IBADAN – A deal to supply 400 million doses of Johnson & Johnson COVID-19 vaccines to African countries hangs in the balance as most countries are reluctant to make upfront deposits and borrow money to get the supplies.

With a looming deadline to express interest and complete the funding applications, Africa CDC John Nkengasong on Thursday appealed to countries to make use of the facility as it will ramp up vaccinations and help achieve herd immunity to curb the spread of the deadly virus. 

While Morocco has administered over 10 million doses of vaccines, countries like Burkina Faso, Tanzania, Eritrea, Chad, Burundi, and the Central African Republic are yet to officially administer a single dose—according to Africa CDC’s COVID-19 vaccination tracker, implying that many African countries are lagging behind the set vaccination goal even as the continent is heading towards the winter season and a possible third wave.

Thus far, only five countries have completed the process required towards accessing funds through African Export-Import Bank (Afreximbank) to pay for the doses they are getting through an arrangement involving key parties including J&J and Africa CDC.

Benedict Oramah, Afreximbank president , said only Botswana, Cameroon, Tunisia, Togo, and Mauritius have completed orders and submitted a 15% deposit as a down-payment for the vaccine supplies.

Thirteen more countries have signed commitment letters, but have not paid any deposits, according to Oramah. Whereas 17 have expressed interests in pre-orders without taking any action.  A total of 21 countries have not expressed any interest in securing the doses. 

The lack of finalisation of paperwork and funding requirements will result in only a fraction of the 400 million doses being delivered.

Oramah did not give a specific deadline date, but said the order book would be closing in the coming weeks in order to move forward with finalising deliveries.

The J&J vaccine is seen as an ideal option for the continent because it’s one shot, which reduces logistics and administration costs, Oramah said.

In March Health Policy Watch reported details of the deal between J&J and the African Union’s African Vaccine Acquisition Trust (AVAT) aimed at equitable access to new COVID-19 vaccines. AVAT would order up to 220-million doses this year and an additional 180 million doses in 2022.

Most of the supplies will be produced at Aspen Pharma’s pharmaceutical manufacturing plant in South Africa and will be made available to African countries through the African Medical Supplies Platform (AMSP), over a period of 18 months.

The transaction was made possible through the US$2 billion facility approved by Afreximbank, who also acted as Financial and Transaction Advisers, Guarantors, Instalment Payment Advisers and Payment Agents.

Prior to the conclusion of the Agreement with J&J, African Member States were asked to make pre-orders for the vaccines and several countries showed strong preference for this particular vaccine. The countries will be able to purchase the vaccines either using cash, or a facility from Afreximbank. 

More Vaccinations Needed to Achieve Herd Immunity

Speaking at a press briefing on 13 May,  Nkengasong said his organisation would continue to encourage member states to use the funding opportunity as countries needed more vaccine doses to achieve herd immunity by 2022.

“I think that we will continue to encourage our countries to go to the AMSP platform to acquire their vaccines. You can only count on your own efforts by investing in health security,” he said.

According to Nkengasong, even if the COVAX-facility is able to deliver all the doses it had promised African countries, it will only be able to meet 30% of the continent’s vaccine needs.

“We have all agreed that if we do not vaccinate up to 60% of the population, we may not be able to get rid of the pandemic on the continent. The fact that the United States is further expanding its vaccination to lower age groups, and China is aiming to vaccinate 80% of its population, speak to the fact that we as a continent cannot say we will only vaccinate less than 30% of our population,” he said.

He however assured that J&J was on course to start the delivery as planned – the first shipment is expected from late July or early August.

“We are working very hard with Johnson and Johnson every day. We are expecting deliveries beginning from the third quarter of the year. We are still pressing hard to see if we can actually have any early deliveries because of shortage and challenging situations. So, yes, we are still on course for delivery,” he affirmed.

Africa’s Overstretched Wallet

Only one African country, South Africa,  has recorded more than one million cases of COVID-19,  but the continent has largely been unable to cope with the pandemic which has had severe impacts on the fragile health systems, including emergency spending on COVID-19 prevention and control measures.

Even as the world battles new COVID-19 variants and supply and roll-out of vaccines remains critically low in Africa, new research from the Partnership for Evidence-Based Response to COVID-19 (PERC) indicates 81% of survey respondents reported challenges in accessing food, 77% reported experiencing income loss and 42% reported missing medical visits since the start of the pandemic. 

Beyond acquiring vaccines, African countries are also spending limited resources on expanding testing and genomic surveillance capacities, public health measures including expanding water and sanitation hygiene measures, acquiring medical oxygen capacities and several others. 

Countries are also trying to restore normalcy to other health issues that have been negatively impacted by COVID-19 thus making them reluctant to further pile up loans while their economies are yet to return to growth.

Two weeks ago, the Nigerian government announced its plans to get 29.6 million doses of the vaccine through AVAT with the support of Afreximbank. The country’s finance Minister Zainab Ahmed, said just over  US $70-million has been released for the deployment of vaccines, which is 52% of what is required from 2021 to 2022.

“Nigeria has set a target of vaccinating 70% of its citizens who are 18 years and above between this year and next,”  Ahmed said.

Window Closing Soon

At the March 2021 announcement of the deal, Oramah said Afreximbank, was proud to be associated with this historic and collective effort. 

“In the midst of a very tight COVID-19 vaccine market, we are highly honoured to have been given the opportunity by the African Union to facilitate this impactful transaction…towards assisting the continent to begin to rid itself of the pandemic and rebuild its economy,” he said at the time.

But during an emergency summit of health ministers on  8 May, he said the window period for African countries to express interest and complete the process is closing soon (no date announced). 

“We want to make an appeal to all of you, especially those who have not made the orders, to please make your orders,” he said..

For Nkengasong, the deal is an opportunity for Africa to meet nearly 50% of its vaccination target.

“The Africa CDC recommended to the African Union that a minimum of 750 million Africans (60%) must be immunised if we are to contain the spread of COVID-19. This transaction enables Africa to meet almost 50% of that target. The key to this particular vaccine is that it is a single-shot vaccine which makes it easier to roll out quickly and effectively, thus saving lives,” he said.

Image Credits: Paul ADEPOJU.