on Thursday, 28 January 2021.

Who will live; those with money or all of us?
The Covid-19 pandemic is raging in Europe and USA and infection rates have exceeded those seen during the first wave last winter and spring. Political leaders are under stress and are taking drastic steps to reduce transmission and minimize mortality and morbidity which has provoked riots in some countries. These countries are working feverishly to rapidly vaccinate the population with a view to reaching 70 – 80% of the vaccinated population which is needed achieve effective herd immunity which can enable return in these countries to normal social and economic life as well as save lives.

There is panic in some quarters resulting in decisions to grab all available COVID-19 vaccines including doses to be produced in the future. There was for example a highly publicized call this week that requires vaccine manufacturers not to export any vaccines without permission from political leaders. Vaccine nationalism has cropped up as new terminology. It is counterbalanced by regular calls from the WHO Director-General, Dr. Tedros, and some European leaders, championing humanity, equity, and solidarity to spare and avail some vaccines to LMICs who have no resources to develop and make vaccines for themselves. There is also the epidemiological argument that pockets of the virus anywhere is a threat to all countries and no country is safe until all countries are safe.

It is this spirit that triggered global leaders to launch COVAX, a solution intended to accelerate the development and manufacture of COVID-19 vaccines, diagnostics and treatments, and guarantee rapid, fair and equitable access to them for people in all countries. Its secretariat is at GAVI in Geneva, a multilateral agency that is already coordinating the supply of vaccines to LMICs for many years. COVAX is working with manufacturers to provide investments and incentives to ensure that manufacturers are ready to produce the doses we need as soon as a vaccine is approved. The Facility also uses the collective purchasing power to negotiate competitive prices from manufacturers.

In 2016, I was a member of a global Commission that produced a report titled “Neglected Dimension of Global Security; a framework to counter infectious diseases crises”. This report admits the sobering truth that there is limited capacity for producing potentially lifesaving vaccines, and not everyone is able to get needed medical products at the same time. This requires difficult decisions about who gets the medical products first. The ability to pay should not determine where products are distributed, as in the case of a country that wishes to stockpile vaccines for its low-risk population. Rather, those who are at the greatest risk and in imminent danger during a crisis—whether they are front-line health workers or a vulnerable local population—should have priority.

This means that, in order to ensure equitable access and distribution of vaccines to those in need, countries must refrain from nationalizing their vaccine manufacturing output. This was illustrated during the H1N1 outbreak in 2009, when governments with preexisting contracts sought to preserve the capacity of firms located within their territorial borders to inoculate their own citizens before giving or selling to other countries. The rationale, which is understandable, was that the governments had an obligation to their citizens before exporting vaccines to other populations. However, the reality was that these populations were at very low risk and the prioritization was consistent with good public health policy.

Africa is currently experiencing a new spike of COVID-19 infections. While we appeal to the global community for solidarity, empathy and humanity, we need to appreciate that these infectious diseases crises are going to increase in frequency. We must call upon African countries to take note; mount an effective response now and prepare for the future pandemics by developing internal capacity to develop, manufacture and distribute vaccines, diagnostics and therapeutics within the continent in partnership with the rest of the world. Africa should join COVAX not just as a beneficiary but as a contributor of the best science and financial resources.

This is the vision of the AU/NEPAD, Pharmaceutical Manufacturing Plan for Africa (PMPA) endorsed by the Heads of State and Government in Accra in 2007. This is the time to rejuvenate this vision. It is a matter of life and death.

Let me conclude by applauding the Leaderships of African countries that have allocated funding for the local development of therapeutics, diagnostics and vaccines for COVID-19. In some countries such as Uganda, clinical trials are now in progress and all people of good will, including regional bodies in Africa should support these efforts.

What do you all think?


Comments (2)

  • Prof. Miriam Khamadi Were

    Prof. Miriam Khamadi Were

    28 January 2021 at 08:08 |
    Dear Prof Omaswa,

    Thank you very much for your communication just read. You end it by asking each of what we think. I would like to say the following:-
    1. Thank you very much for writing this update on the urgent matter of COVID-19 related vaccines. I found your update informative on the challenges that are posed in the current and future of outbreaks anywhere in the world.
    2. I join your call for African countries to take note and initiate action. In this regard, I propose that Directors of Medical Research Centres in all African Countries--such as the Kenya Medical Research Institute, KEMRI-- be included in the list of names that get these communications.

    With thanks and looking forward to a healthy Africa,
    Prof. Miriam Khamadi Were EBS, IOM
    Dr PH, MPH (Johns Hopkins), MB ChB (Nairobi), BA (William Penn), Dip. Ed (Makerere)
  • Patrick KADAMA

    Patrick KADAMA

    31 January 2021 at 13:39 |
    Thanks Francis for this timely piece.
    This is an important matter to de-link from panic by our policy makers and their technical advisors. A strong informed voice from the region is required for an equitable outcome by ensuring as you rightly make the call that "Africa should join COVAX nott just as a beneficiary but as a contributor of the best science and financial resources."
    You allude to a discourse between the EU and big-Pharma corporates who have proposed to reschedule contracted supply comitments to the EU by cutting this down by a whole 60%!!!. This has surprisingly elicited an interesting reaction from the UK refusing to disclose their contracted agreement with the big-Pharma corporates. This lack of transparency in this discourse, at that level, is unfortunate for the COVAX facility; especially if, Covax beneficiary member states are to interface directly with big-Pharma for access to vaccine products under "Emergency Use" legal frameworks.
    Engagement with commercial entities during product developmental stages require the at most caution to considerations of all benefits and liabilities of final products after the emergency phase. The panic and scramble you describe, is obstructing the visibility of the lack of transparency of this product development which in the long run may be borne by the least informed; These are usually the poorer member states. The AU and WHO need to lead countries in the region to mitigate this situation by negotiating on an informed basis, the most equitable contractual arrangements for African countries in particular, to access these COVID-19 trial vaccines for "Emergency Use," prior to commercial marketing as full partners not just donation recipients. The involvement of our population is an invaluable investment in the product development and possibly equity in the final product value.

    I shall try to keep in touch on this despite currently being away and indisposed its a subject I had inted to comment upon much earlier in the development stages of the ACP-COVAX axis concepts.

    Sorry for a long comment but thank you for bringing the matter to the fore.

    Patrick KADAMA

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