Mixed Reaction in Africa to WHO’s New Position on Booster Shots

IDABAN, Nigeria – The decision of the World Health Organization (WHO) to drop its opposition for COVID-19 vaccination booster shots has raised concerns in Africa about the potential depletion of COVID-19 vaccine doses available to African countries. 

On Friday, Health Policy Watch reported WHO recommended the wider administration of a third shot of the Pfizer-BioNTech mRNA vaccine – as well as jabs for children age 5 and older.

In its statement, the global health body said it was recommending boosters for most adults because in the short-term, “a third dose (booster dose) may fully or partially restore vaccine effectiveness”.

WHO also stressed that its new recommendation came after updated projections that should ensure ample supplies for Africa through COVAX, the global vaccine facility and bilateral deals to accommodate low-income countries, even with widespread administration of boosters.

Along with sharply increased vaccine production by end 2021, the reduced severity of Omicron may also reduce vaccine purchases in high-income countries – further easing supply pressures, according to a report by the forecasting firm Airfinity on Friday.

However, Nigerian public health consultant, Ifeanyi Nsofor told Health Policy Watch the WHO’s new position still has provoked concerns about COVID-19 vaccination efforts in Africa after months of scarcity.

“I’m absolutely worried that the new prioritization for boosters is going to affect Africa’s vaccine shipments with everyone now going for boosters,” he said.

He added, however, that insofar as many low- and middle-income countries have already stockpiled vaccines for booster campaigns, then using the doses for boosters could also prevent wastage.

“Giving boosters in low- and middle-income countries (LMICs) makes sense because of the likelihood of vaccines expiring thereby preventing wastage. Beyond that, full vaccination is no longer two doses. It is now plus a booster dose. So, LMICs have to be in line with global practice,” he told Health Policy Watch.

Moreover, the global health body’s new position on boosters also provides a signal to low-income countries that can thus prime their health systems accordingly, with support from COVAX and donors – and that will help citizens avoid future discrimination, e.g. in international travel. 

More foot-dragging on boosters, he added, could have further put LMICs at a disadvantage because of the changing definition of ‘fully vaccinated’ in many high-income countries to mean three jabs – regardless of WHO’s positions.  “People from the global south could be denied entry to western countries because they have not been boosted,” he told Health Policy Watch

COVID cases, deaths drop in Africa

Dr Matshidiso Moeti, WHO Regional Director for Africa

Meanwhile, the WHO this week reported that both COVID cases and deaths are now in decline across the continent – effectively concluding Africa’s shortest upsurge yet, lasting just 56 days.

Addressing journalists on Thursday, Dr Matshidiso Moeti, WHO Regional Director for Africa said weekly COVID-19 cases in Africa have now dropped significantly and deaths dipped for the first time since the peak of the fourth pandemic wave that was propelled by the Omicron variant.

“Newly reported cases fell by 20% in the week to 16 January, while deaths dropped by 8%. The decrease in deaths is still small and further monitoring is needed, but if the trend continues the surge in deaths will also be the shortest reported so far during this pandemic,” Moeti told journalists.

In South Africa where the highest number of COVID-19 cases and deaths have been reported in Africa, and where the continent’s first sequence of the Omicron variant was reported, the country has now recorded a downward trend over the past four weeks. 

“Only North Africa reported an increase in cases over the past week, with a 55% spike. Cases fell across the rest of Africa, where, as of 16 January, there were 10.4 million cumulative COVID-19 cases and more than 233 000 deaths,” Moeti said.

Africa is yet to turn the tables on the pandemic

Regarding the severity of the Omicron variant, the data from Africa has shown that like elsewhere, the recent wave resulted in the lowest cumulative average case fatality ratio of the pandemic. The proportion of deaths to confirmed cases—to date in Africa stands at 0.68%, in comparison with the three previous waves during which the case fatality ratio was above 2.4%.

In spite of the comparatively more favorable outcomes for the continent regarding the Omicron variant, and the COVID-19 pandemic in general, Moeti urged prudence.  

“Impact has been moderate, and Africa is emerging with fewer deaths and lower hospitalizations. But the continent has yet to turn the tables on this pandemic,” she told journalists.

The slow pace of vaccine roll out on the continent continues to increase the chance of more virus mutations emerging, putting the continual effectiveness of available tools at risk.

“So long as the virus continues to circulate, further pandemic waves are inevitable. Africa must not only broaden vaccinations, but also gain increased and equitable access to critical COVID-19 therapeutics to save lives and effectively combat this pandemic,” she said.

Adequate testing kits available for Africa – Africa CDC 

Dr John Nkengasong, Director, Africa CDC

While the continent still has a wide gap in COVID-19 vaccination, the continent’s public health stakeholders told Health Policy Watch that the continent is not in short supply of antigen testing kits – a problem that has been seen recently in some rich countries as a result of the huge Omicron surge. 

Consequent shortages of PCR tests forced the UK government to revise aspects of its COVID-19 testing policy, pivoting to more rapid tests – a strategy adopted in many other countries as well. But the surging reliance on rapid tests then created bottle necks and shortages of rapid tests with both pharmacies and manufacturers running short of supplies.  In the United States, US President Biden finally intervened last week to buy a billion tests and distribute them freely to Americans, beginning on 19 January.   

On the contrary, Africa is not faced with such shortage, John Nkengasong, head of the Africa Centres for Disease Control and Prevention (Africa CDC) told Health Policy Watch.  

“For rapid antigen tests, we have not yet seen a situation on the continent where we have a shortage of those tests,” he told Health Policy Watch.

That is perhaps due to the fact that even before the Omicron wave, Africa had begun stockpiling the rapid COVID tests, which are less expensive and easier to administer, creating a robust supply chain. 

Dr Abdou Salam Gueye, Regional Emergency Director at the WHO Regional Office for Africa also told Health Policy Watch that the global health body is continually working with African countries to improve their testing plans.

“COVID-19 is the first pandemic of this magnitude in our lifetime and we are working with countries already in order to do the best to scale it up,” he said.

In 2022, Nkengasong said efforts will be geared towards expanding testing across the continent, in addition to helping countries to quickly rollout vaccines.

“There are three things that we will be emphasizing in 2022, scaling up testing, scaling up vaccination and making sure that we work hard to have access to new drugs for treating COVID-19,” he said.

Image Credits: Paul Adepoju , WHO AFRICA.

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