THE second phase of the COVID-19 pandemic is already underway. Like the rest of the world, Africa is pinning its hopes on the anticipated imminent approval of a COVID-19 vaccine that could begin mass production by early 2021. The continent’s urgent need for vaccines emanates from a desperately weak health system. The region remains vulnerable to the potential devastation from unmitigated spread. Africa’s timely access to a vaccine will be critical to its ability to limit phase II viral spread and protect the vulnerable while avoiding further lockdown of economies as the primary means of controlling viral transmission within communities.

guest column:Lenias Hwenda

Africa as a region needs to urgently articulate a plan for securing a vaccine for its most vulnerable populations, and for safely delivering it to African destinations from manufacturing sites outside the continent without the risk of it getting spoilt by temperature fluctuations. Africa cannot effectively deploy a COVID-19 vaccine and run an effective large-scale vaccination campaign without addressing its cold chain infrastructure gap. This is one of the most urgent infrastructure requirements for Africa’s COVID-19 vaccine deployment preparedness.

An adequate cold chain infrastructure to effectively deploy a COVID-19 vaccine
Nine of 300 candidate vaccines worldwide are in various stages of phase III clinical studies. Three are leading the race — Oxford-AstraZeneca, BioNTech-Pfizer and NIH-Moderna. Outside the West, China has two biotech companies CanSino Biologics and Sinopharm, both with phase III vaccines. Sinopharm is co-developing one of its two vaccines with the multinational Johnson & Johnson, but this trial has become the second to be suspended due to serious complications affecting one of its participants. The Gamaleya Research Institute of Russia also has a vaccine in phase III trials posited in the race to become the first to reach the market.

Whichever vaccine wins the race, its delivery anywhere in the world will face many hurdles including the availability of safety data, acceptance and finance. Each of these vaccines will require adequate cold chain facilities to be effectively deployed in vaccination campaigns. Low-middle-income countries (LMICs) will face the challenge of limited access to vaccine brought on by the limited cold chain infrastructure available for effectively deploying and managing large-scale vaccination campaigns of COVID-19 proportions. In particular, Africa has limited cold storage facilities across its airports. This elevates the risk that the COVID-19 vaccine destined to some African destinations could get spoilt by temperature fluctuations en route.

Africa’s successful public health campaign against COVID-19 is not a mystery
Following a first wave of the COVID-19 pandemic that has taken more than one million lives worldwide, the second wave is already underway in Europe and elsewhere. Africa is widely recognised for its successful COVID-19 phase I response. According to the WHO, Africa remains one of the least affected regions in the world. This is largely explained by the fact that Africa took some basic public health interventions that have been proven to be effective at mitigating COVID-19 spread. When basic scientific facts are acknowledged, for instance, the fact that the average Sub-Saharan African country imposed more stringent containment measures more quickly than the average EU country and the United States, Africa’s COVID-19 outcomes are not a mystery. The majority of African countries adopted comprehensive contact tracing policies including at airports well before COVID-19 began spreading in Africa countries. The Africa CDC instituted a sustained, agile and responsive policy that continues to be adjusted in real time in line with emerging scientific evidence on contact tracing and isolation, which governments have tailored to their cultural and national contexts. Africa’s population is regularly sensitised to the reality of disease outbreaks like Ebola, yellow fever and lassa fever. Such awareness among the public created strong buy-in by African communities and widespread acceptance of the necessity of control measures. Effective communication, community by-in and public acceptance are critical ingredients in any successful public health campaign. Africa also drew on its rich previous experience with contact tracing and isolating, for instance with Ebola and tuberculosis patients. These experiences enabled African governments’ greater success at isolating high-risk contacts than other governments, including the UK’s.

These public health measures have been proven and demonstrated to significantly reduce the impact of COVID-19 spread in countries around the world. While this does not rule out the possibility that other factors may have played a role, there is little data to support the proposed explanations for why and how Africa escaped the worst fate predicted.

The world, it seems, is willing to accept any other explanation — genetics, the youthful population, cross protection from exposure from other pathogens, even the weather, before accepting that this was a success born out of deliberate actions taken by African leaders. The wilful refusal to acknowledge the facts — that the scientifically proven public health interventions that were taken into account for the public health outcomes that were observed in preference of the unproven hypothesis to explain Africa’s COVID-19 phase I outcomes — is driven by arrogance.

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