Unprotected African health workers die as rich countries buy COVID-19 vaccines | Science

By Kai KupferschmidtFeb. 17, 2021 at 2:45 p.m.

Science‘s COVID-19 reporting is supported by the Heising-Simons Foundation.

On January 6, gastroenterologist Leolin Katsidzira received a disturbing message from his colleague James Gita Hakim, cardiologist and renowned HIV / AIDS researcher. Hakim, director of the University of Zimbabwe’s Department of Medicine, had fallen ill and tested positive for COVID-19. He was admitted to a Harare hospital 10 days later and transferred to an intensive care unit (ICU) after his condition deteriorated. He died on January 26.

This is a crushing loss for Zimbabwean medicine, says Katsidzira. “Remember: we have suffered a huge brain drain. So people like James are people who make the system work, ”he adds. Scientists around the world have also mourned Hakim. He was “a unique research leader, a brilliant clinical scientist and a humble, welcoming and inspiring mentor,” wrote Melanie Abas, Fellow at King’s College London.

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But Hakim’s death also highlights a harsh reality in the global response to the coronavirus pandemic. Countries in Europe, Asia and the Americas have administered more than 175 million vaccines to protect people against COVID-19 since December 2020, with most countries prioritizing medical workers. But not a single country in sub-Saharan Africa has started vaccination – South Africa will be the first this week – leaving health workers dying where they are initially scarce.

The exact toll of COVID-19 among health workers is difficult to assess, but Hakim was one of many prominent doctors to succumb in recent weeks in Africa, which has suffered a second wave of the pandemic. Just a day before him, American doctor David Katzenstein, who had moved to Harare after his retirement and headed the Biomedical Research and Training Institute there, died of COVID-19 in the same hospital. These losses represent many more, says Robert Schooley, an infectious disease researcher at the University of California, San Diego, who worked with Hakim for many years. “We don’t hear from many others who work in the health workforce behind them.

Neighboring Mozambique has lost an anesthesiologist, gastroenterologist and urologist in recent weeks, said parasitologist Emilia Noormahomed of Eduardo Mondlane University, as well as two young general practitioners. Several others are seriously ill. These losses hit Mozambique hard, which has only about eight doctors per 100,000 population, compared to nearly 300 in the United States. “It will literally take an entire generation to rebuild itself” from such losses, says Ashish Jha, dean of the School of Public Health at Brown University.

Global inequalities have existed since the start of the COVID-19 pandemic. Intensive care units, ventilators and oxygen are scarce across the African continent, for example. But in the first few months, the basic public health measures needed to control the spread of the virus put countries on a more or less level playing field, says John Nkengasong, head of the African Centers for Disease Control and Prevention. And Africa has weathered the pandemic relatively well, in part because of its young population.

But now the vaccine rollout has put rich countries at a definite advantage. Many have bet on multiple vaccines and signed contracts for doses sufficient to vaccinate their populations multiple times, limiting supplies to the rest of the world. According to the World Health Organization (WHO), three-quarters of all vaccinations to date have taken place in 10 countries which account for 60% of the world’s gross domestic product; 130 countries have not yet administered a single dose. “I don’t know why there isn’t a huge clamor to do something about this,” says Gavin Yamey of the Global Health Institute at Duke University. “The world is on the brink of catastrophic moral failure,” said Tedros Adhanom Ghebreyesus, director-general of the Ethiopian-born WHO, in January. In a joint statement last week, he and UNICEF Executive Director Henrietta Fore called on governments that have vaccinated health workers and those most at risk to share doses with other countries, and vaccine manufacturers to distribute vaccines fairly.

The fairness gap could soon extend to COVID-19 therapies. The first drug convincingly shown to reduce the death rate from the virus, a steroid called dexamethasone, is inexpensive and used around the world; Hakim received it before he died. But tocilizumab, which further reduces mortality in a British study published on February 11, is an antibody about 100 times more expensive than dexamethasone and is not widely available. “The [pandemic’s] the second wave, and potentially the third, is being tackled by a combination of public health measures and biomedical interventions, and this will increase inequalities, ”says Nkengasong.

Beyond the moral argument, there are strong economic and public health reasons for closing the gap. Vaccinating those most at risk globally would reduce hospitalizations and deaths sooner across the globe, allowing societies to reopen and economies to recover. It could also help reduce the circulation of the virus around the world, reducing the risk of new viral variants emerging.

WHO and other international organizations have worked to close the gap through the Global Vaccine Access Mechanism COVID-19 (COVAX), a joint mechanism to purchase billions of doses of multiple vaccines and distribute them to participating countries. It’s starting to pay off, albeit slowly: On Monday, WHO gave an emergency use list for two versions of the AstraZeneca vaccine – University of Oxford, manufactured by the Serum Institute of India and SKBio, a company South Korean. COVAX plans to start providing these injections to countries this month and to ship more than 300 million doses in the first half of the year, including 1.15 million in Zimbabwe and 2.43 million in Mozambique. It also plans to distribute 1.2 million doses of the Pfizer-BioNTech vaccine.

Bruce Aylward, senior advisor to Tedros, admits that the initial supply is only sufficient to cover a small portion of the populations of many developing countries. “But the reality is, we’re going to be delivering a lot more doses to a lot more people in a lot more places a lot faster than ever without the COVAX facility,” he says.

To get more vaccines sooner, African countries have formed a Vaccine Procurement Task Force which, with funding from mobile phone company MTN Group, has already purchased 7 million doses of the AstraZeneca-Oxford vaccine. The first 1.5 million doses are expected to be shipped to 19 countries on February 22, allowing health workers in those countries to be vaccinated by the end of this week. The overall goal is to vaccinate around 35% of the population of African countries by the end of the year, and then 25% more next year, Nkengasong says. (Many Western countries are hoping that their entire population will be covered this summer or fall.)

Schooley believes the United States should take a more active role in protecting healthcare workers in countries like Zimbabwe. The US President’s AIDS Emergency Plan, launched in 2003, has saved countless lives by providing more than $ 80 billion in the fight against HIV, he notes. “We’ve been working with our counterparts in sub-Saharan Africa for 20 years to try to help them build a more resilient healthcare infrastructure,” says Schooley, “and we sit idly by watching who is torn apart by the coronavirus. “