COVID-19 vaccination in Africa may be shifting from a supply challenge – to one of effective vaccine distribution, declared  a senior World Health Organization official in the African Region on Thursday. 

African countries will have adequate access to COVID-19 vaccine supplies in 2022, said Dr Abdou Salam Gueye, Director of Emergency Preparedness and Response, WHO Regional Office for Africa. 

However, significant challenges remain in ensuring that available doses are administered efficiently, and vaccine hesitation is overcome, Gueye stressed. 

“We can tell you that in 2022 in Africa, the countries that express the need to receive vaccines will receive it, and they will receive enough vaccines,” he said at a press briefing hosted by the Africa Regional Office, based in Brazzaville. 

https://twitter.com/i/broadcasts/1kvJpAlZmZZxE

“The problem will be though what we are doing regarding operationalizing those vaccines in the countries. From taking them from the capital cities to where they are needed including at the sub-regional level,” Gueye told Health Policy Watch.

In Geneva, however, WHO’s Director General, Dr Tedros Adhanom Ghebreyesus sounded a somewhat different note.  He warned a meeting of WHO’s emergency committee that so far some 1 billion Africans, 85% of the continent’s population, have yet to receive a single vaccine dose, and  “ending the inequitable distribution of vaccines, therapeutics and diagnostics remains the key to ending the pandemic.” 

Need for the right mix of strategies to promote vaccine uptake 

According to Gueye, however, there are now many vaccines within the delivery pipeline for Africa – and countries are now being offered more from various suppliers every day. 

So finding the right strategy in order to provide vaccines to all the people who are demanding vaccines is now a higher priority for the continent considering several studies showed largely wide acceptance of the vaccines among Africans.

“In a World Bank-sponsored study, more than 80% of African participants demanded and accepted the vaccines when they were offered the vaccination. There is a positive side if the governments are working toward a good operationalization of  vaccination,” he added.

Treatment also is now a priority

Gueye stressed that treatment options now need to be reinforced, as well, in the African context. 

“COVID is the first pandemic in our lifetime of this level and it has so much impact but it is not the only pandemic that existed and testing, treating were pivotal resources used to fight those diseases (HIV). I do believe also that in the third year of COVID-19, testing, caring for patients and treating them will be an important pillar to develop in all countries,” he said.. 

“It will not be only for cases that are severe or critical, it will be for almost all the cases where something may be done. If the treatment is done appropriately and on time, it might limit the infection of other patients. This is why testing, caring and treating are the priorities for WHO and we are working with countries already in order to do the best to scale it up.

Race for Paxlovid

At an earlier briefing Thursday by the Africa CDC, the Director John Nkengasong, told journalists that talks with Pfizer are underway to assure African countries access to the company’s new Paxlovid treatment.

“We are in really close discussions with Pfizer to see what can be done to make the drugs available on the continent and accessible on the continent, that is, the Paxlovid drugs,” said Nkengasong.

In clinical trials, the treatment has demonstrated a 90% success rate in prevention of severe disease if taken at early stages of infection. 

Already approved by the US FDA and the United Kingdom’s Medicines and Healthcare products Regulatory Agency, the global race for the pills is already underway.

The United States government alone has signed an agreement for 10 million courses of the drug at $530 per course.  

And according to other reports, a handful of rich countries have already secured most of Pfizer’s own supply of the new drug. 

I started tracking Paxlovid government procurement announcements outside of the MPP license territory.

A handful of rich countries have already placed orders for nearly 30 million courses, securing the estimated supply from Pfizer in the next six months.https://t.co/URaJdESyWV pic.twitter.com/7T8b3U8hAG

— Luis Gil Abinader (@abinader) January 9, 2022

This means that low-income countries will need to rely up generic versions that are to be produced royalty-free, under the terms of a recent licensing agreement between Pfizer and the Medicines Patent Pool – with the first such license with Bangladesh struck just this week. 

https://twitter.com/RebeccaDRobbins/status/1480633419528687617

However, Pfizer’s new agreement with MPP coveres only 95 of the lowest income countries. It thus leaves many lower-middle and middle-income countries out in the cold –  and potentially unable to secure either the discounted generics or the higher-priced Pfizer versions of the pill. 

Is the shift to a focus on treatment – also a reflection of the failure of vaccination campaigns? 

Meanwhile, Dr Anita Graham, an internist at the University of Witwatersrand in South Africa noted that the decision to commence conversations in Africa around treatment implies failure to protect Africans against severe infection, in addition to dealing with a predominantly unvaccinated population.

“So once we have failed and we are dealing with a population who now has severe disease, we need to think about pharmaceutical management and there definitely are agents like the new Pfizer drug that has a therapeutic advantage — decreases the chance of death or ICU admissions and these drugs have been shown with early evidence to work. H

Hwever, they come with contingencies, and this is mostly cost and availability,” Graham told Health Policy Watch.

“So I don’t think that is an isolated solution, although I do think it is part of the plan, and part of the way forward in treating severe COVID,” Graham said.

Omicron hospitalization in South Africa – unvaccinated cases seem to predominate

With Omicron now accounting for up to 95% of new cases in South Africa, Graham provided said that most of the patients that she has admitted and treated for COVID-19 were largely unvaccinated – or in some cases vaccinated over a year ago. 

“Anecdotally, I can say that I have not had a single patient that is fully vaccinated, hospitalized,” she said, adding, “The patients that were hospitalized are those who are unvaccinated, partially vaccinated, patients who have been vaccinated more than a year ago whose immunity might have waned, and patients who have severe comorbidities,” she said.

For patients with comorbidities, Graham noted that those with comorbidities that are fully vaccinated but are hospitalized are often hospitalized for non-COVID-related disease.

“For instance, they are admitted for cancer and they coincidentally swabbed positive for Omicron,” she said.

Graham also noted that while all answers are not yet available, what is increasingly becoming important is the duration of the first infection to ascertain whether a previously infected individual would have some protection against new infections.

“With time, there is natural waning of immunity and with time there will be no leftover residual antibodies to fight a new variant. However, with a seroprevalence of more than 70% in some parts of Cape Town in South Africa, this high seroprevalence may be contributing to why we are having a less severe fourth wave. But my belief is that it is multifactorial — natural seroprevalence together with vaccination and the Omicron variant possibly being less virulent,” she added.

COVID Infections rising in North & West Africa; waning in South; high test positivity rates reflect under-reporting 

#COVID19 deaths in #Africa rose by 64% in the seven days ending on 9 January compared with the week before mainly due to infections among people at high-risk.

Deaths in the fourth wave are however lower than in the previous waves. Hospitalizations have remained low. pic.twitter.com/8IuOSoTXlF

— WHO African Region (@WHOAFRO) January 13, 2022

While COVID cases in southern Africa have now plateaued or are declining, those in West Africa and North Africa are now rising at worrisome rates – and overall deaths rose by 64% in the first week of January, the Orgaization said. 

“South Africa, where Omicron was first reported, saw a 9% fall in weekly infections. East and Central Africa regions also experienced a drop. However, North and West Africa are witnessing a rise in cases, with North Africa reporting a 121% increase this past week compared with the previous one,” WHO’s Gueye stated.

Nkengasong also revealed that the case fatality rate (CFR) of COVID-19 in Africa is 2.3% which is higher than the global average of 1.8%. Africa also accounts for 4.3% of deaths reported globally – disproportionate to the number of overall cases reported. 

Regarding testing, Africa has conducted over 91 million COVID tests with a cumulative positivity rate of 11.1%.  That high positivity rate also suggests high levels of under-reporting of overall infections, experts say. 

60% of African-acquired doses have been distributed while expired dose donations from rich countries also remain an issue 

As of now, Africa CDC reports that a total of 563 million COVID-19 vaccine doses have been procured by 54 Member States out of which 340 million doses have been administered (60.4% of Africa’s total supply). So far only 10.1% of the African population has been fully vaccinated.

On Thursday, the global health analytics firm Airfinity estimated that 241 million COVID-19 vaccine doses purchased by the G7 and EU will go unused and will expire by March 2022. Airfinity said its forecast is based on analysis of G7 and EU vaccine supply while accounting for doses administered, boosters for everyone over 12 years-old, vaccine hesitancy and donations.

Rasmus Bech Hansen, Airfinity’s co-founder and CEO said the numbers illustrate, once more, how vaccinating the world is now largely a distribution problem, rather than a supply issue. 

“Even after successful booster rollouts, there are surplus doses available that risk going to waste if not shared very soon. The emergence of Omicron and the likelihood of future variants shows there is no time to waste,” Hansen said in a press release.

In a separate interview, Seth Berkley, the CEO of Gavi, the Vaccine Alliance and a leader of the WHO co-sponsored COVAX global vaccine facility, also underlined the distribution challenges faced. He said that by July 2022, it is possible for the world to produce vaccine doses sufficient to immunize 70% of the global population, as per WHO’s global target for 2022.

He added that there are “between 20 and 25 coutries that have been problematic on absorption. And those are getting special attention.”  

“In terms of the number of doses that will exist in the world, it is possible in terms of what we have visibility on. But at the end of the day, we don’t know what’s going to happen with Omicron, boosters, new variants, manufacturing problems, etc.,” he told Politico.  “The critical issue is what does each country want? At the end, we will serve what the countries want…”

Image Credits: Paul Adepoju, USAID, Airfinity .