Africans are learning lessons from other world regions

How do you assess the current state of African Covid-19 vaccination campaigns?
Well, it may surprise you, but I think we are doing pretty well. One can always debate whether a glass is half empty or half full. There is actually plenty of good news. The best is that vaccinations have begun in many African countries. In the past, our continent would wait for a decade or so before an innovative pharmaceutical became available. This time, it only took a few months. That is a very good start and I am quite confident that we can build on it further.

So COVAX, the multilateral initiative to provide vaccine doses to at least 20 % of partner countries‘ populations, is doing its job?
Yes, it is, though it is obviously not fulfilling all expectations. Access to vaccines is not equal around the world. The situation is much better in high income countries than it is here. The great achievement, however, is that COVAX has been facilitating vaccine supply to developing countries, and as regulators are approving more and more vaccines, I hope that supply will improve fast. The African Union is also playing a useful role in procuring vaccines, and national governments have made agreements with vaccine suppliers too. After a slow start, I believe vaccination campaigns will pick up speed fast.

Should the WTO (World Trade Organization) waive patents internationally to boost supply?
No, I do not think it is a priority now. What we need in this time of crisis, is close cooperation. All parties involved must do their best to speed up vaccine production and ensure global equity on access. Extended legal disputes will not help, and licensing plus the sharing of technology will take a lot of time anyway. The essential thing now is to focus on protecting as many people as possible as fast as possible. I’ll admit that not all signs have been good so far. It is absurd and unacceptable that small, least developed nations in Africa have been made to pay higher prices per vaccine dose than the developed nations. Oxford University and AstraZeneca have set the right example with generous licencing and prices that cover their costs. More generally speaking, patents are currently not what is restraining people’s access to vaccines.

What are currently the main obstacles in ­Africa?
Well, vaccine supply is certainly the main problem. To a large extent, African countries have been depending on imports from India. The serum Institute of India has the license to produce the AstraZeneca vaccine, but India has stopped exporting in view of the dramatic suffering coronavirus is causing at the domestic level. So yes, Africa needs both vaccine supply and vaccine delivery to increase fast. That said, we must also rise to daunting logistical challenges. We don’t want to store vaccines once we get them, we want to get them into people’s arms. One problem is that cold-chain infrastructure is needed, but not available everywhere. That, in turn means, that the most innovative mRNA vaccines are not a good option for our remote areas because they need to be kept particularly cold. It certainly makes more sense to expand existing cold-chain networks to ensure effective distribution of vector vaccines than to build entirely new infrastructure to distribute mRNA vaccines.

Even expanding the existing networks must be hard in places where electric power is not available or erratic and where the roads are basically dirt tracks.
Yes, it is difficult, but we do have ample experience in how to rise to those challenges. African vaccination campaigns have been quite successful in the past decade, so we have foundations we can build on. On the other hand, the scale of operations is different this time. In conventional vaccination campaigns, children are the target group. To contain the spread of Covid-19, we must inoculate adults.

What kind of “soft infrastructure” do you need? I imagine that media outreach is important for example.
Yes, people have lots of questions about vaccinations. We need staff who are able to answer those questions. It is not enough to have doctors, nurses and paramedics who can competently administer a shot. They have to be able to address people’s worries and gain their trust. After all, we are not only fighting a pandemic, but also an infodemic. A lot of the information that is circulating out there is not very good or even entirely false. At this point, we do not know how common vaccine hesitancy is, though we do know it exists. So long as we do not have enough vaccines for great numbers of people, we cannot find out what share of them does not have faith in science-based medicine. Quality reporting in mass media concerning what Covid-19 is, how it is spread and how one can protect oneself will certainly help. Non-governmental organisations are playing a role in awareness raising as well and contribute to make people want to get vaccinated.

Who is responsible for making vaccination campaigns work?
National governments bear the main responsibility. Only they can do the necessary regulatory work, including the approval of pharmaceuticals. Moreover, they have the authority to involve all stakeholders. If you leave health care entirely to the market, poor people and disadvantaged communities will not be served. A vaccination campaign is not worth much, however, if it only reaches the most prosperous 20 % or so. Even they will not be safe when an epidemic escalates and new strains of the disease keep emerging. Only governments can ensure that health measures become universal, which for practical purposes means that they reach at least 80 % but preferably 95 % of the population or so. Best practices include setting the right incentives for getting private-sector institutions on board.

To what extent has Covid-19 disrupted other vaccination campaigns and health care in general?
The impact was – and is – tough. In many cases, nonessential services including vaccinations have been suspended. Health staff has become even more overburdened and exhausted. Our capacities are stretched even in good times. We know that, even in good times, most Africans do not have access to professional health care when they need it. These are not good times. The sad truth is that the prevention and treatment of other diseases are currently being neglected because coronavirus is absorbing capacities. Lack of prevention, however, means suffering in the future. Tuberculosis and HIV/AIDS programmes have recently not been getting the attention they normally get, and even the treatment of patients has often deteriorated.

You are saying that even though, the pandemic has not hit African countries particularly hard so far. Reasons include a large share of young people and the fact that much public life takes place outdoors. That was said about India too, however. Should the pandemic escalate on your continent the way it recently has there, things will get much worse.
Yes, there is a risk of the situation deteriorating. We must prepare for the worst. As I specialise in vaccinations, I am not involved in patient care, so I cannot give you a full and realistic picture of what is going on in hospitals and health centres. The good news, however, is that Africans are observing what is happening elsewhere, and we are learning those lessons. African governments took action early on when they saw Europe’s pandemic situation early last year. That certainly helped in terms of softening the impact of Covid-19. Our ­authorities know that Africa may become the next India. Indeed, we see signs of a third wave potentially starting in South Africa. The lesson is that we must not let down our guard. Vaccinations must go on; hygiene measures must go on. African governments and the African public in general realise that the situation is dangerous.

What is the responsibility of donor governments in your eyes?
I think they bear responsibility at three levels:

• Their highest-level responsibility is to keep up with development of new tools to combat the new variants. At present, low-income countries depend on the medical progress made in high-income countries.
• Their mid-level responsibility is to share data regarding how a disease spreads, how effective a pharmaceutical is or what is like to constrain a vaccination campaign. We can – and will – learn from their experience and apply what is relevant to our context.
• Their responsibility at the grassroots level of developing countries is to support capacity development. Cooperation is really important, including in terms of building skills. Transferring money will not solve the problem in the long term because human capital is essential too.

Benjamin M. Kagina is a senior research officer who works for the Vaccines for Africa Initiative (VACFA) at the University of Cape Town’s School of Public Health and Family Medicine.
benjamin.kagina@uct.ac.za