Ambitious Global COVAX Facility Delivers First Doses In Accra Ghana
Thumbs up: WHO representative in Ghana, Francis Kasolo, on left, with UNICEF’s representative, Anne-Claire Dufay as first COVAX vaccine doses arrive on 24 February in Accra, Ghana.

Under cloudy skies, Ghana’s first precious doses of Covid-19 vaccines arrived Wednesday morning at Accra’s Kotoka International Airport. They are also the first supplies to be distributed by the WHO co-sponsored COVAX facility on the African continent.

The arrival of some 600,000 vaccines marks a milestone in months of effort by WHO, UNICEF, GAVI and other partners to mount the largest global vaccine campaign in history – and ensure that scarce and often pricey COVID-19 vaccine doses are distributed more equitably to countries around the world. 

“This day is the culmination of many months of planning, research, negotiation & coordination,” tweeted WHO Director General Dr Tedros Adhanom Ghebreyesus, who co-launched the COVAX initiative nearly a year ago. “But it’s just the beginning. We still have a lot of work to do to realize our shared vision for VaccinEquity by starting vaccination in all countries within the first 100 days of the year.”  

COVAX hopes to deliver 2.3 billion doses by the year’s end — mostly to 92 low- and middle-income countries that are part of a GAVI-backed Advanced Marketing Commitment scheme. The equity scheme aims to overcome price and supply barriers thrown up by high-income nations, which have already snapped up one billion more vaccines than they need for their populations.

Ghana was selected as the first African recipient of vaccines after sending a rollout plan to COVAX, demonstrating that its health-care teams and cold chain equipment could support a quick distribution. The WHO Ghana office, known for its efficiency and close collaborations with Ghana Health Services, can be relied upon as a flagbearer for the initiative, insiders say.  

“This is a momentous occasion,”  declared WHO’s representative in Ghana Francis Kasolo, in a joint statement with UNICEF’s representative, Anne-Claire Dufay, just as the first palettes of AstraZeneca/Oxford vaccines, produced by India’s Serum Institute, were unloaded on the airport runway. 

“After a year of disruptions due to the COVID-19 pandemic, with more than 80,700 Ghanaians getting infected with the virus and over 580 lost lives, the path to recovery for the people of Ghana can finally begin,” said Kasolo. 

The initial COVAX shipments will be used to vaccinate frontline healthcare workers, adults over the age of 60, and people with underlying health conditions in the weeks to come, said the Ghanaian authorities on Wednesday.

Ghana’s program manager for immunization, Kwame Amponsa-Akyianu, told reporters earlier this month that the country aims to vaccinate two-thirds of its population of over 31 million people.

The historic shipment comes a week after Africa’s coronavirus death toll surpassed the 100,000 mark. That is a fraction of the death toll on other continents, but it is now rising fast as a second wave of infections overwhelms hospitals – most of which lack the oxygen supplies and intensive care units that are standard in more affluent regions.

Coronavirus Disease 2019 (COVID-19)

Africa CDC Also Welcomes Deliveries

John Nkengasong, Director of the Addis-based Africa Centres for Disease Control and Prevention, sounded a similar note, saying: “These first deliveries of COVID-19 vaccines through COVAX are a critical moment in Africa’s fight against the virus.” 

Nkengasong described the first deliveries as “an important step towards our continental goal of immunising at least 60% of Africa’s population with safe and efficacious vaccines against COVID-19″ over three years. 

So far, the African Union (AU) has secured some 670 million doses of the AstraZeneca, Pfizer and Johnson & Johnson vaccines – in addition to the COVAX supplies of some 90 million doses that will flow to the continent.  Russia has also offered to supply 300 million doses of its Sputnik V vaccine to the AU scheme along with a financing package.

Desperate to begin vaccinations soon, South Africa, Uganda and Rwanda, among others, have also made smaller bilateral deals. And China has donated small batches of its Sinopharm vaccine to to countries like Zimbabwe and Equatorial Guinea. 

Still, the rollouts underway in Europe, the Americas, India and even the Middle East remain the exception rather than the norm.  Of the 210 million doses of vaccine that have been administered globally so far, half have been doled out in just two countries, Tedros warned on Tuesday. 

Ghana’s Minister of Health Kwaku Agyeman-Manu at Accra’s Kotoka International Airport

Nigeria Watching Ghana – And Wondering When Their Turn Will Come  

But just north of Accra, in the continent’s most populous country and the largest economy, Nigerians were eying the local vaccine landscape with concerns about how and when a campaign would commence on home turf. Such plans have yet to be announced by the government.

Emeka Nsofor, CEO of EpicAFRIC,a philanthropic impact agency, told Health Policy Watch that while the country’s epidemiological response to the pandemic has been impressive so far, the paucity of information and the non-availability of a timeline for the delivery of COVID-19 vaccines is becoming a source of major concern not only to professionals, but to the public.

“It is not good for Nigerians to be watching clips of the vaccines being delivered to South Africa, Zimbabwe and other African countries when no one knows when Nigerians will start receiving the vaccine,” he told Health Policy Watch.

Nsofor said the government ought to have made its plans for procuring and administering doses public – whether they are secured through COVAX, the AU or other means.

“By now we should have known who will get the vaccines first, where will they be administered, who are the officials that will be involved,” he added.

In several countries where vaccines are already being administered, frontline health workers and aged individuals are eager to be the first to receive the jabs in their arms. But in Nigeria, health workers are less optimistic about their prospects.

At the Casualty and Emergency unit of Nigeria’s first teaching hospital, the University College Hospital, a physician who was among the first in his unit to test positive for COVID-19 told Health Policy Watch that he dreads getting reinfected. Not knowing when he will be able to receive a jab compounds those fears and is “very discouraging”, he said.

“Getting the virus was a very scary experience for me, especially at a time when we knew so little about it. Every now and then, I still dread contracting it again. I believe receiving the vaccine would protect me and allay my fears but realising that no one, probably including the government, knows when we will get it, is very discouraging,” he told Health Policy Watch on condition of anonymity.

For its part, the Nigeria Center for Disease Control (NCDC) continues to coordinate testing, messaging and other aspects of the country’s response to the pandemic. It recently released findings of household seroprevalence surveys conducted in four Nigerian states — Lagos, Enugu, Nasarawa and Gombe States.

The survey findings revealed that the prevalence of SARS-CoV-2 antibodies was 23% in Lagos and Enugu States, 19% in Nasarawa State, and 9% in Gombe State.

“This means that as many as 1 in 5 individuals in Lagos, Enugu and Nasarawa State would have ever been infected with SARS-CoV-2. In Gombe, the proportion is about 1 in 10,” NCDC said in a statement.

South African Variant – A Risk In Ghana

The fact that the B-1351 variant, first discovered in South Africa, has now spread to eight African countries including Ghana, has further implications for the vaccine campaign in the West African region. 

In a small South African trial, experts found that the AstraZeneca vaccine had virtually no efficacy in reducing mild or moderate COVID cases among people infected with the B-1351 virus strain – leading authorities in Pretoria to cancel the vaccine rollout and switch to a Johnson & Johnson jab – which has recently demonstrated efficacy against the variant in Phase 3 trials. 

The WHO nonetheless has said it recommends AstraZeneca’s use across Arica – even in countries infected with the variant. Speaking at a recent press conference, WHO experst maintained that the vaccine is still likely to reduce incidence of severe COVID cases, even among people stricken with the B-1351 strain. 

However, the African Union has issued a slightly different recommendation – that countries where the strain is “dominant” shift gears to another vaccine. 

So experts will be closely eyeing Ghana’s AstraZeneca rollout to see how the vaccine performs against the variant in the real world laboratory there.

Map of African Union Member States by hotspot level on PERC (Partnership For Evidence-Based Response) dashboard.

Expect More African Pressures On COVAX to Roll Out Johnson & Johnson – Following Expected FDA approval Friday

COVAX’s preliminary candidate-specific supply of COVID-19 vaccines for 2021 and 2022, as of 20 January. Since then Novavax also committed 1 million more vaccines.

The arrival of the AstraZeneca vaccine batches in Ghana also coincides with big news of a likely US Food and Drug Administration emergency approval of the J&J vaccine as early as Friday – following today’s positive FDA expert panel review of the vaccine

The J&J results, reported by the FDA review, showed a 66% average efficacy for the vaccine in preventing moderate and severe disease in Phase 3 trials The trials involved over 44,000 recruits in the US, Latin America, and South Africa. 

The J&J vaccine was also 64% efficacious in preventing moderate and severe disease in the South African trial arm – a significant finding from the first large-scale trial of a vaccine meeting up with the B.1351 variant. And more important, the vaccine was 85% effective in preventing severe disease – 82% in South Africa. While that is not as good a showing as the 90% or better efficacy results for the mRNA vaccines by Pfizer and Moderna, J&J trial was the first to directly pit a vaccine against the B.1351 variant, which has been the one most resistant to vaccines generally among the recent SARS-CoV2 mutations to emerge. 

The J&J vaccine also has the advantage of being a one-shot vaccine which can be stored in a normal refrigerator rather than ultra-cold storage conditions – factors that could significantly help rollout in low-income countries where access to cold storage as well as to health services is more challenging. 

The FDA approval of the  J&J vaccine will almost certainly pave the way for a WHO greenlight, leading to a COVAX rollout of the vaccine as soon as commercial supplies are available. 

But that, in turn, could also give rise to new dilemmas for COVAX distribution plans.  In African countries like Ghana, faced with creeping vases of the B.1351 variant – there may also be future pressures to swap out AstraZeneca vaccines for J&J doses.

Although J&J has in fact committed to provide 500 million vaccine doses through COVAX facility – AstraZeneca dose still comprise the lions share of the COVAX portfolio, with some 720 million doses already procured. 

The bottom line is that while the jury is still out on AstraZeneca’s performance against the B-1351 variant, the J&J trial data shows clear efficacy for the vaccine in preventing serious disease in the African setting – where other vaccines have not [yet] been widely tested and tried.

And that means that the COVAX rollout – even as it begins, is set to face a new series of challenges in a constantly evolving landscape of science, big pharma deals and geopolitics.

Image Credits: WHO Ghana, PERC, Gavi.

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