Among potential vaccines on clinical trials for the SARS-CoV-2 virus globally, the Ox1CoV-19 VIDA-Trials in Johannesburg is the sole candidate in Africa – a collaboration between Oxford University and University of Witswatersrand. This is worrisome despite capacities to conduct clinical trials in other countries including Senegal, Egypt and Algeria. Determined to increase this number, as part of a joint continental strategy for COVID-19, the African Union Commission launched the Consortium for COVID-19 Vaccine Clinical Trials (CONCVACT). While this partnership hopes to bring global vaccine developers, funders and other organizations to facilitate more late stage clinical trials within the continent, it is far from achieving its goal. This comes amid growing vaccine nationalism; a “my country first” approach in allocation, irrespective of risk of transmission of disease elsewhere. Although, the United Nations General Assembly has called for an equitable, efficient and timely access to any successful outcome, issues ranging from nationalism, monopoly and patents often persist in countries where they are produced.
Amidst the COVID-19 pandemic, the United States’ acquisition of almost all stock of three-months production for remdesivir, an anti-viral drug originally developed against Ebola Viral Fever, highlights this phenomenon. Although the country has a higher number of infections alongside mortality than elsewhere, several nations had also participated in the trials that birth the drug. While production of remdesivir has been licensed outside for developing nations, potential COVID-19 vaccine distribution if not beyond national borders pose a challenge for African countries.
Prior to emergence of SARS-CoV-2 pandemic, a significant number of countries in Africa relied on the Global Alliance for Vaccine and Immunization (GAVI). To ensure equitable access, it launched COVID-19 Vaccines Global Access (COVAX) – a tool to help countries minimize risk in investment, co-led by World Health Organisation (WHO) and Coalition for Epidemic Preparedness (CEPI). Thankfully, the tripartite partnership secured a 300 million doses deal with AstraZeneca – a leading biopharmaceutical company for the Oxford vaccine. Still, it could face hurdles, as the number of countries participating is unclear. For those who may consent eventually, how long they would remain committed when the scramble begins is also vague. This is because growing tension between the United States and China could pose a threat to multilateralism especially with the former withdrawing funds to WHO. Presently, China displays a positive disposition towards Africa with recent donations of medical supplies and has also pledged supply for potential vaccines. Nevertheless, the fluid political nature of global health generates so many uncertainties as more often, it is a tool for international diplomacy than health. Given China’s population and limitations of industrial capacity elsewhere, a major challenge would be scaling production and timely distribution to all countries upon successful development of a vaccine. Interestingly, national legislation in many countries prohibits exports of medical supplies in events of public health emergencies as demonstrated with export restrictions of personal protective equipment from Asia, United States and Europe.
As a result, for African countries, access would require successful COVID-19 vaccines being treated as a global public goods, marked with equity and transparency. Importantly, these technologies should be added to the WHO COVID-19 technology access pool and licensed elsewhere to boost production. But how this would work without key countries in research and development which includes the United States, Russia and India is questionable. Although as part of a global action for universal access, the European Union Commission has raised almost $16 billion to support low and middle income countries. Nonetheless, the African Union had earlier joined other countries calling for a “people’s vaccine”, citing the flexibilities in World Trade Organisation (WTO) Doha public health declaration, which grants compulsory licensing during emergencies. By removing potential barriers posed by intellectual property rights for new drugs and vaccines, production can scale up and would go a long way in ensuring timely access to billions of people in vulnerable communities. But again, the vaccine industry remains a multi-billion corporation with diverse stakeholders and African states are dependent on others for basic medical supply – which is not new. Thus, a much stronger global framework is needed at the highest level to prevent avoidable deaths in the wake of the pandemic.
The huge gap in access provides a market for private sector engagement post-pandemic and the African Academy of Sciences has begun mapping clinical trial sites led by African researchers to increase their visibility. This would enhance the relationship between trials investors, partners and regulators. Remarkably, the global health architecture is potentially as strong as its weakest link. Given our inter-connectedness, ensuring equitable and fair access is not only vital worldwide, it is also essential in halting further spread. At the same time, sustainability would rely on development of regional research institutions or infrastructures along with production capacities. This is essential for survival of Africa within the global community.
Evaborhene Aghogho Nelson is a Nigerian physician with extensive experiences in community health, engagements and delivery in underserved. He is currently a postgraduate Msc global health and development candidate at University College London, where he conducts research on health system inequities.
Miss Haafizah Kilu, Msc global health and development University College London.