Vaccine procurement and distribution – the continent's next big Covid-19 test

(Photo: usatoday.com / Wikipedia)

By Arnold Tsunga, Tatenda Mazarura and Mark Heywood

9 Feb 2021

Notwithstanding that there is no vaccine with 100% efficacy in preventing Covid-19, global efforts at developing a vaccine have reached encouraging levels.

Recent announcements that the Pfizer and Moderna vaccines have been approved by the Food and Drug Administration (FDA) in the US, while the AstraZeneca-University of Oxford vaccine was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK, have been cause for optimism.

The development and approval of the vaccines is the biggest hope in the fight against a resurgent Covid-19, more transmissible because of the 501Y.V2 variant that emerged in South Africa last year, as reported by the BBC.

The rollout of vaccines across the world has just begun with many countries, mainly in the Western world, already taking deliveries. However, there is concern at what is being referred to as “vaccine nationalism”, as developed countries hoard vaccines while many other countries, mainly in Africa and the developing world, are left without.

Winnie Byanyima, executive director of UNAIDS, has warned that a global vaccine apartheid is unfolding, saying that “people’s lives must come before profit”.

Vaccine nationalism also resulted in Rwandan president Paul Kagame protesting: “We’re not asking for charity, but fairness – instead of the hoarding and protectionism currently in play.”

Meanwhile, in a memo to the AU, the International Commission of Jurists (ICJ) has recommended the African Union acknowledge that Covid-19 vaccines are a “public good” and that all states must ensure access to these vaccines in order to realise the human rights of their inhabitants.

The vaccine deficit has become all the more apparent for Southern Africa, where the current second wave of the pandemic has led to more cases and fatalities, as well as reports of the overwhelming of medical facilities in countries like Malawi and Zambia, leading Gavi, the Global Vaccine Alliance, to suggest that Covid-19’s impact may be “vastly underestimated” in African countries.

While the global fatality rate has been falling slightly, Southern African Development Community (SADC) countries have experienced a surge in the number of infections and deaths.

According to the Africa CDC, the fatality rate for Africa has crept up from 2.1% in July last year to 2.5% currently.

Ultimately 60% of Africa's 1.3 billion people will need to be vaccinated in order to achieve continent-wide herd immunity, but sadly neither the continent or the SADC region has fared well in vaccine procurement and distribution. One major problem is that instead of acting proactively many governments seem to be waiting for a donated vaccine from overseas.

Healthcare professionals do serological tests for Covid-19 on people living in areas of high density in the Angolan capital. (Photo: EPA-EFE / AMPE ROGERIO)

Challenges in vaccinating the SADC region

WHO and Covax Initiative

Early in the life of the pandemic, the World Health Organisation and a number of countries noticed the need for a global coalition to “support the research, development and manufacturing of a wide range of Covid-19 vaccine candidates, and negotiate their pricing”.

The aim was to ensure “equal access to these vaccines once they are developed” and to have “two billion doses available by the end of 2021... enough to protect high risk and vulnerable people, as well as frontline healthcare workers globally”.

The fear was that without Covax there was “a very real risk that the majority of people in the world will go unprotected against SARS-CoV-2, and this would allow the virus and its impact to continue unabated”.

Covax was important in Africa to try to ensure that an inability to pay for the vaccines “did not become a barrier to accessing them”.

In a January supply forecast, Covax notified countries in Africa of its aim to start shipping nearly 90 million Covid-19 vaccine doses to the continent in February 2021.

The Covax interim distribution forecast on doses for Southern Africa as of 3 February was as follows:

Angola 2,544,000

Botswana 117,600

DRC 6,948,000

Eswatini 108,000

Lesotho 156,000

Malawi 1,476,000

Mozambique 2,424,000

Namibia 127,200

South Africa 2,976,000 and 117,000

Zambia 1,428,000 and

Zimbabwe 1,152,000.

However, Covax also issued a precautionary note that its “indicative distribution is intended to provide interim guidance to facility participants” for planning, but “it is therefore non-binding and may be subject to change”.

It is also important to note that it is not yet clear what recent news about the lack of efficacy of the AstraZeneca vaccine on the 501Y.V2 variant may mean for the Covax distribution plan.

The AU Vaccine Initiative

It is reported that the African Union (AU) has secured 270 million doses of Covid-19 vaccines for distribution throughout the continent.

African countries will pay between $3 and $10 per dose to access the shots secured by the AU, according to a draft briefing on the plan prepared by the African Export-Import Bank (Afreximbank).

If member states choose to purchase unilaterally, they have to wait until July 2022, but they can bring this forward to April 2021 if they make use of the AU’s pooling facility.

The outgoing AU chairperson, President Cyril Ramaphosa, said the vaccines secured by the AU will be supplied by Pfizer, AstraZeneca through the Serum Institute of India and Johnson & Johnson, and will be allocated according to countries’ population sizes.

The vaccines will require approval from the Africa Centres for Disease Control and Prevention and further approval from local regulatory and other mechanisms.

It is also reported that to facilitate easy transportation of Covid-19 vaccines from China to Africa, Ethiopian Airlines has signed a partnership agreement with Cainiao Smart Logistics Network, the logistics arm of China’s Alibaba Group. In early February this led to the first tranche of vaccines landing for storage in Ethiopia.

Where do SADC countries stand in vaccine procurement?

As of 7 February, Angola had 20,062 coronavirus cases and 475 deaths. In December 2020, Angola announced it was to receive five million doses of a Covid-19 vaccine in February 2021. Health minister Silvia Lutucuta said seven million more doses would be delivered in April in partnership with Covax.

The first vaccination phase will cover people who are over 40 years old and those with high exposure risks. The second phase will be for people between 20 and 39, market vendors and public service drivers, among others.

By 7 February, Botswana had registered 23,503 coronavirus cases, and 163 deaths. Unlike many other African countries, Botswana does not qualify for subsidised vaccines under the Covax scheme because, like Namibia and South Africa, it is classified as an upper middle-income country.

Moses Keetile, deputy permanent secretary in the health ministry, told Reuters that Botswana signed an agreement with Covax giving it the option to buy vaccines for 20% of its population.

Botswana already made an upfront payment to Covax in November 2020 and will have the option to secure roughly 940,800 vaccine doses under a two-dose regimen.

Malawi, one of the poorest countries in the world, had 26,875 cases of coronavirus as of 7 February, with 837 deaths.

Malawi is reported to be struggling to treat escalating numbers of patients with little prospect of a vaccine to protect them from the virus. According to Médecins Sans Frontières (MSF)/Doctors Without Borders, new cases increased exponentially in January 2021, doubling every four to five days.

Queen Elizabeth central hospital, the main facility offering Covid-19 care in Blantyre, is nearing full capacity for patients needing oxygen support.

By 3 February, 1,298 frontline health workers in Malawi had tested positive for Covid-19, while nine had succumbed to the disease. MSF says without vaccination, particularly to protect frontline health workers, the situation will soon be untenable.

Eswatini and Mozambique are also reportedly struggling to contain the spread of the new strain.

(Photo: usatoday.com / Wikipedia)

Eswatini, with 16,181 cumulative cases and 604 deaths as of 7 February, is planning a 100% vaccine coverage of its population. Principal secretary in the health ministry, Simon Zwane, told Reuters that it had earmarked 200 million emalangeni for the roll-out of vaccines to all of its 1.3 million people.

The cost of vaccinating 20% of its population will be covered by the Covax initiative at a cost of around R200 per person.

In Mozambique, case numbers are currently almost seven times higher than at the peak of the first wave. Yet, complains MSF head of mission Natalia Tamayo Antabak, Mozambique has “not received a single dose of vaccine to protect the most at-risk people, including frontline health staff”.

South Africa, which is the epicentre of the virus in Africa with 1,473,700 infections and 46,180 deaths as of 7 February, received its first batch of one million Covid-19 vaccines on 1 February 2021.

In an unfortunate turn of events, South Africa has temporarily halted the use of the Oxford/AstraZeneca vaccine after evidence emerged that the vaccine did not protect clinical-trial participants from mild or moderate illness caused by the 501Y.V2 variant.

The doses produced by the Serum Institute of India were expected to inoculate frontline healthcare workers, starting mid-February. By the end of 2021, South Africa intends to have inoculated 40 million people, representing 67% of the country's population of 60 million.

Importantly, President Cyril Ramaphosa clarified that his government sought “to make the vaccine available to all adults living in South Africa, regardless of their citizenship or residence status”. This, after health minister Zweli Mkhize said in a statement that only South African citizens would receive the vaccine, drawing protests from Human Rights Watch which argued that South Africa is home to an estimated 4.2 million migrants, refugees and asylum seekers.

Zambia, with a cumulative total of 62,633 cases and 853 deaths, saw a huge surge between early December and late January. To date, 59,003 cases have been reported, with 51,305 recoveries and 812 fatalities.

Zambia says it has been allocated 8.7 million doses of the 270 million Covid-19 vaccines secured by the AU. The number of doses may rise to 25 million by December 2021.

In Zimbabwe, 70% of known infections (now totalling 33,964) and more than two thirds of the 1,269 deaths were recorded since the beginning of January 2021.

On 4 February 2021, President Emmerson Mnangagwa said there were plans to vaccinate at least 60% of the population using government and private sector funding, adding that Russia and China had shown willingness to donate Covid-19 vaccines.

There was controversy after finance minister Mthuli Ncube said the vaccination will not be entirely free, before arguing that he was quoted “out of context”.

Lesotho, too, has felt the sharp end of the second wave with cases more than doubling since 1 January. At the beginning of 2021, the country had recorded 3,206 cases and 65 deaths. By 7 February, the figures had reached 9,380 cases and 183 deaths.

In addition to the 156,000 free doses allocated by Covax, Prime Minister Moeketsi Majoro announced in January that his government would set aside R240-million (US$15.8-million) to procure more vaccines.

Seychelles, with total infections of 1,504 and only six deaths as of 7 February, became on 10 January 2021 the first African country to roll out a Covid-19 vaccine.

Seychelles received a donation of 50,000 doses of the Sinopharm vaccine from the UAE Armed Forces and 100,000 doses of the AstraZeneca vaccine from India. The government says it aims to be the first country in the world to vaccinate at least 70% of its over-18 population.

Tanzania’s denialism and vaccine denialism

The Tanzanian government is probably the only one in the world that has publicly denied the threat of Covid-19. President John Magufuli’s government has been widely criticised for its approach to the pandemic. It has not updated its number of coronavirus infections (509) since April 2020.

Magufuli has expressed conspiracy theories about the vaccine and has even cast doubt on the vaccines themselves, calling them “dangerous for our health” and urging his people to instead put their faith in prayer.

Magufuli’s health minister Dorothy Gwajima told a press conference on 3 February in the capital, Dodoma, that “the ministry has no plans to receive vaccines for Covid-19”.

Andry Rajoelina, president of the island state of Madagascar, has touted an untested herbal remedy for Covid-19 instead of the vaccine.

Reports from the Democratic Republic of Congo (DRC) – with 23,599 cases of infections and 681 deaths as of 7 February – say that President Felix Tshisekedi has hailed locally-made “products”, including one called Manacovid that is on sale at pharmacies in Kinshasa for $110 a bottle.

The WHO has cautioned against any claims about products that lack scientific proof to show safety and effectiveness. Although the DRC seems not properly organised for the Covid-19 vaccination rollout, the country has a lot of practical experience in vaccination against dangerous diseases such as ebola. Valuable lessons on how to deal with the logistical nightmare of distribution will come from the DRC.

Immense challenges await even after vaccines are procured

For Southern Africa, the need for a vaccine could not be more urgent given not only the rising number of cases, but also a health delivery system that is simply unable to cope with even a low level of stress.

Once the procurement of the vaccines is achieved, there will remain the immense challenge of cold supply chains on a continent that has weak and underdeveloped infrastructure.

Cold chain capacity is one of the most important factors in distributing any vaccine. Added to this is the question of endemic corruption we have previously reported on that needs to be combated.

Ultimately, vaccine nationalism needs to be replaced by international vaccine equity.

In the words of the UN independent expert on human rights and international solidarity, Obiora C Okafor: “This pandemic will not end for anyone, until it ends for everyone.

“The virus can still travel from the vastly unvaccinated massive population of the Global South to the Global North, including in its increasingly mutating forms.

“International vaccine solidarity should be much preferred over international vaccine competition.” DM/MC

Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c), it is prohibited to publish information through any medium with the intention to deceive people on government measures to address Covid-19. We are, therefore, disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information we should know about, please email letters@dailymaverick.co.za

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