Africa: Why COVID vaccine inequity is still a big, and deadly, problem for all of us
The good news: The U.S., Canada, the U.K. and Europe are all gearing up to dole out new COVID-19 vaccines this fall to tackle the ever-evolving coronavirus. The bad news: supply and distribution issues will continue to plague continents like Africa and poorer countries in the global south.
These countries and regions, as the pandemic approaches the three-year mark, remain under-resourced with fewer vaccine manufacturers, less funding and weaker distribution channels.
And the pattern is being repeated with the monkeypox outbreak. For example, countries on the African continent have reported deaths, but have no access to vaccines. The U.S., where vaccines are being distributed, has no reported deaths to date.
“Nothing has fundamentally changed from 2020 to now,” Achal Prabhala, coordinator of the Access IBSA project, which advocates for equitable medicine access in India, Brazil and South Africa, said in an interview with Yahoo Finance.
“So when we get the reformulated [COVID] vaccines out late this fall, we will follow exactly the same pattern as the mRNA vaccines have followed to-date,” he added.
The situation has improved somewhat, with supply no longer the hurdle. But distribution and labor issues remain.
The bottom line is this: Without addressing supply and distribution equity issues—and if vaccination rates continue to be low— the odds of stopping the pandemic anytime soon are slim.
“If low income countries could have vaccinated on the same timeline as high income countries, we probably wouldn't have prevented Delta, but there's a very good chance we would have prevented Omicron, and all the subsequent (subvariants) to Omicron,” said USAID COVID-19 Task Force executive director Jeremy Konyndyk at a recent conference hosted by The UPS Foundation, UPS (UPS) Impact Summit.
In other words, Africa’s problem is everyone’s problem, as Ted Chaiban, Global Lead Coordinator for COVID-19 Vaccine Country-Readiness and Delivery at UNICEF, told Yahoo Finance.
"We forgot that no one is safe until everyone is safe," he said. "There needs to be a reckoning."
Can the private sector lead?
Advocates for intellectual property waivers for COVID-19 vaccines, which would have opened the doors to sharing vaccine formulas, were disappointed earlier this year when the World Trade Organization failed to reach a meaningful deal among member countries.
But, longer-term manufacturing efforts by companies are now underway to increase future vaccine supplies in Africa, explained John Nkengasong, who once led the Africa Centers for Disease Control and is now U.S. Global AIDS Coordinator and Special Representative at the U.S. State Department.
The timelines are still too long—and that’s not ideal, experts say. But Nkengasong noted "the momentum is there, to regionalize manufacturing capacity."
"It is no longer acceptable...that certain parts of the world will just wait for vaccines to be manufactured elsewhere and then they are consumed," he said in June at the White House Future of COVID-19 Vaccines Summit.
Chaiban agreed.
"You need to decentralize, and encourage, the local manufacture of health commodities," he said.
"There's some huge capacities in African economies to work on some of these issues," he added.
The Africa quandary
Vaccines, especially routine vaccinations for both kids and adults, have largely been viewed as an unprofitable business — until COVID. The mRNA companies, such as Moderna (MRNA) and Pfizer/BioNTech (PFE/BNTX), have raked in billions during the pandemic.
That’s created more interest in the adult vaccine business, including for poorer countries.
But even with COVID-19 vaccine makers ramping up interest in Africa, timing remains an obstacle, Prabhala said.
So even with new formulations of vaccines in the works, the African continent and poorer countries are likely to get them only after wealthier countries.
“I think it’s a clamor of press release more than a clamor of action,” Prabhala said of the announced agreements.
“It’s a clamor to get attention, to get attention and be seen as doing something for the African continent. Because you really have to go through the press releases to understand how long these things will take to be operational,” he said.
He added: “In some cases, the manufacturing sites could take years to build out, and in the few existing spaces, it is unlikely the latest formulations of the vaccine will be produced – at the same volume, if at all – in the next few months.”
The drug companies, he and other advocates have said, are ignoring existing capacity. For instance, a study Prabhala co-authored for Doctors Without Borders (Médecins Sans Frontières) shows there are at least 100 manufacturers in Asia, Africa, and Latin America that are capable of manufacturing mRNA vaccines.
Promises vs. reality
Examples of the recent interest in Africa, and results, include:
• Pfizer has a partnership with Biovac in South Africa. But it has yet to provide updates on production of the original COVID-19 shots, even though it promised doses in the second half of 2022. The company also vowed to provide its patented products to low and middle income countries, starting with specific partnerships on the African continent. (Pfizer also partnered with drone delivery company Zipline to test the potential of delivering doses to hard-to-access areas, but nothing has been done at scale.)
• Moderna has committed to build a new facility in Kenya, which could be producing filling doses as early as 2023. But it, too, has no recent updates. The company has to date relied on contract manufacturing partners like Catalent (CLT) and Rovi to meet global demand. In addition, it said it would not enforce its patent in low and middle income countries. But, on the other hand, Moderna has said it is too busy to help with any tech transfer.
"That got a lot less attention, but, frankly, was probably a bigger issue, a bigger constraint, toward global production,” USAID’s Konyndyk said of tech transfers.
(It's also noteworthy that not every country in Africa counts as low or middle income. One of the breakout public health stars of the pandemic, South Africa, does not qualify as either.)
• Johnson & Johnson (JNJ) licensed South Africa’s Aspen Institute to make its doses earlier this year. But but the demand for J&J’s single shot has waned, largely because mRNA vaccines have stronger protection, and fewer side effects. Aspen is considering closing down production of the doses as a result.
• The Serum Institute of India, which is now producing Novavax’s (NVAX) doses for the world, including in the U.S., halted production of the AstraZeneca (AZN) vaccine, which it had successfully delivered to the African continent before the Indian government halted exports. Now SII, the world’s largest vaccine producer, has also announced its intent to open a plant in Africa in order to rebuild its reputation there.
But the companies will need to do more.
“I think we should work towards, and certainly the private sector could work towards, a norm or a best practice that intellectual property — when there's a declared a public health emergency of international concern — will be broadly shared, will be licensed, and there will be an effort towards tech transfer,” USAID’s Konyndyk said.
“Clearly some version of that is what we're going to have to do if we're going to accelerate equity. You can't both have only one company within its own infrastructure and cover everyone that's going to need it in the timeline we're going to want," he said.
Beyond COVID
Why is all this so important?
To build resiliency for future pandemics, explained Marie-Ange Saraka-Yao, managing director of resource mobilization and private sector partnerships at GAVI.
GAVI, the Vaccine Alliance which is a collaboration, among others, of the World Health Organization, World Bank, Bill & Melinda Gates Foundation, and various governments, says the African continent only has 10 vaccine manufacturers that could handle the volumes needed in an emergency.
But with partners, GAVI hopes that the region can build up resiliency to produce 60% of its vaccine needs by 2040.
To that end, European countries and the European Union are investing in partnerships as well as manufacturing sites in Africa and Latin America.
Eva Kadilli, director of the supply division at UNICEF, said this type of broader vaccine resiliency is needed – especially to avoid new manufacturing facilities sitting idle.
"The issue is all of these facilities and investments that are coming...how do you keep them warm (running)? Because there is a need for keeping them warm and that needs investment, so that they can respond in the cases of outbreaks or pandemics as well. And it is a question for the entire international community,” she said at the UPS Impact Summit.
Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations (CEPI), said as much at the White House Summit:
"It has to be sustainable. It cannot be something that is mothballed and work when you need it to,” he said.
And that takes money and a market approach to ensure places like Africa will succeed in the long run.
“Manufacturers of vaccines made in Africa may need to price their vaccines higher than global competitors in order to the cover the costs of starting up,” according to a GAVI report on the subject.
“That can mean that to accommodate the entry of new African vaccine suppliers, irrespective of whether that supply goes to African nations or further afield, buyers, including GAVI ... may initially be prepared to absorb a premium for these vaccines," the report said.
That, GAVI’s Saraka-Yao said, is key to finally solving the inequity problem.
“Building factories just for a pandemic vaccine may not be the right thing to do,” she said.
“What we are really trying to look at is having a portfolio approach where we look at what’s needed."
Follow Anjalee on Twitter @AnjKhem
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