The Covid-19 pandemic continues to rampage through lives and livelihoods across the world. Many steps have been taken to end the lockdown and slow the spread of the virus, including testing and tracing. Still, absent a vaccine or a cure, the number of cases will continue to increase as lockdowns are lifted, and with that. death and devastation. On May 14, more than 140 current and former world leaders, academics, and experts called on world governments, ahead of the World Health Assembly on May 18, to produce a vaccine "rapidly at scale and made available for all people, in all countries, free of charge."
The World Health Assembly is taking place in an acrimonious environment, as the row between the US and China continues to escalate. But politics aside, we need all hands on deck to find a vaccine, and we need this to happen in a way to ensure the global public good. Specifically, we must include African countries and the wider developing world as partners in this search.
There is a need for the world health body to bring governments together for clinical evaluation of the efficacy and safety of any COVID-19 future vaccine. This must follow the ramping up of regional manufacturing capabilities for local immunization, and reaching an advanced purchase agreement with manufacturers and suppliers as well as building up multilateral financial partnerships before even a vaccine is made available.
Ending the lockdown
Decisions to impose or lift lockdowns could be extremely challenging politically. Governments must find an appropriate middle ground between a long, broad lockdown that damages the economy and a reopening that is too soon and too fast, risking public health and potentially subsequent lockdowns. Data on emergency room visits are an early indicator of changing disease rates. Quantifiable measurements such as decrease in new cases and relatively low hospitalization and death rates should be used to guide this important decision.
Qualitative measurement such as Virus Monitoring System (VMS) is another pre-requisite for re-opening. The VMS requires sufficient testing capacity, reasonable testing turnaround times (must be short), the ability to screen large numbers of asymptomatic individuals (different from mass testing), and the presence of robust contact tracing with the ability to rapidly inform and quarantine affected individuals.
African countries could focus primarily on providing testing to key public hospitals and community settings, where patients are likely to show up in order to rapidly determine their COVID-19 status, and to public health laboratories, which should be equipped with the latest testing equipment. African countries should learn from other countries that have strong testing systems in place to inform them when problems come up. In parallel, African countries should conduct random population testing to determine the virus’ prevalence across regions and provinces.
Contact Tracing is a Job for the Whole Community
As for Tracing, African states, should build contact tracing teams of five people, each led by an epidemiologist or public health specialists. Recruits could include phone bank staff (since so much tracing work is done by phone), workers from health organizations, social service and non-profit agencies. Community and religious organizations, businesses, and others are well placed to provide services for cases and contacts who must remain in isolation or quarantine. However, it is not cleat if these developing nations have the resources to build up sufficient testing capacity within short time span as well as a robust contact tracing with the ability to rapidly inform and quarantine affected individuals.
A Winning Strategy to End the Lockdown
Governments need to establish protocols, standard operating procedures, structure and begin training the recruits now. Effective response to epidemics is greatly enhanced by a well trained workforce, coordinated through a public health Emergency Operations Centers, enhanced facilities, state-of-the-art equipment, and objective assessment exercises. Most importantly, Governments need to execute regional lift of lockdown in a way that allows for adjustments as conditions change.
Once the conditions are met, one strategy could be restarting social and economic activity on the basis of transmission risk. First, reopen the most essential operations, such as medicine, energy supply, logistics, and food, then activities with medium transmission risk, such as manufacturing, construction, and retail and lastly businesses with high transmission risk, including restaurants, hotels, and education institutions.
Restarting social and economic activity on the basis of transmission risk while continuing strict isolation for vulnerable populations such as the elderly or patients with cancer may be the right strategy in the near term for lower income African countries that are unable to rapidly build up health care and testing capacity. However, can people who live in the most densely occupied households and neighborhoods in the world isolate their vulnerable and elderly? Are Cancer centers in Africa ready to embrace the many challenges and uncertainties caused by the pandemic? Are they equipped to adopt measures to protect those patients with cancer who are known to have higher risk of mortality compared with the general population?
Additionally, the disease is disproportionately hurting poorer communities. Likewise, the economic impact of the shutdown is hitting low-income workers and those in the informal sector the hardest. Policymakers will need to make sure that, as their countries open up, the recovery doesn’t make inequality even worse than it already is.
The Vaccine’s Journey Must Include African, and Other Developing, Nations
The world is currently focused on the development of vaccines for COVID-19. It is vital for Developing nations to take part in the solution. There are already at least 254 therapies and 95 vaccines related to Covid-19 being explored. The first nation to develop a vaccine for Covid-19 could have an economic advantage over others as well as a tremendous public-health achievement. And the urgency to develop a vaccine quickly is eclipsed only by the need to make sure it is very safe. Traditional international regulatory pathways need to be adapted (timelines shortened) to enable reach this milestone. And as soon as a vaccine is available, medical staff will be inoculated as a priority. Then it will be applied to risk groups, and finally to the wider public.
China is making rapid progress, with three vaccines entering advanced development. The US is entering the race with five or six companies which operate primarily in the U.S. The Europeans are also making great progress and the laboratory sprinting fastest is at Oxford University in London whose first few million doses of the vaccine could be available by September. The professor leading the vaccine development efforts in Oxford said September 2020 is a “realistic date” to expect a vaccine that could work. However, the challenge for the three competing powers (USA, China and EU) is to make enough vaccines for their populations and for other nations who cannot develop their own vaccines and medicines.
Africa must make sure it’s part of the search for a coronavirus vaccine. In this context, it’s important to look at how prepared African scientists and institutions are to lead clinical trials for vaccines and medicines in Africa. Research which takes place in Africa is predominantly funded by northern sponsors, with national academics and clinicians partnering in the research process and international research organisations providing oversight to ensure that participants are protected.
Africa, Start Preparing Factories NOW!
It’s important for African countries to take steps to prepare to manufacture the vaccine on a local and/or regional scale once a vaccine is available. More than one vaccine would be needed in any case as this will help avoid bottlenecks in manufacturing. The most prepared country in Africa could inoculate its own population quickly and share the product with other countries who need it.
Vaccine factories, however, follow strict guidelines governing biological facilities and usually take around five years to build, costing at least three times more than conventional pharmaceutical factories. Manufacturers may be able to speed this up by creating or repurposing existing facilities.
African Governments and industry will need to come to an agreement regarding manufacturing and distribution. Risk-sharing agreements between governments and pharmaceutical firms are nothing unusual and Africans governments may have a leverage over manufacturers (AstraZeneca, GlaxoSmithKline, Sanofi, Pfizer) with the most promising vaccines and medicines and with commercial activities in their territories. Of note, the race leader Oxford’s spinout Vaccitech and partner AstraZeneca have agreed to supply the vaccine “at cost” during the pandemic including to the developing world.
Generally speaking, African countries are ill-prepared and vulnerable to the persistent threat of pandemics and large-scale disease outbreaks. Preparedness investments in these countries often compete with more visible priorities such as education, housing, transport infrastructure, and other pressing health needs.
Over the past several years the World Bank Group has established itself as the leading international financier for health emergency preparedness and response in developing countries. However new catalytic financial mechanisms are needed to respond to the outbreak of the novel coronavirus (COVID-19).
There are also funds that are provided by the Emergency Reserve Fund for Contagious Infections Diseases at the US Agency for International Development (USAID) which normally directs the funds to the World Health Organization (WHO) under the Strategic Preparedness and Response Plan (SPRP). However, President Trump’s unilateral decision to stop US financial contribution to WHO (15% of WHO’s GDP) would necessarily compromise the existing financial mechanisms in place and directly impact African countries at the peak of COVID-19 pandemic.
Building partnerships with international philanthropic foundations, such as the Bill & Melinda Gate Foundation, is essential given the leading role Bill Gates has played since the start of COVID-19 pandemic in the first quarter of this year.
In January, when the coronavirus began spreading, the Gates Foundation committed $10 million to helping medical workers in China and Africa. Recently, Gates said on a TV show that his foundation would fund factories for the seven most promising potential vaccines. Most importantly, he said he wanted production capacities to be built up in the developing world, noting that poorer countries in Africa, Latin America and Asia would be served last if markets were to decide who gets access to a vaccine.
On May 4th, a high-level meeting of government leaders with representatives of the European Union and the Bill and Melinda Gates Foundation took place to discuss raising €8 billion ($8.6-billion) in funding for a global vaccine distribution agency to be established at the World Health Organization (WHO). African countries could benefit greatly from this multilateral philanthropist initiative.
The COVID-19 shock will have a major and long lasting impact on Africa and the developed world alike. Novel vaccines and medicines designed to defeat the virus will save lives and allow the world economy to recover. Africa ought to be considered partners in the solution for COVID-19.
Partnering through commitment to financial investments and technology transfer in research and manufacturing will create self-sufficiency, security, and economic prosperity. Helping these countries improve their abilities to respond to epidemic threats creates health capacities that can last well into the future.
By contrast, Ignoring Africa may result, beyond any ethical consideration, in harmful geopolitical consequences worldwide. Economic recession, surging unemployment, financial hardship, political instability, rise of radicalization and a surge in refugees and migrants are among the issues that would plague Africa and the world for years to come.
Kaouthar Lbiati is a medical doctor with an MSc degree in International Policy and Health Economics from the London School of Economics. She is also a health policy specialist at the Moroccan Institute of Strategic Intelligence.