Effort: In an effort to get people vaccinated against Covid-19, Kenya’s health workers go door to door for people who live far from health facilities. The more benign Omnicron variant has also made people complacent. Photo: Briaqn Ongoro/AFP
Despite an oversupply of Covid-19 vaccines, 900 million Africans still need to be vaccinated. The continent’s average vaccination coverage is just 19%.
The situation is not only caused by vaccination complacency; it can be attributed to limited operational capacity, historic vaccine procurement backlogs and competing crises in many African countries.
Vaccine hesitancy worldwide is currently driven by the lower health risk of the predominant and highly infectious Omicron variant.
A Mail & Guardian investigation of the World Health Organisation (WHO) African Covid coalface operators, a supplier and the year-old Afrigen mRNA vaccine research hub in Cape Town has exposed some stark realities.
One is that 11 of the continent’s 54 countries have less than 10% of their population fully vaccinated. These are, from lowest to highest: Burundi, the Democratic Republic of the Congo, Madagascar, Cameroon, Malawi, Mali, Niger, Senegal, Burkina Faso, Tanzania and Sudan.
Phiona Atuhebwe, of the WHO Africa region, says most of these countries are also dealing with humanitarian crises and outbreaks of other vaccine-preventable diseases such as measles, yellow fever and poliovirus type 2.
The main obstacles to absorbing Covid vaccine supplies are: insufficient political commitment, competing priorities, the limited involvement of local structures in the planning and roll-out of Covid‑19 vaccines and insufficient time for planning.
Other bottlenecks included delays in the release of funds to support planning and implementation of activities and increasing vaccine hesitancy.
Atuhebwe says misinformation and disinformation are rife, while trust in the safety and efficacy of vaccines, and the progressive low risk perception caused by countries relaxing public health measures, play major roles.
Booster doses have been administered to just 11.4% of people fully vaccinated in 38 of Africa’s countries.
The WHO is a partner in the global Covid-19 vaccine delivery partnership, and active in 10 African countries where conditions are “ripe to have maximum impact”.
According to Stavros Nicolaou, group senior executive at Aspen Pharmacare Holdings, Africa’s only Covid-19 vaccine producing “fill and finish” facility in Gqeberha in the Eastern Cape is under threat.
With the global philanthropic Covax purchase and distribution hub overlooking the facility’s annual 350-million dose producing capacity, the reversal back to general anaesthetic drug production is now being considered.
“Unless we can sustain these facilities through vaccine procurement, we’ll have to pivot away from our Astenovax Covid vaccine, for which we hold the [only] African rights,” Nicolaou said.
With 600-million doses remaining of the original global, advance-purchased 2.1-billion doses of Covid vaccines remaining, Covax did not buy a single dose from the Gqeberha facility.
This flies in the face of the African Union heads of state call on 17 May for 30% of the continent’s vaccine requirements to come from African producers — and its demand that Africa be allowed to establish its own procurement mechanisms.
Aspen holds the Johnson & Johnson licensing agreement for Covid-19 vaccine production at the Gqeberha plant but its Covid vaccine production line was consciously halted three months ago.
The WHO is trumpeting its African vaccination successes.
Atuhebwe said Chad “required urgent delivery of funding to enable the launch of their planned campaign before Ramadan. The Covid-19 Vaccine Delivery Partnership coordinated the mobilisation of nearly $5-million in five days. The outcome was that 1.6-million people were vaccinated in 10 days. This was equivalent to 52% of the national target, including more than 10 000 health workers, 18 000 refugees and 9 500 nomads.”
Meanwhile, Petro Terblanche, managing director of Afrigen Biologics, says it will take at least three years before an African-manufactured Covid-19 booster — or any other crucially needed locally made mRNA-based vaccine — becomes available.
The WHO-backed Afrigen technology hub in Cape Town was launched on 21 June last year to build African mRNA vaccine production capacity.
Given the waning Covid-19 pandemic, its innovations will probably be more relevant to other diseases. The centre was set up in response to global historically tardy vaccine assistance to Africa.
The prospect of African-made mRNA vaccines of all types is a beacon of hope in a world where high-income countries routinely send “left-over” vaccine and drug supplies to low and middle income countries (LMIC) — often after global pharmaceutical companies have conducted drug development trials in these LMIC countries.
Terblanche said it was critical not to underplay the Covid-19 vaccinations that are still required.
“The minimum required by WHO is 40% of a country’s population vaccinated. SA has just got to over 50% but there are still 900-million people in Africa who need to be vaccinated.”
She said that two years ago, Africa was desperate for Covid-19 vaccine supplies.
“If they had been available, everybody would have been vaccinated by now, because people were scared. Now, everyone’s relaxed. I doubt we’ll get this continent anywhere close to 70%. In South Africa we might but for the WHO to comfortably declare this pandemic over we need those kinds of vaccination levels.
“The less vaccination, the more variants. All we can do is hope the next variant is as kind to us as Omicron has been. Vaccine advocacy is incredibly important now,” she stressed.
Terblanche said that eight billion doses of Covid vaccine had been administered globally with “superb” safety levels. Although there had been some side-effects, the cost-benefit equation was positive.
“In terms of African capacity, we have the Gqeberha Johnson & Johnson plant but things can easily go wrong, as they did there with the contamination issue last year. Their current situation reinforces just how important it is for us, as a continent, to get preferential procurement.
“But we need to build the sector to ensure we have local pandemic preparedness and vax equity with a long-term sustainable model. We’re currently having very constructive discussions with Gavi, Unicef [United Nations Children’s Fund]and the African Union,” she said.
Gavi is the Global Vaccine Alliance, and partners with Covax, the vaccines pillar of the Access to Covid-19 Tools Accelerator. They form a global risk-sharing mechanism for pooled procurement and equitable distribution of Covid-19 vaccines.
Terblanche said her technology hub, which will produce vaccines through a centre of excellence and training in Milnerton, Cape Town, and networks with other African research centres, had a candidate Covid-19 booster vaccine in development.
The thrust of “fast-moving” research was to develop a stable mRNA vaccine formulation that adhered to refrigeration temperature of four to eight degrees, instead of the currently available Covid vaccine that requires storage at -20°C.
“That’s difficult. Four to eight degrees Celsius is what the whole African refrigeration chain network can do. We have a process that is hugely innovative and cost effective for sequencing from an active pathogen to producing an mRNA substance. We’ll use that technology to reduce the cost, end to end, from production to cold chain by 50%.
“We may not have the big pharma collaboration but the biotech is coming together — this technology will change the world. It’s very exciting.”
Asked where she saw the technology hub in three years’ time, she said they hoped to have established mRNA platforms in five African countries and 10 others, eventually producing a booster Covid-19 vaccine that “ticks all the [LMIC] boxes”.
Afrigen was also working intently on a tuberculosis vaccine. She says the latest development, to be announced next month, involves an agreement signed with a US partner, one of the world’s foremost research entities, on process improvements and vaccine targets for paediatric diseases. Success here would have positive effects on the unacceptably high levels of childhood mortality in Africa.
Terblanche warned that with Africa’s current levels of Covid unvaccinated populations and health compromised people, the continent was “a breeding ground for variants”.
“Just look what happened with Delta — that was the worst we could have asked for. We need to get our people vaccinated,” she said.
Atuhebwe agreed: “We have to keep vaccination on the radar or face the real possibility of a more dangerous variant emerging in Africa. We don’t know what’s around the corner.”
She said African countries were struggling to absorb now-plentiful vaccine supplies. “It’s about getting vaccines into the arms of health workers, the elderly and those with comorbidities, financing the operations and paying the vaccinators — vaccine hesitancy is actually a small slice of the pie.”
Bigger countries with populations scattered over vast rural regions such as Nigeria, Ethiopia and Kenya, posed greater vaccine distribution problems. But some lower-income countries like Rwanda had done “extremely well”.
The WHO said 60% of the world’s population has been vaccinated for Covid but in the poorest 52 countries — home to 20% of the world’s population — just 14% of people have received even one dose.
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