Martins Hile, Editor, Financial Nigeria magazine
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COVID-19 vaccine rat race is a wake-up call for Africa 22 Jan 2021
The rapid development of safe and effective vaccines against COVID-19 has been hailed as the top scientific breakthrough of 2020. As of last month, several vaccine candidates that already demonstrated high levels of efficacy against COVID-19 in clinical trials had received approval for use in a number of countries.
But this great scientific endeavour is also the subject of many questions and conspiracy theorising. For example, some people – mostly in Nigeria and other African countries – have asked why vaccines to address old diseases such as malaria, which still kills hundreds of thousands of people yearly on the continent and is the fourth leading cause of death in children under five years, have not been widely developed.
The World Health Organisation (WHO) has described malaria as an "ancient" disease. Yet, only in 2019 did the United Nations agency and its partners launch the world’s first malaria vaccine. To date, the vaccine implementation programme remains in a pilot phase in selected areas across three African countries: Malawi, Ghana and Kenya. Nigeria, the most malaria-endemic country in the world – accounting for 25 per cent of the 229 million malaria cases and 23 per cent of the 409,000 deaths worldwide in 2019 – was not included in the pilot phase. The WHO African region accounted for 94 per cent of the global malaria toll two years ago.
There is a better question COVID-19 vaccine-hesitants in Africa should ask. The question is: Why are African countries not developing the know-how and resources to develop vaccines to prevent the diseases that are disproportionately ravaging their citizens? Africa has less than 1 per cent of the world’s vaccine production capacity, according to Simon Agwale, a Nigerian virologist and Director at the African Vaccine Manufacturing Initiative. McKinsey and Company says between 70 and 90 per cent of drugs consumed in Sub-Saharan African (SSA) countries are imported.
Lack of expertise in developing vaccines and other drugs to address critical health challenges like malaria in Africa is just one of the reasons all the malaria-endemic countries are on the continent. African countries are perpetually dependent on support from foreign governments and organisations to address their deficits in public health spending. For instance, out of the $3 billion that was mobilised globally in 2019 for malaria control and elimination, African governments contributed only 31 per cent ($900 million).
Lacking in public funding and also bereft of political will, many African countries have been unable to implement effective malaria eradication procedures that other countries deployed to eliminate the disease from their shores, even without using vaccines. Mauritius and Algeria represent the bright spots in Africa in terms of malaria eradication. While the former has been malaria-free since 1973, the latter received its malaria-free certification in 2019.
Not surprisingly, Nigeria missed its target to achieve malaria elimination last year, based on the country’s revised National Malaria Strategic Plan (2014-2020). Indeed, the country had the world's highest malaria burden during a period it was supposed to be preparing to celebrate the success of its national strategy to eliminate the disease. This is a classic example of how policies are designed in Nigeria without the required levels of implementation.
There are high barriers to entry for African drug makers in the vaccine production market. For one, African companies lack the funding required for vaccine research and development, and then for building the vaccine production facilities.
According to Gavi, the Vaccine Alliance, high fixed costs make new vaccines relatively more expensive. Low-income countries usually benefit from vaccines when prices come down following reduction in cost of production as a result of productivity gains and economies of scale. Rich countries would have paid the initially higher prices of the vaccines to defray the fixed costs.
But this means that low-income countries would not have priority access to critical vaccines, like the ones for COVID-19. A debate is currently ongoing about ensuring fair and equitable access to COVID-19 vaccines to those countries mainly in Africa. But low-income countries would find it more difficult to recover from the pandemic if they are left behind in vaccine access. COVID-19 had exerted heavy tolls on the economies and welfare of citizens in the poor countries.
To ameliorate the situation, the WHO-backed COVAX initiative is at the frontlines of global effort aimed at addressing the need for fair access to tools in the fight against the pandemic. As of the end of last year, COVAX said it had secured 1.3 billion doses of COVID-19 vaccines to be made available to 92 low- and middle-income economies by the end of 2021. These doses would just be enough to cover about 20 per cent of the populations, mostly vulnerable individuals and healthcare workers. But experts say herd immunity to COVID-19 would be likely achieved when 80-90 per cent of individuals in the population are either vaccinated or have previously been infected with the coronavirus.
Low-income countries like Nigeria are relying on COVAX to supplement the limited supplies of COVID-19 vaccines they would be able to purchase directly from the drug manufacturers. But funding for the programme is reportedly below its target because the rich countries that should provide much of the financing are focusing on hoarding the vaccines for their citizens.
A study by the Duke Global Health Innovation Center at Duke University released last November provides reasons most people in low-income countries might wait until 2024 for COVID-19 vaccinations. The report says wealthy countries are buying up vaccines even before they are ready. While no single low-income country had made a direct agreement to purchase vaccines as of two months ago, nearly 3.8 billion doses of COVID-19 vaccines had been purchased by high- and middle-income countries, with options for another five billion.
According to People’s Vaccine Alliance, a collaboration between several aid groups, including Oxfam and Amnesty International, billions of people around the world will not receive COVID-19 vaccines for years to come. The group's analysis shows rich countries have bought enough doses to vaccinate their entire populations three times over.
People’s Vaccine Alliance also called on drug companies with promising vaccines to share their technology for the purpose of producing more doses to expand access and affordability. At this stage, it is wishful thinking to expect profit-making drug makers to suddenly become magnanimous and openly share their intellectual property.
The ongoing COVID-19 vaccine race should be a wake-up call for African countries. Africa needs its own moment of scientific breakthrough, not only in vaccine development and manufacturing to address existing vaccine needs. It also needs innovative solutions to the socioeconomic and environmental factors that are perpetuating poverty and affecting the economic competitiveness of the continent.
Africa's future prosperity is contingent on its ability to develop home-grown solutions to its challenges, including diseases, which are hobbling the continent's economic growth and development. Those solutions cannot be conceived and developed on commercial and industrial scales without significant investment in creating science, technology and innovation (STI) centres out of African tertiary institutions.
If African companies develop substantial capacities to develop vaccines and manufacture drugs, they would help in stemming capital exports on the continent through the importation of the healthcare products. Other benefits would include increasing jobs and economic growth and boosting health outcomes on the continent.
Will 2021 be the year Nigeria and other African countries make serious efforts towards investing in STI for future breakthroughs? Not much learning happened last year in Nigerian public universities. For nine months, the universities were shut down as government and the Academic Staff Union of Universities (ASUU) bickered over unpaid remuneration and the method of paying lecturers. Such disruptions to the academic calendars of tertiary institutions, coupled with other dysfunctions in the system, are recipes for poor educational outcomes. They also defeat the purpose of aligning high learning outcomes with development.
It is time for Nigerian and African policymakers to create effective linkages between education and private sector development. The external dependencies in Africa’s healthcare delivery has poorly served its people and economies.
Martins Hile is the Executive Editor of Financial Nigeria publications.