An African plan to control COVID-19 is urgently needed

The Lancet
As governments in countries hit hardest by COVID-19 prepare vaccination programmes against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), other nations face a more uncertain future.

In Africa, for example, the pandemic continues to grow, but heterogeneously. Cases are rising sharply in Morocco, Tunisia, Algeria, Libya, Egypt, and South Africa. But in Africa’s most populous nation, Nigeria, WHO reports only 1173 deaths from COVID-19. Although data are sparse, the first wave of the pandemic seemed to peak in early August. Numbers of COVID-19 deaths declined through September, but the disease has been stubbornly persistent since then, burning slowly through communities throughout the continent. As of Dec 1, WHO reports 1·5 million cases and 33 573 deaths from COVID-19.

Despite the diversity of the pandemic in Africa, and the fact that many countries appear to have been spared the human calamity that has afflicted so many nations elsewhere, the continent still needs a vaccination plan. COVID-19 is a global health emergency that demands a global solution. No community is safe from SARS-CoV-2 unless all communities are protected. Further national lockdowns to drive down the prevalence of the virus will not provide a permanent answer to the epidemic threat. With tens of millions of Africans plunged into extreme poverty by COVID-19, further mandates to shut down economies will precipitate humanitarian and health crises.

COVAX, the Gavi-led financing mechanism to provide COVID-19 vaccines to low-income and middle-income countries (LMICs), plans to have 2 billion doses of vaccine available by the end of 2021. 97 high-income countries have now signed up to the initiative and 92 LMICs—including most African countries—will be supported by the plan. COVAX aims to secure enough doses of any vaccine to provide protection to an initial 20 percent of people in signatory countries. That level of coverage may help with the immediate aim of protecting the most at risk, but it is insufficient to achieve herd immunity. For a virus whose R0 is 2·5, around 60 percent of the population would need to be vaccinated to extinguish community transmission. And that figure assumes a perfect vaccine. For a vaccine with an efficacy of 90 percent, the proportion of the population to be vaccinated rises to 67 percent. If a vaccine with an even lower efficacy is used, the proportion will rise still further. The University of Oxford–AstraZeneca partnership has pledged to supply COVAX with “hundreds of millions of doses” of their vaccine, which—importantly for African countries—needs only the standard 2–8°C cold chain.

In July, the African Union Commission and the African Centre for Disease Control and Prevention launched a safety-net strategy to secure access to vaccines and treatments for countries on the continent. The Consortium for COVID-19 Vaccine Clinical Trials (CONCVACT) has already set up several Africa-based clinical trials of vaccines and scaled up production of both testing and diagnostic facilities. CONCVACT has orchestrated pan-African cooperation, set up information-sharing platforms, and led the creation of technical capacity for screening and surveillance.

Despite these advances, the vaccination of two-thirds of Africa’s 1·2 billion population will still require huge investment and faces substantial logistical challenges. According to a WHO analysis, the African region has an average score of 33 percent readiness for a SARS-CoV-2 vaccine roll-out—far below the necessary 80 percent benchmark. The estimated cost of delivering a vaccine to priority populations alone is estimated to be around US$5·7 billion—and this figure does not include the additional cost of injection materials and other consumables.

Further concerns include transparency and patent protection. Médecins Sans Frontières (MSF) points out that the six front-running COVID-19 vaccine candidates have had $12 billion of taxpayer’s money invested in their development. Yet vaccine deals with countries are often “shrouded in secrecy”, MSF argues. There have also been calls to waive intellectual property rights on COVID-19 vaccines. India and South Africa first made the request in October. A waiver would help ensure more equitable access to a vaccine and could be a turning point in the pandemic for nations with few resources.

Whether existing initiatives will translate into an effective and universal COVID-19 vaccination programme for Africa remains to be seen. But as the governments of wealthy countries push their way to the front of the vaccine queue, their leaders would do well to remember that without a vaccine plan for African countries and other nations with resource constraints, the protection of their citizens from COVID-19 will be an illusory victory. – The Lancet