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Coronavirus explosion in India complicates Africa vaccine roll out

By Olivier Marbot
Posted on Tuesday, 11 May 2021 20:10, updated on Thursday, 13 May 2021 09:55

The body of a Covid-19 victim is carried off to be cremated at a crematorium ground in New Delhi, India, on 6 May 2021. Ishant Chauhan/AP/SIPA

“Frankly, until the beginning of this year, we lived as if the virus did not exist,” says a French woman living in Delhi. “Everything changed between late March and early April.”

Although the number of Covid-19 infections was high at the time, it seemed no cause for alarm given the number of people living in the subcontinent. The situation also appeared to be under control.

A month later, however, the figures are staggering: 4,000 deaths and 400,000 new cases are reported daily. Furthermore, the whole world has seen horrifying images of hundreds of funeral pyres burning continuously across the country.

There are concerns as to whether the continent will experience an ‘Indian-style scenario’ in the weeks or months to come.

After all, India and Africa have a number of things in common: populations of comparable size with a high proportion of young people, health services with limited capacity and many people on middle, low or very low incomes.

However, most scientists agree that at this stage, this is pure speculation.

“Only half of the doses delivered to the continent have been administered,” says Matshidiso Moeti, regional director for Africa at the WHO.

But the disaster in India has another, more immediate consequence for Africa, as it is the continent’s main vaccine supplier. Its famous Serum Institute of India (SII) is the world’s third-largest supplier.

Unlike the other major players in the vaccine sector (China and Europe), India has long specialised in low-cost products designed to combat major diseases affecting tropical areas. However, ever since the outbreak of Covid-19 cases in the country, SII – which was one of AstraZeneca’s main suppliers via the Covax initiative – has been unresponsive.

Mistrust and fatigue

“From March to May, a total of 140m doses manufactured in India will not have been delivered to Africa,” says Thabani Maphosa, general manager of country programmes for the Gavi vaccine alliance, which co-pilots Covax.

This has affected the pace of vaccination. The continent had accounted for a modest 2% of the total doses administered worldwide in March, but this proportion has now fallen to 1%.

The problem is not only related to delivery, however, says doctor Matshidiso Moeti, regional director for Africa at the World Health Organisation (WHO). “Only half of the doses delivered to the continent have been administered,” she says. Eight countries have used all the units received, 15 have administered less than half and nine others have used less than a quarter.

This is often due to a lack of resources as well as trained and competent personnel, but also because of scepticism. A significant percentage of the population is weary of complying with restrictive precautionary measures as the number of patients still seems low. Additionally, there are also concerns over rumours that certain vaccines supposedly are ineffective or have worrying side effects, such as AstraZeneca’s.

Ghana, Rwanda and Botswana as success stories

In contrast, Moeti says, Ghana, Rwanda and Botswana have distinguished themselves by vaccinating very quickly and on a large scale. These countries are considered to be success stories because they were able to anticipate and plan their vaccination campaigns.

They identify the populations to be targeted as a priority and, in some cases, even carry out simulations to deal with potential obstacles.

WHO officials cite some more good news; mainly, the US decision to support the temporarily lifting patent protections for Covid-19 vaccines, despite protests by pharmaceutical giants who are determined to fight the decision.

In the meantime, Covax officials are diversifying their supply sources.

“France and Sweden have already committed to supplying some vaccines,” says Maphosa. “Moderna has just promised to supply us with many doses, and we are in discussions with Johnson & Johnson as well as with Russian and Chinese suppliers… In fact, we are interested in all WHO-validated vaccines.”

China, mainly through Sinovac and Sinopharm, has entered a phase of intense lobbying and is presenting itself as an option to Indian manufacturers, who are unable to meet their commitments. The country has already delivered 240m doses  and promised an additional 500m vials.

This is enough to relegate to the background, at least for a while, allegations that the effectiveness rate of certain Chinese vaccines are below 70%, while Sputnik-V and Pfizer-BioNTech claim rates of more than 90%.

This also makes Indian laboratories nervous: their Asian rivals seem to be taking advantage of their current predicament to try and control what remains, first and foremost, an immense and profitable market.

Variant concerns

Another cause for concern is the proliferation of virus variants, which are often more virulent and/or more contagious, as questions arise as to whether the current vaccines will be able to protect against them.

The B1.351 strain, known as the South African variant, has so far been identified in 23 countries on the continent. The ‘British’ B1.1.7 has been identified in 20 countries. The ‘Indian variant’ – officially known as B.1.617 – has been identified in Uganda as well as Kenya, and is already causing concern.

But Moeti insists on keeping things in perspective. “It is possible that this variant is more transmissible than the others. We are studying it in order to learn more about it. But it is also possible that Indian vaccines, when they become available again, will be more effective against this specific strain. And, on the other hand, the symptoms are the same as for the other forms of the virus,” she says.

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