. African governments must invest in vaccine trial capacity and incentivise the private sector to do so.
Pharmaceutical companies should also invest in much more diverse vaccine trials. This requires regulatory and governance support. Africans have in the past been subjected to poorly regulated and unethical medical trials. National regulatory capacity must be developed so that African countries can take leadership in developing, designing, and implementing vaccine trials, while protecting Africans.
There is still a role for donor countries and external funding partners. This support should focus on building long-term capacity and not just vaccine provision. Vaccine trials should be done in collaboration with research partners in African countries for sustainable capacity-building, local ownership and in the spirit of global health collaboration.
COVID-19 has shown us the weaknesses in the global health system and the risks associated with vaccine insecurity in Africa. The continent and its external partners need to address vaccine testing capacity as foundational investments in stronger health systems in Africa.
Oyeronke Oyebanji is a Nigerian public health professional and a 2021 Aspen New Voices Fellow. She is a Strategy Coordinator at CEPI (Coalition for Epidemic Preparedness Innovations) and an Analyst for the COVAX Strategic Coordination Office. Follow her on Twitter @OyeRonke_