Misinformation is particularly pervasive in times of great anxiety and diminished trust in authorities. Concerns have been exacerbated by the media, including comments made on French TV channel LCI about a vaccine trial in Africa, leading former footballer Didier Drogba to comment:
“Do not take African people as human guinea pigs! It’s absolutely disgusting.”
In 2019, the WHO listed vaccine hesitancy as one of the one of the top 10 threats to global health. Hesitancy is defined by the WHO as delay in acceptance or refusal of vaccines despite availability of vaccination services. The issue of vaccine hesitancy raises a key question in any forthcoming Covid-19 mass-vaccination effort: Will Africans be willing to take the vaccine?
This is particularly true because the vaccine question goes beyond public health into economic recovery and reconnecting with the world post Covid-19. Put simply, African countries currently face disproportionate restrictions on air travel despite a relatively lower number of cases. Making the case to lift these types of restrictive policies will depend upon Africa’s ability to prove its citizens do not pose a global public-health risk.
Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. Some data exists, globally, around vaccine willingness and there are some lessons that can be drawn from the perception of and behaviors relating to vaccines that have been rolled out in sub-Saharan African countries and elsewhere before the Covid-19 pandemic.
Africa has good experience from its established vaccination campaigns, including using vaccines to counter outbreaks such as with Ebola in the Democratic Republic of the Congo in 2018 and meningitis in 2010 to 2015. However, those efforts have mostly targeted children and young adults or localised outbreak areas. Certain features of any successful vaccines that may impact rollout strategy are still unknown such as the number of doses that will be required or the temperature at which it will need to be stored but governments should establish their distribution frameworks and start addressing gaps in preparedness.
Getting the vaccines from manufactures to countries is a mammoth task. It not only requires that airlines have enough space to transport them, but also that the vaccines are kept at a stable, cold temperature from the moment they leave the manufacture until they are administered. Ensuring the facilities needed for this are in place known as the “cold chain” is critical part before COVID-19 vaccines arrive. UNICEF for instance has stepped up its planning with the airline industry and countries including Botswana may work jointly with the development partners and UNICEF in this regard.
The rapid development of the Covid-19 vaccine is one of humankind’s most outstanding collaborative scientific achievements. A global effort to defeat an enemy that recognizes no borders, no race, and no gender, the vaccine is a profound demonstration of the boundless capability of harnessing the world’s best minds. Now, health professionals will take this momentous achievement, with the hope it brings, and begin to deliver the promise of a “new normal.”
This welcome endeavour is called the COVID-19 Vaccine Global Access (COVAX) initiative. It is co-led by the World Health Organization (WHO), the Coalition for Under this scheme, even poor nations should have enough vaccines to protect health-care workers and the most vulnerable 20% of their populations. Even after a covid-19 vaccine is found to be effective, it could still take a year to reach the general public, according to experts. And the roll out of any vaccine will be accompanied by difficult decisions about who should be prioritized to receive it. Even when the vaccine is available, it does not mean within a month everybody will be vaccinated.
Rolling out a vaccine over a year will mean that decisions must also be made about which groups get vaccinated before others. There will have to be some prioritisation, that’s going to be a difficult choice that will have to be made by policy makers. How do they distribute it to the best advantage and to which high risk groups first? Aside from the difficulties of manufacturing, storing, and distributing a vaccine, success of an immunisation programme will rely heavily on public trust and access. As such, it is important that vaccine hesitancy and barriers to uptake are tackled.
The Covid-19 has now been developed but still, Africa has reasons to worry. Already, several high-income countries have signed their own contracts with individual companies to buy selected vaccines. In April 2020, Africa CDC launched a Partnership to Accelerate COVID-19 Testing (PACT). The COVAX initiative promises to benefit Africa, and many people on other continents. It hopes to offer lower-income countries equitable access to a diverse portfolio of potential vaccines at highly subsidized prices. Africa, like all continents, needs an accessible vaccine to save the lives and health of vulnerable populations, and to maintain economic development with Botswana not being an exception
it is important to note that this is not the first time that there is a scramble for access to therapies. It happened with HIV, for example. And Africa has ended up at the end of the queue every time. Antiretroviral drugs to treat HIV entered the market in the mid-1990s. The prices that companies set for these drugs put them out of reach. As deaths in rich countries plummeted, infected people were left to die across Africa.
It is estimated that, between 1997 and 2007, 12 million Africans died waiting for enough life-saving drugs to reach the continent. The drugs’ arrival was largely thanks to the efforts of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Relevant literature is showing that the ‘whole of Africa’ coordinated approach is needed to prepare for the development, purchase, access and roll-out of a COVID‑19 vaccine. That must be built now. Success will require collaboration between political leaders on the continent and those elsewhere, including the WHO, Gavi, CEPI, regulatory agencies, implementing partners, donors and the private sector.
The strategy on the response to Covid-19 in Africa must be noted it has three pillars. The first is to accelerate African involvement in the clinical development of a vaccine. The second is to ensure that Africa can access a sufficient share of the global supply. The third is to remove barriers to widespread delivery and uptake of the vaccine across Africa.
It has also been noted that new financing will be required to pay the billions of dollars for COVID‑19 vaccinations, including advance payments to secure supply. The Africa Export Import Bank (Afreximbank) has committed to a vaccine-financing framework for Africa. This will allow pooled purchases of medical supplies and support for vaccine manufacture. Countries will issue promissory notes to Afreximbank, which will arrange about $4 billion in revolving credit to back orders from African suppliers that have been certified by Africa CDC.
African countries will need efficient processes to fast-track market authorization of safe and effective COVID-19 vaccines. CONCVACT is working out how to harmonize decisions of country-level regulators with global processes (such as the WHO pre-qualification programme) and expedite roll-out across the continent.
In partnership with others, Africa CDC has set up the Africa Medical Supply Platform, a system to coordinate procurement that can be adapted for vaccine distribution. In preparation for the rollout of the Covid-19 vaccines, it is recommended that the following be the guiding principle:
Quickly and efficiently schedule eligible people with an eye toward equity and inclusion, manage post-vaccination symptoms and testing and educate the nation about the vaccine focusing on those who are “vaccine reluctant” by providing access to expert scientists and clinicians. Botswana must be committed to equitable access to the vaccine and must ensure that anyone who interacts with Covid-19–positive or Covid-suspected patients has equal opportunity to be vaccinated.
To support the culture of transparency, information must be routinely shared about the vaccines as it becomes available. Making experts available to receive and respond to questions to building trust. Additionally, launching a “confidence campaign” featuring thought leaders and influencers sharing why they chose to be vaccinated, as we know that seeing people admired making the decision to receive the vaccine will help to inspire confidence in the vaccine.
As the world has developed effective Covid-19 vaccines, forward planning on rollout should start now. Governments need to do the following things. Engage their public early to counter any potential vaccine hesitancy, appoint or activate a vaccine coordinating group, decide on their prioritisation plan for who gets vaccinated and when, identify the personnel and logistical requirements for the rollout, start now to implement the tech solutions that will help them with their rollout and recording of the programme
Community engagement and social mobilisation are fundamental to counter vaccine resistance. Early community engagement and social mobilisation will play a key role in proactively curbing any existing mistrust of state actors and health-care providers. This requires coordination with local leaders, formal and informal structures and networks, partners and government agencies.
Thabo Lucas Seleke is a Researcher & Scholar Global Health Policy Analysis
