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Agreements for the provision of Covid-19 vaccines to help protect people in African countries are far from adequate, without sufficient doses to vaccinate enough of the continent’s population to ensure herd immunity. The question remains how cash-strapped African governments will finance this.
African states have three main avenues to secure the supply of Covid-19 vaccines – directly with pharmaceutical companies, through the COVAX facility, a global initiative, and the African Acquisition Task Force of vaccines (AVATT) set up by the regional bloc of the African Union.
Few cash-strapped African countries have the financial means to compete with the wealthy countries which are also struggling to obtain essential coronavirus vaccines. In addition, there are few large pharmaceutical companies based on the continent, putting Africa at a disadvantage in negotiating contracts, while other countries take advantage of a national advantage.
“On their own at the current market price, there will be very few African countries that will be able to afford the vaccine,” said Mosoka Fallah, a public health specialist who worked on the Ebola outbreak. in Liberia this week. Africa is calling Podcast.
Collective bargaining
The COVAX facility, designed to provide equitable access to vaccines for all participating countries, recently announced its distribution plans for what is essentially a sort of purchasing consortium.
“This planned deployment is a crucial first step to ensure equitable access to vaccines,” said Dr Matshidiso Moeti, Africa Director of the World Health Organization (WHO). WHO is leading the COVAX facility alongside Gavi and the Coalition for Epidemic Preparedness Innovations (CEPI).
“Africa has indeed observed other regions start vaccination campaigns against Covid-19 a little on the margins,” added Moeti, during a recent press briefing.
COVAX will supply 88.7 million doses of AstraZeneca / Oxford and Pfizer-BioNTech vaccines to 47 African countries.
Delivery of the AstraZeneca / Oxford vaccine, manufactured by the Serum Institute of India and South Korean company SK Bioscience, will begin in February, with all doses due to be distributed by the first half of 2021.
The Serum Institute of India will deliver 75 million doses of the AstraZeneca / Oxford vaccine to 38 African countries – at least 26 million doses by the end of April and 49 million by the end of June, according to an RFI calculation based on the COVAX intermediate distribution forecast.
Nine other African countries will receive some 13 million doses of the AstraZeneca / Oxford vaccine manufactured by SK Bioscience, of which 2 million will be delivered by May and more than 7.5 million by June 30. The rest will be provided in the second half of 2021.
Stringent requirements for Pfizer-BioNTech
Cabo Verde, Rwanda, South Africa and Tunisia have been selected by COVAX to receive nearly 320,000 doses of Pfizer-BioNTech vaccines, which have more stringent cold storage requirements.
“We are extremely happy to be among a few countries receiving this Pfizer vaccine,” Rwanda Minister of Health Dr Daniel Ngamije told reporters. “It is an indicator of the performance of the health sector because we were able to meet all the strict requirements.”
Some African countries self-finance their participation in COVAX, while the vast majority are eligible for donor-funded assistance to pay for vaccines.
Equatorial Guinea and Gabon have signaled their intention to participate in COVAX, with a non-binding confirmation of intention before December 15, but they are not included in the interim forecast, possibly because they no longer want to participate.
Burundi, Eritrea, Madagascar and Tanzania, all classified as low-income countries, could have received vaccine doses supported by COVAX, but decided not to enter the facility.
Burundian authorities say they do not need vaccines, Antananarivo government says it prefers local treatments and in Tanzania the health ministry says it does not intend to accept vaccines because he does not have the virus.
COVAX’s planned interim distribution covers only 3.3% of the total population for the 145 participants globally, but the facility says it is on track to deliver at least 2 billion doses by the end of the year, with $ 1.3 billion for 92 low-income people. country, covering 20% of the population of each country.
“Covax has a funding challenge, to see if it can raise the bar above 20%,” said Mosoka Fallah, who works at the National Institute of Public Health in Liberia.
Local African initiative
AVATT focuses only on African countries and was established in August 2020 under the leadership of former African Union President and South African President Cyril Ramaphosa.
Some 270 million doses have been secured with at least 50 million available for delivery from April to June, and the remainder by the end of 2021. The doses will be supplied by Pfizer-BioNTech, AstraZeneca / Oxford and the vaccine at a dose of Johnson & Johnson, according to a statement from the South African Presidency on Jan. 13.
This initiative is effectively subscribed by the African Import-Export Bank (Afreximbank) to the tune of 2 billion dollars.
AVATT was opened on Jan.19 and received expressions of interest from 20 countries, according to Dr John Nkengasong, head of the African Centers for Disease Control and Prevention, speaking on Thursday.
“Out of the 20 countries, they have expressed interest in ordering more than 200 million doses,” Nkengasong said. “I think it’s going very well,” he added.
Afreximbank will guarantee the purchase agreements and, upon delivery, countries will be able to settle their invoices themselves or use a five-year payment plan, the South African presidency said.
“AVATT is not clear to me, can African countries afford it, at what interest rate,” said public health specialist Fallah, a guest lecturer at the Harvard School of Public Health. “What happens to heavily indebted countries?”
Later on January 27, the South African Presidency said AVATT had also received offers for 400 additional vaccine doses, although the timing and funding for those doses is not yet clear.
Borrow for vaccines
The South African presidency said in mid-January that the African Union was working with the World Bank so that African countries could access US $ 5 billion to purchase vaccines. This amount was later said to represent US $ 12 billion for vaccine purchases through “grants or on highly concessional terms.”
“We are preparing emergency vaccine financing projects in 21 African countries, including DRC, Ethiopia, Niger, Mozambique, Tunisia, Eswatini and Cabo Verde to name a few” , said World Bank President David Malpass.
The combination of supplies currently described, of both COVAX and AVATT, including the supply of 400 million doses, foresees a possible 758 million doses of vaccine for the African continent, but does not include distributions of COVAX in the second half of 2021 when supplies would be significantly ramped up.
Considering the need for two doses of Pfizer-BioNTech and AstraZeneca / Oxford vaccines, this would cover 379 million people, although the Johnson & Johnson vaccine only requires one dose.
Africa would need to vaccinate 780 million people out of its 1.3 billion inhabitants to achieve the 60% target deemed necessary for herd immunity.
Chinese and Russian efforts
In addition to vaccines developed by Western pharmaceutical companies, other candidates developed by China and Russia are also being made available to help protect populations in African countries.
Less information on safety and testing is known about these vaccines, although some details of some studies and trials are starting to come to light, as the Lancet recently released data on Russia’s Sputnik V vaccine.
Chinese vaccines will be provided to Egypt, Equatorial Guinea, Morocco, Sierra Leone and Zimbabwe. Morocco has reportedly ordered 10 million doses of the Sinopharm vaccine and the Seychelles, a small island nation, have launched a vaccination campaign with the Chinese vaccine thanks to a donation from the United Arab Emirates.
The exact supplies destined for Africa do not seem clear, but the Chinese Foreign Ministry recently said it has exported or is in the process of exporting vaccines to 22 countries.
The Sputnik V vaccine has received approvals for use in Guinea and Tunisia, while a vaccination campaign is underway in Algeria, according to the Sputnik website. Supply agreements and financing details for African countries remain elusive.
The Africa CDC said it was engaging in discussions on Chinese and Russian vaccines, with Dr Nkengasong saying the organization was “open to all manufacturers and manufacturers of vaccines,” adding that they had signed an agreement. confidentiality with the Russians to review the data on Sputnik.
Improve multilateral efforts
The overall Covid-19 vaccine supply picture is subject to constant change, as new agreements with manufacturers are made and funding details released. The AVATT initiative is less established than COVAX, which was set up earlier.
“Both platforms are good but they have their challenges,” said Fallah, who was lauded for his contribution to tackling the Ebola epidemic in West Africa in 2014-2016.
The published supplies remain far from sufficient to protect the population of the African continent, and apart from donor support via COVAX, as well as potential support from China and Russia, the AVATT initiative appears to depend on countries seeking funding.
“Each of these platforms is great because they are collectively negotiating for the African continent, but we need to refine these platforms,” Fallah added, wondering if some supplies through AVATT could be obtained through grants rather than loans. .
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