Inequality in vaccine coverage between low-income countries and high-income countries is extreme.
Estimates show that between 1.6 and 2 million people die from vaccine-preventable diseases every year around the world, with the vast majority of these deaths occurring in Africa and low-income countries.
With the world already fissured by deep-rooted racial discrimination, concern around the ethical engagement of participants in Covid-19 vaccine trials in African countries is now riddled with controversy.
Vaccine trials have become such a sensitive matter mainly because of the way some European researchers undertake unethical experiments and trials on Africans by treating them as testing labs.
Such unethical conduct resulted in the launch of a social media initiative in the form of a Change.org petition to stop coronavirus trials in Africa.
When asked whether Africa should take part in vaccine trials since European countries and large pharmaceutical companies always use developing countries as testing grounds, scientist and public health researcher, Taelo Morapedi said: “Of course, Africa should take part in vaccine trials.”
Speaking to this publication, she indicated that to snub this prospect could potentially lead to the exclusion of Africa’s researchers from being major players in the race to develop a vaccine for Covid-19.
“Given the way the coronavirus pandemic is accelerating in neighbouring South Africa and Zimbabwe, it is essential that vaccine studies be carried out in Botswana and other countries across Africa to determine the immune response of Africans and how they respond to the vaccine trials, rather than just relying on clinical trials being conducted in Australia, Europe and other western countries,” says Morapedi.
These sentiments were also shared recently by World Health Organisation (WHO) regional director for Africa, Matshidiso Moeti who said vaccine trials must not just be held in Western countries because Africans have different circumstances and different genetic make-up that may affect how the vaccine works.
“I encourage more countries in the region to join these trials so that the contexts and immune response of populations in Africa are factored into studies,” said Moeti who is also a Public health specialist and medical administrator.
She also said there is already existing vaccine manufacturing capacities in countries such as Algeria, Egypt, Ethiopia, Morocco, Senegal, South Africa and Tunisia because these facilities are involved in the development of vaccines including yellow fever and Ebola.
The first clinical trial in Africa for a Covid-19 vaccine started in South Africa, run by the University of Witwatersrand. The trial which involves 2,000 volunteers aged 18-65 years old also includes people living with HIV. Shabir Madhi, the principal investigator of the South African Ox1Cov-19 Vaccine VIDA-Trial said it is critical to conduct a Covid-19 vaccine trial in an African setting because of differing circumstances.
“When a vaccine works in one country or setting, it doesn’t necessarily mean that the same will occur in another setting because we’ve got our own unique circumstances in the African context,” he said.
As scientists race to gain more insight into Covid-19, another warning has been issued that failure to factor in Africans in the studies could result in the African continent having a Rotaviruses Vaccine Problem.
This is when vaccines are effective in Europe and North America but less effective in Africa mainly because the vaccines were mainly based on rotavirus strains predominantly found in Europe and North America. “Therefore, little or no data for Africa amounts to poor or no representation at vaccine development,” says Morapedi.
Morapedi said it is not sustainable in the long run for Botswana to continue adopting drastic measures such as the 48-day April lockdown to contain the spread of Covid-19. “Strict lockdowns such as the first 48-day lockdown in Botswana are no longer sustainable. Almost all the sectors in the country were decimated and recovery is still a struggle for majority of the population. Finding an effective vaccine is probably one of the best chances that Botswana and other African countries have to return to normalcy, and this can only happen if African countries participate in these trials,” she says.
Current statistics show that only 2% of clinical trials conducted globally occur in Africa. It is believed that if the same low clinical trajectory continues, this could hamper the effectiveness of a future Covid-19 vaccine on the African continent.
In April 2001, African Union Heads of State met and pledged to set a target of allocating at least 15% of their annual budgets to improve the health sector. But two decades later, only a few African nations have managed to allocate the pledged amount to their healthcare systems.
According to Morapedi this has had serious repercussions for scientific research on the African continent.
“Africa, Eastern Europe, Asia and the Middle East are rarely involved in trials. With regards to Africa, most sponsors prefer countries such as Kenya and South Africa which have reliable healthcare infrastructure, and this is why we see that the Covid-19 trials are being done in South Africa.”
While Morapedi admits that the African continent has the capacity to apply knowledge and mass produce vaccines against Covid-19, she says there is need for the continent to be more involved in vaccine trials and research.
Speaking recently in an online virtual conference on how the African continent plans to play a part in the development, production, and distribution of future coronavirus vaccines, the continent’s top epidemiologist, Dr. John Nkengasong, who is the director of the Africa Centre for Disease Control and Prevention said a Covid-19 vaccine would allow member states to return to a fully functional economy and society.
His concerns are not unfounded. The World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus has already issued a muted warning that Africa will not escape the spread of the coronavirus.
While local infection rates are low in Botswana, the country has not dodged the bullet. South Africa and Zimbabwe are experiencing high local transmission rates and medical health practitioners who spoke to The Telegraph say the vortex pull that coronavirus is exerting on her two neighbours is likely to spill in Botswana.
This became evident a fortnight ago when Botswana’s minister of health and wellness, Dr Lemogang Kwape announced that the greater Gaborone region would be under a two-week lockdown as a result of a sudden surge in local infections mainly at schools.
A political commentator, Kabo Matlhaope, who spoke to this publication, indicated that Africans participating in vaccine trials is just one piece of the puzzle. He said what should worry the continent the most is how the vaccines will be distributed once found.
“Our failure to unite as Africa and embark on extensive trials on the continent is slowly catching up with us. If a vaccine is ever found, Africa will be on the back of the queue because countries such as Russia, India and the United States of America have said they would like to secure exclusive rights over the Covid-19 vaccine,” said Matlhaope.
The problem posed by vaccine nationalism to African countries with fewer resources is that it further disadvantages countries such as Botswana which have fewer resources and bargaining power. Whilst regional organs such as the African Union (AU) have reiterated the need for a fast and even-handed distribution of any successful Covid-19 vaccine, there are still major hindrances as some countries are using their financial muscle to secure hundreds of millions of doses.
If this is not resolved soon, the catastrophic history where access to HIV treatment in sub-Saharan Africa was delayed, and resulted in millions of deaths, is likely to happen again.