An invisible divide formed early last year as COVID-19 vaccines spread through rich countries, while the rest of the world waited. In one part of the globe, newly vaccinated doctors and nurses breathed sighs of relief and grandparents hugged their grandchildren for the first time in months. In the other part, hospitals overflowed with an unmitigated surge of COVID-19.
“We saw our fellow nurses dying with COVID,” says Milly Kumwenda, a nurse at Queen Elizabeth Central Hospital in the city of Blantyre in southern Malawi, as she recalls a deadly surge of the disease in January 2021. After two cabinet ministers died of COVID-19, Malawi’s president declared a state of national disaster. The aid agency Médecins sans Frontières (MSF, also known as Doctors without Borders) rushed to help and issued an appeal to the rest of the world: “Malawi urgently needs access to the vaccine.”
Vanishingly few doses arrived — in unpredictable spurts and often close to expiry. By the time the next surge hit in July 2021, just 1% of Malawians had been vaccinated. Many people had stopped seeking care by then because they had lost faith in the health system, says Loveness Gona, another nurse at the hospital. There are few ventilators in Malawi, no antiviral infusions or monoclonal antibody treatments, and chronic shortages of drugs to manage deadly symptoms such as blood clots and inflammation. These are some of the reasons that death rates among people hospitalized for COVID-19 in low-income countries have been more than twice as high as in wealthy nations1. Gona remembers coming into work to find corpses propped up in chairs in the hospital waiting room, their loved ones demanding a test. “Somewhere else, they’d be alive,” she says.
Vast, ongoing delays in the global distribution of COVID-19 vaccines have resulted in death on a massive scale and arguably allowed the evolution of the Omicron variant, which was first reported in South Africa late last year. Such inequities are jarring, but hardly new. Many years passed before life-saving vaccines and drugs for pneumonia and HIV were widely available in Africa, and important treatments for cancer and cystic fibrosis that are common in rich countries remain almost unobtainable in poorer ones.
At the root of the problem lies a dependence on the limited goodwill of countries — mainly in the global north — where the majority of large pharmaceutical companies are based. That’s why more than a dozen countries in the global south are banding together with the World Health Organization (WHO) and other groups in a long-term initiative to build vaccine- and drug-making capacity throughout Africa, South America, Asia and Eastern Europe. “The COVID-19 pandemic has shown that reliance on a few companies to supply global public goods is limiting and dangerous,” said WHO director-general Tedros Adhanom Ghebreyesus as he announced the initiative last year.
Called the mRNA vaccine technology transfer hub, the initiative is built around the shiny new promise of messenger RNA as a tool for vaccines and drugs. At the hub’s core is a small biotechnology firm in Cape Town, South Africa, called Afrigen Biologics and Vaccines. It is linked to South African universities and pharmaceutical companies based in 15 countries, including Senegal, Argentina and Indonesia (see ‘Changing the equation’). Together, these groups aim to make their own effective mRNA vaccine against COVID-19, before expanding into other diseases that are relevant to their regions, be it HIV, Zika or measles.
Brazzaville, 16 June 2022 – Africa is intensifying COVID-19 vaccination of high-risk population groups with some promising signs. Nearly 50% of health workers and people over the age of 60 are fully vaccinated against the virus in countries reporting data to World Health Organization (WHO).
The data from June 2022 from 31 countries reporting on COVID-19 vaccinations of high-risk groups shows a significant increase compared with the end of December 2021 when only 33% of health workers and 10% of seniors were fully vaccinated. While this is good progress, vaccination coverage, including booster doses, needs to be significantly higher to protect these vulnerable groups.
Only two African countries (Mauritius and Seychelles) have fully vaccinated 70% of their total population. Rwanda is expected to achieve this target by the end of the month based on the pace of its current uptake, bringing to three, the number of countries in Africa reaching the 70% global target by the end of June.
However, Africa has a largely youthful demography, with 45% of the continent’s population under the age of 18. In a bid to use vaccines strategically, most countries are targeting their adult population. WHO is recommending to countries with low vaccination coverage to focus on high-priority groups – health workers, older adults and people with comorbidities. The continent’s coverage of people over 18 years is estimated at 34%, significantly higher than the 18% full coverage in the general population. Nine countries have fully vaccinated more than 70% of their adult population, while 21 have reached more than 40% of adults.
“Having been beset by poor access to doses, costly delays and shortfalls, Africa’s COVID-19 vaccination progress so far is no mean feat,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Africa’s youthful population has helped the continent weather the COVID-19 pandemic. While protecting young people at high risk of COVID-19 is paramount, focusing efforts on vaccinating older people, health workers and other vulnerable populations will ensure we stay a step ahead of the virus.”
WHO recommends that countries continue to focus on high-priority populations such as health workers, people with comorbidities and older people, and to diversify vaccination delivery strategies, combining vaccination in fixed health facility sites with efforts to take vaccination to the communities through mass vaccination campaigns and intensification of routine immunization activities.
To date, at least 31 countries have planned mass vaccination campaigns until the end of the year. During mass vaccination campaigns, WHO recommends that countries set up bespoke mobile teams for targeted vaccination of high-priority groups. Learning from the experience of HIV testing and treatment, provider-initiated COVID-19 vaccination should be offered in primary health care and in special units offering care to people with comorbidities such as HIV, diabetes, cardiovascular diseases and cancer.
WHO and partners are focusing support on countries that risk falling behind. Fourteen African countries with less than 10% vaccination coverage are to receive multi-partner country support, with WHO stepping up efforts to strengthen the management of COVID-19 vaccination data in its assistance to these countries, many of which are also grappling with humanitarian crises and/or diseases outbreaks.
Over the past week, the number of new COVID-19 cases in Africa marginally increased following a sustained three-week decline. This slight uptick was due to the recent surge in cases reported in East and North Africa. As of the 13 June 2022, there were 11.9 million COVID-19 cases in Africa, including 254 442 deaths.
Dr Moeti spoke during a virtual press conference today facilitated by APO Group. She was joined by Dr Daniel Kyabayinze, Director, Public Health, Ministry of Health, Uganda; Professor Emmanuel Nakoune, Acting Director of the Institut Pasteur in Bangui, Central African Republic; and Dr Peter Fonjungo, Director of the United States Centers for Disease Control and Prevention in the Democratic Republic of the Congo.
Also on hand from WHO Regional Office for Africa to respond to questions were Dr Abdou Salam Gueye, Director of Emergency Preparedness and Response; Dr Thierno Balde, Regional COVID-19 Incident Manager; Dr Fiona Braka, Team Lead, Emergency Operations; and Dr Phionah Atuhebwe Vaccines Introduction Medical Officer.
South Africa’s daily coronavirus test positivity rate neared a record, rising above 30% on Saturday for the first time in almost five months as two sublineages of the omicron variant spread rapidly ahead of the nation’s winter season.
There were 8,524 new Covid-19 cases identified, representing a 31.1% positivity rate of those tested, the National Institute for Communicable Diseases said in a statement on its website. That’s the highest rate since the 32.2% recorded on Dec. 15, when a record 26,976 cases were recorded. The surge means South Africa is close to its highest positivity rate yet. The record so far was 34.9% on Dec. 14.
The positivity rate is taken as an indicator of how fast the disease is spreading through the community as many cases go undetected.
Still, only five deaths were recorded in the last 48 hours and just over 2,600 people are in the hospital with the disease. At the peak of the wave in mid-2021 when the delta variant was rampant, hundreds of people were perishing daily and hospitalizations peaked at about 16,000.
South Africa, which together with Botswana identified the omicron variant in November, was the first country to experience a wave driven by the strain and the way it played out was seen as an indication for what could happen elsewhere. Last month South African scientists identified two omicron sublineages, BA.4 and BA.5, and laboratory experiments have since shown that those strains can reinfect those who have already had the original omicron strain.
The current surge in infections and positivity shows that even though previous waves have been caused by the emergence of new variants the sublineages are now having the same effect, Tulio de Oliveira, who runs gene sequencing institutes in South Africa said on Twitter.
Source - Bloomberg
Dr. Tedros Adhanom Ghebreysus said that it is too soon to know if subvariants BA.4 and BA.5 cause more severe symptoms, but they are “another sign the pandemic is not done with us.”
WHO began tracking BA.4 and BA.5 in mid-April. They are in addition to previously discovered subvariants BA.1 and BA.2, the latter of which is now dominant around the world. South Africa reported 2,650 COVID-19 cases in the last 24 hours, according to WHO, but more than 6,500 new cases on May 1, with its numbers trending upward.
Despite the new variants, Ghebreysus did report that COVID-19 cases continue to decline globally and weekly deaths are at the lowest point since March 2020, when the pandemic first began.
He said though that testing remains critical, with genetic sequencing the reason the two recent subvariants were identified in South Africa as other countries have stopped the practice.
“In many countries, we are essentially blind to how the virus is mutating,” he said.
“We don’t know what is coming next.”
Ghebreysus said the goal remains to vaccinate at least 70 per cent of countries’ populations around the world. While vaccine availability has improved significantly, he said demand is limited by a lack of political commitment, operational capacity problems, financial constraints and misinformation. He urged countries to address vaccine bottlenecks.
He also noted that while vaccine manufacturers are posting record profits, the WHO cannot accept prices that make the treatment available for the rich and not the poor, calling the disparity a “moral failing.”