Searching for a COVID-19 vaccine (also) for Africa

When there is finally a vaccine for COVID-19, how will it be distributed? Africa has often been at the back of the line in vaccine delivery, but the continent now wants to ensure that, when it does, it reaches its people.

"When we have an effective vaccine against COVID-19, it has to be deployed at an unprecedented speed and scale and equity has to be at the centre of our efforts. Too often, African countries have ended up at the bottom of the queue for new technologies, including vaccines," lamented World Health Organization (WHO) Regional Director for Africa Matshidiso Moeti at a press conference last week.

The continent is seeking access to the long awaited panacea despite being the region least affected by the pandemic so far, with more than 13,200 deaths and more than 600,000 cases of coronavirus, although infections have accelerated in recent weeks after restrictions against its spread were relaxed in many countries.

Some 190 vaccines are currently in development and 16 are in clinical trials, in a race against time to get them to the public as soon as possible. But it's not so much when that drug will be, but how it will get there.

"We are very focused so that the phenomenon we call 'vaccine nationalism' does not happen," South African Professor Helen Rees, WHO's senior advisor on vaccines in Africa, told Efe. Such 'vaccine nationalism' would mean that the countries producing the vaccines would monopolize them all for their own population.

The concern is not surprising in light of the aggressive market behaviours that have been unleashed since the beginning of the health crisis. The "war" between countries over the purchase of masks or the rapid move by the United States to acquire almost all the available stocks in months of the antiviral Remdesivir - one of the most effective treatments for severe cases of COVID-19 - are good examples.

To try to prevent this from happening with the vaccine, WHO and the Vaccine Alliance (GAVI) have launched the COVAX Facility, a mechanism to try to provide equitable and responsive access.

Normally, to access a vaccine, countries negotiate directly with the pharmaceutical companies or laboratories that manufacture them. If there is only one, the price shoots up.

The mechanism is that, instead of giving rise to a market war, as much of the international demand as possible is managed through the COVAX Facility. But for that to happen, many nations, rich and poor, have to join the initiative. "It is (also) an economic advantage for the company producing the vaccine," Rees adds.

Ensuring access for all countries would also protect the most vulnerable populations first, such as health workers or people with comorbidities (coexistence of two or more diseases in one individual), regardless of where they live.

"What it means is that we assume that a life in Malawi and one in Montana (USA) are of equal value and deserve to be protected," GAVI's Programme Manager, Thabani Maphosa, told Efe. "But there is also another issue surrounding the danger of COVID-19. Equity is not about giving one to Malawi and one to the US, you have to look at the risk and vulnerability of people who get sick and see that everyone can access it," he says.

While waiting for the vaccine, Africa is also playing another card: participating in international medical trials. 25% of the vaccines used worldwide are given in Africa, but less than one per cent are manufactured there.

When the COVID-19 shield appears, the world will automatically need billions of doses in an unprecedented scenario where Africa will most likely be dependent on the outside world.

Only six African countries currently have overall vaccine manufacturing capacity, and of all the coronavirus immunization development projects, only one, the details of which are not yet known, has been registered as "made in Africa" (at a university in Nigeria).

This is why the continent has decided to try to get its head in the international trials. "By participating, we will have a stronger moral argument to say that we cannot be part of the science that discovers therapies, vaccines or diagnostics and then not have access to those same products,'" says Rees.

The initiative was taken by South Africa (the country hardest hit by the pandemic in the whole continent) at the end of June, joining the clinical trial with the vaccine from the British University of Oxford, which is one of the most promising and advanced.

In the southern nation, a team led by the University of Witwatersrand (Johannesburg) will study it in 2,000 volunteers - 50 of them HIV carriers - who will join the 10,000 in the UK trials and another 3,000 in Brazil.

"It is imperative that we know how vaccines work in African contexts," study director in South Africa, Shabir Madhi, said at a recent virtual press conference.

The rest of the experts agree. In Maphosa's words, "the risk is that we use a vaccine that has been developed and tested in Europe, and we find that the virus strain in Africa is different and end up losing a lot of money and resources (...)". We can't assume," he insists, "that a vaccine will always work the same way in different contexts.

To put Africa on the trial map, the African Union (AU) last week launched a consortium for clinical trials of the COVID-19 vaccine (Concvact), which it hopes will soon see more than a dozen trials in Africa.

"Success in developing and accessing a safe vaccine requires an innovative and collaborative approach, with significant local manufacturing in Africa. We need to support the contribution of African scientists and health professionals. We need to act urgently," said South Africa's head of state and current AU president, Cyril Ramaphosa, in launching the consortium.

The other side of the trial coin is to combat the perception that Africans are being allowed to use themselves as "guinea pigs" for the West.

Not surprisingly, at the start of the pandemic, statements were made on television by a French doctor who unashamedly suggested that vaccines be developed and tested in Africa. In South Africa, in fact, the start of the Oxford vaccine trial already sparked small protests in this regard.

African experts, however, remind that being part of the solution is not the same as being a guinea pig. "Less than 2.5% of the world's clinical trials are conducted in Africa, which constitutes 17% of the population. If there is anything to criticize, it is that not enough clinical trials are being done in Africa," says Madhi.

"We want to give our people the opportunity to contribute and help solve this pandemic. And we want to have the moral right to be able to order vaccines when they become available," Rees emphasizes.