In what may be a first for the African continent, the Ugandan government has decided to allow private sector health providers to import and distribute their own COVID-19 vaccines amidst strict regulations – in an effort to expedite the country’s vaccination drive, which is caught in the crosswinds of vaccine supply shortages plaguing the entire region and low-income countries more generally.

The Ugandan decision comes just after the Kenyan government decided last week not to allow the private importation of vaccines –  due largely to fears of fake vaccines swamping markets.

The immediate future of vaccine roll-outs in African countries remains uncertain in the wake of India’s recent decision to suspend for the immediate future, its bulk supplies of AstraZeneca vaccines, produced by the Serum Institute of India (SII), to low-income countries in Africa, Asia and the Americas.  Those countries are largely  dependent on vaccine deliveries arranged through the WHO co-sponsored COVAX facility.   Meanwhile, South Africa and Nigeria have also made strategic decisions to shift away from further bilateral purchases of the AstraZeneca vaccine in favour of the Johnson and Johnson jab – which will nonetheless take longer to deliver.

In an effort to expedite the vaccination drive, the Ugandan Ministry of Health last week outlined the rules whereby the private sector will be able to participate in the  COVID-19 vaccine supply chain, including an accreditation process which will require them to source the vaccine, detail the quantities to be imported and the cold chain capacity of the provider.

Providers will  be required to import only those vaccines that have received an “Emergency Use Listing” from the World Health Organization as well as being cleared by the national drug regulator, the Uganda National Drug Authority.

Uganda has thus far vaccinated 80,836 people since vaccinations commenced on 10 March.  The country received a first tranche of 864,000 doses of the AstraZeneca COVID-19 vaccine on 5 March from the COVAX facility – out of a total expected COVAX supply of about 3.5 million doses that was supposed to be delivered over the course of 2021.  But as with many African countries, COVAX vaccine deliveries for April, May and possibly even beyond, are now in jeopardy due to the suspension of Indian exports – as SII redirects its vaccine production to domestic use in India, which is seeing a surge of COVID cases.  

“A list of facilities will be provided and a Memorandum of Understanding will be  signed spelling out the modalities of the collaboration,” said Jane Ruth Aceng, the Minister of Health, regarding the private procurement arrangements. She added that the vaccines authorized for import to private sector health service providers, would have to be administered by that same health care provider – and could not be resold again. The ultimate goal, said Aceng, was to protect the consumer.

Safety of Citizens is Paramount

Alfred Driwale, the programme manager of Uganda National Expanded Programme on Immunisation echoed Aceng’s sentiments: “One of the roles of the government is to protect the public so we want to know most importantly the source of the vaccine. The safety of the people is paramount”.

The private sector represents half of all health services delivered in Uganda.  But up until the pandemic, private health care providers have not been deeply involved in mass immunisation programmes. In Uganda, over 90% of immunisations are administered free of charge by the public health system, which receives support from GAVI, The Vaccine Alliance.   

The Private sector will also be required to import the vaccines through the National Medical Stores which is the national agency for the storage, importation and distribution of all drugs in Uganda. This will ensure that the maintenance of the cold chain and viability of the vaccines, officials said.

“If the private sector will help us to acquire COVID-19 vaccines it is good and we have created rules to have order ” said Driwale. He said a few private players have approached the Ministry of Health, but none have qualified yet.

High Demand, Low Supply Opens Market for Fake Vaccines

However, allowing the private sector to participate in the COVID-19 supply chain at a time when demand outweighs supply, opens the market to fake vaccines and exploitation and abuse, Gideon Badagawa, the Executive Director of the Private Sector Foundation-Uganda told Health Policy Watch. Badagawa said he is against complete liberalisation of the COVID-19 vaccines for the private sector in Uganda  and said the government should remain in control to maintain standards and enable the private sector to follow specifications. 

In cases where private sector health services are authorized, participation should be in a ‘phased manner’ – allowing only those who meet the government specifications to participate. In the case of COVID vaccines, he said, only about 10 health sector entities would have the capacity.  “They can allow just a few players initially because the COVID-19 vaccines are delicate and not everybody can participate in the market,” said Badagawa, adding that: “If we import in partnership with the government it will enable us to follow the specifications that are required”.

Grace Kiwanuka, Executive Director of the Uganda HealthCare Federation had mixed reactions to the decision. “It is a right step to mobilise domestic resources and it helps us to achieve herd immunity which would be difficult if only left for the government,” she said. But on the other hand, she warned that Uganda is an open economy – and privatizing the vaccine market opens the way for profiteers to substitute saline and glucose solutions for genuine vaccines.

For just those reasons, Uganda’s neighbory, Kenya, on Friday said that it would ban the “ importation, distribution and administration of vaccines, until such time there is greater transparency and accountability in the entire process”.  The Kenyan government’s ban comes amid fears that counterfeit inoculations may otherwise infiltrate the market.  

South Africa’s Medical Aid Giant Ready To Help With Vaccinations

Meanwhile, frustration over the slow pace of vaccination in South Africa also saw the health services giant, Discovery Health, announce plans last week to vaccinate up to 550, 000 of its high risk members within weeks of vaccines becoming available, through a partnership with the South Africa government.  In the case of South Africa, however, the supplies would still be procured by the government, and then distributed by Discovery Health. 

The private medical aid company said it plans to vaccinate up to 50, 000 of its members a day. 

Discovery Health CEO Adrian Gore said the company would be establishing  20 large-scale vaccination sites and plans to vaccinate three million adult beneficiaries, beginning on May 1.

Gore  said Discovery would not be importing any vaccines, but that it was ready to vaccinate its members in high volumes when the supply of vaccines became available from the South African government’s health department.

“Our segmentation approach is aligned with the national prioritisation framework, as guided by the ministerial advisory committee. Simply, this means that we know exactly who should receive the vaccine first, and we will communicate quickly with our scheme members to confirm their place in the roll-out, contingent on vaccine supply,” Gore explained.

“This would help realise meaningful health and economic outcomes, and avoid many preventable Covid-related deaths,” he said, adding that those who qualify to receive the vaccine, will be contacted by the medical aid.

Abacus pharma Limited , one of the companies hoping to participate in the COVID-19 vaccine supply chain in East Africa, said collaborating with the government would help expedite the COVID-19 vaccination drive.

“Opening up the vaccines to the private sector will help accelerate the process of providing protection as long as it is done in a thoughtful manner and in line with regulatory requirements,” said Rajaram Sankaran, Group Chief Executive Officer & Director on Board at Abacus Pharma (Africa) 

“We would be glad to collaborate with the government such that we complement their efforts and not duplicate. Such public-private partnerships would be more sustainable in the long run,” Sankaran told Health Policy Watch. 

Image Credits: ABC7 News.