It is every medical scientist’s dream to play a role in healing the world of any disease and to see the every human being living a healthy illness-free life. I remember in late February when COVID-19 was finding its way into Africa, my family and friends back in Botswana wouldn’t stop begging me to come back home to run away from the disease as it was beginning to spread rapidly in South Africa. What they failed to understand at that moment was that when health situations get more and more challenging, that’s where we get even more interested, more curious, more involved, all with the aim of getting to the bottom of whatever health problem is arising, as soon as possible, and to save as many lives as we can.
By virtue of me being an MSc Medicine (Vaccinology) student at the University of the Witwatersrand, I got to live one of my biggest dreams ever; contributing to healing the world in such a crucial and dire time that the entire earth is facing. I became part of the group that is running the ChAdOx1 nCoV-19 vaccine trial at the Chris Hani Baragwanath Academic Hospital site. The vaccine was developed at Oxford University with the first Phase 1 trial initiated in the UK on April 23rd, 2020.
Three further randomized controlled trials were started across the UK, in Brazil and in South Africa. The candidate consists of a replication-deficient chimpanzee adenoviral vector ChAdOx1 which contains the SARS-CoV-2 structural surface glycoprotein antigen (spike protein; nCoV-19) gene. There is another recently initiated Phase 1/2 trial of the vaccine in Kenya.
When you get involved in such a huge trial you get to experience and appreciate the massive amount of work being done to ensure the trial runs smoothly, the extensive planning done prior to the resumption of the trial, the resources put in, the amount of money spent to put everything together and the level of coordination coupled with expertise required to carry out the trial. All these made me realize how far a lot of African countries are from carrying such huge clinical studies, why we continue to rely on external funding for our studies and why it often takes time for us to implement health interventions that we so desperately need. So are we ready for the coming vaccines?
COVID-19 vaccines to Africa
It is no secret that every country out there is scrambling to have much of its own population protected from the COVID-19 disease as quickly as possible with minimal expenditure, and the best way to do that currently is through vaccination. Several candidates have now released their safety and efficacy information, now working on getting approval to be rolled out in different countries.
The Pfizer/BioNtech vaccine has already been approved in both the UK and the United States, with both nations having already started their vaccinations. Prior to administering the first jab on its population, the UK had ordered 40-million doses of the vaccine and 7-million of the yet-to-be approved Moderna candidate. The FDA in the U.S has planned a meeting on December 17th to consider the application by Moderna for the approval of their vaccine in the country. This goes on to show that Africa is a long way from getting vaccines through the normal purchase as these big economies have already pre-ordered almost all the doses that these two companies will produce for the remainder of 2020. Both Moderna and Pfizer/BioNTech have announced that they will be able to produce about 70 million doses of their vaccines by the end of 2020, and those are the doses preordered by the two superpowers.
Africa’s best hope lies in the Oxford/Astrazeneca vaccine candidate for several reasons. There are a number of factors to be considered before each country can decide which vaccine to procure for its population. The major one being the cost of the dose, which Oxford/Astrazeneca comes in advantageous for African nations as its dose costs about a tenth of the other two. The second factor is storage. The Oxford/Astrazeneca can be stored between 2°C and 8°C compared to the Pfizer/BioNTech vaccine which requires refrigeration at -70°C which will be very difficult for most African nations to manage. The Oxford vaccine also offers a longer shelf-life of 6-months. The third factor is production capacity by the producing companies. Oxford/Astrazeneca have reported that they can produce about 200 million doses by the end of 2020 and about 3 billion doses by the end of 2021 compared to the other two candidates as they reported lower production volumes.
What do these vaccines mean to Africa
The obvious positive gain from enough successful vaccination during this pandemic is that life will go back to normal, Africa’s economy will recover and COVID-19 infections will start dropping. However, all these come at a huge cost and efforts that have to be immaculately carried out with well-trained personnel, adequate resources as well as concerted coordination from everyone. This means that governments in all African states have to be thoroughly pro-active in everything they do, those that will engage COVAX for vaccine procurements will have to do so well in time to avoid missing out on doses. COVAX is a third pillar of the ACT Accelerator programme, aimed specifically at ensuring equitable access of vaccines to small countries out there so that small economies do not get left behind. However, that requires governments out there to act quickly to engage COVAX and secure their initial doses to give to their first groups of people.
It should be a lesson going forward that we should prepare better for future pandemics because this will not be the last one. Also, the next one(s) we experience may even hit harder than COVID-19 so Africa can no longer afford to be on the back foot all the time. On the bigger scale of thinking, we should work towards building our own pharmaceutical manufacturing plants, producing our own PPE, our own clinical and surgical equipment production plants and reduce our over reliance on external assistance. This pandemic should have taught us that every country will look after its own people before they can start thinking about offering another country some assistance.