After months of frustrated efforts to unlock global vaccine supplies for the African continent, WHO and African Union leaders are now pinning their hopes on US President Joe Biden’s reported plan to call heads of state to a “Global Pandemic Summit” on the sidelines of the United Nations General Assembly, which opened today, as a way out of the current deadlock. 

Biden reportedly is circulating a plan to hold the summit on 22 September – with the aim of reaching a joint commitment to the vaccination of 70% of the world’s population by the GA session in September 2022, ensuring that “additional doses and adequate supplies are available to all countries”, according to a set of targets circulating among embassies, and obtained by the Washington Post.  

To achieve that, the Biden plan for the Global COVID-19 Summit also calls for “expediting delivery of approximately 2.0 billion previous committed doses..  including by converting existing dose sharing pledges into near-term deliveries, swapping delivery dates to secure earlier delivery of doses to LIC/LMICs, and eliminating cross-border bottlenecks in the supply of vaccines and critical inputs.”

But speaking at Tuesday’s press conference following two days of meetings in Geneva, African Union and African Centers for Disease officials stressed that the era of “pledges” for vaccine donations to Africa, needs to end and investments in African vaccine manufacturing to begin, as part of any ‘New Deal’ on pandemic response in low- and middle-income (LMICs) countries. 

“”We, as the African Union, are calling on a permanent structure,” said Masiyiwa, a billionaire entrepreneur and AU Special Envoy for COVID-19, “and this is something that we will be calling on to be put in place at this summit that President Biden is convening. 

“We strongly believe that the pledge architecture, where countries gathered together and made pledges….  has had its day.  Let us now have a permanent structure.  Vaccine sharing is good. But we shouldn’t have to be relying on vaccine sharing, when we can come to the table, put structures in place, and then say that we also want to buy.”  

Calls for new African vaccine facility

This should involve the creation of a new, and permanent African vaccine facility, supported by the African Union, World Bank and International Monetary Fund, said Professor Benedict Oramah, President and Chairman of the Board of Directors, Afreximbank. 

Afreximbank has provided financing for the continent’s purchase of some 400 million Johnson & Johnson vaccines – backed by the World Bank. But Benedict stressed this is only the beginning of a long road that will require the procurement of booster doses as well. And so a more permanent finance mechanism is needed for countries to manufacturer and purchase doses themselves – rather than being solely reliant on goodwill donations.  

While “thanking” COVAX for the role it has played in facilitating global COVID vaccine supplies, “going forward, we need the IMF to do the vaccine facility – to make it possible for countries to now access these vaccines through the structures put in place,” said Oramah.  Those structures should include domestic manufacturing and procurement financed through African mechanisms, such as “Afreximbank, providing the initial financing, and then they refinance it in a way that makes it possible for the current accounts to carry all this – while the World Bank continues to provide institutional structures that are required to effectively administer vaccines.”

Africa is region with lowest rates of vaccine coverage in the world 

Among all LMICs, Africa stands out for its particularly low vaccination rates so far – with under 3.5% of its population vaccinated – as compared to 60-70% in some high-income nations, African Union also said, speaking at a WHO press conference in Geneva. Of 5.2 billion doses delivered worldwide, only a tiny fraction have reached Africa, noted WHO Director General Dr Tedros Ahanom Ghebreyesus. 

And as things stand now, COVAX, the global vaccine facility, only has sufficient doses in the delivery pipeline to vaccinate roughly 20% of the population in the 91 lowest income countries by the end of the year, using some 1.4 billion purchased and donated doses, admitted Gavi CEO Seth Berkley at the WHO press conference.  And it would hit 36% coverage by March, 2022.

That falls far short of WHO’s target of 40% vaccination by December 2021 and 70% by March 2022. 

To reach those targets, “the world needs 2.4 billion additional doses to go into low income countries to get us to 40% by the end of this year,” Said Bruce Aylward, a special WHO advisor on the pandemic. “Those doses exist,” he said, citing recent pharma statements to the effect that there are now sufficient doses for everyone to go around – including high- and low-income countries. 

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I think the question we ask is: where are those doses if there are enough for everybody?” Aylward asked.  “And [the US Summit] next week is all about making sure there’s a clear path to ensuring they go to where they’re needed.”  

Barriers that have fouled vaccine access – both countries and manufacturers share blame

Speaking at the close of a two-day Geneva meeting, which also included Dr John Nkengasong, Africa CDC director and African Regional Director Matshidiso Moeti, the WHO and AU officials said that in they had reviewed in painstaking detail the various obstacles  in the way of African vaccine access – and ways to overcome them. 

The challenges have included export bans, including the interruption of supplies from India in March 2020 when the subcontinent experienced its own COVID surge, but also barriers on the exports of vaccines and their inputs to a complex supply chain, they noted. 

But the African officials also repeated longstanding complaints against rich countries for vaccine hoarding, as well as against pharma for preferential sales to high income countries of huge vaccine quantities – in excess of actual population needs. 

“We want to buy from the same manufacturers,” said Masiyiwa. “But to be fair, those manufacturers know very well that they never gave us proper access. They gave access on a very different basis. “When they knew that supplies were restricted at the beginning, there was no production… they [pharma manufacturers] had a moral responsibility to ensure that others also had access,” he said. 

“And we find this very sad. It’s very sad. We could have addressed this very differently. We as Africa will now address this through setting up our own manufacturing capabilities.” 

Countries’  export restrictions also holding up distribution 

But countries’ export restrictions on vaccines as well as the many vaccine manufacturing inputs also continue to foul deliveries – and these are poorly understood, Masiyiwa said. . 

“My principal job is to negotiate with suppliers, and the suppliers have over the last 8-9 months, made it clear that the biggest challenge that they face are export restrictions, export restrictions are being operated right across the board. So, if those export restrictions aren’t there, where are the vaccines, because the production is happening? 

“We’re not seeing the vaccines, and we are being told by the suppliers, they are facing export restrictions. 

He added that without resolving, “this issue around the movement of the various ingredients that drive production… we will not even be able to get manufacturing effectively set up.” 

“We need to get these restrictions removed, and we had a very constructive discussion around this issue with the WTO yesterday,” he said.

AU leaders call on India to remove its ban on AstraZeneca vaccine exports – now that domestic COVID surge has subsided

Masiyiwa also appealed to India to resume its deliveries of AstraZeneca vaccines, produced by the Serum Institute of India – noting that the countries’ embargo on the export of vaccines, remains the most outstanding example of restrictions fouling distribution plans.  The SII vaccines were a centerpiece of COVAX and African countries – until exports were abruptly cancelled in March.  

“We understood that at the time why they were put in place, it was because there was that massive surge in India, and we were incredibly, incredibly sympathetic. But we do now urge our colleagues to show sympathy to us, because we are the ones facing difficulty now. We need to see some of those vaccines begin to come through.” 

Finally, both African Union and WHO officials repeated their call to countries to support a waiver on intellectual property on COVID vaccines and therapeutics,  currently being negotiated by the World Trade Organization – saying that this would help jump-start more manufacturing in developing regions. 

“American taxpayers, European taxpayers financed some of this intellectual property, and so it should be for the common good,” said Masiyiwa.  “So we ask for this IP to be made available.  It was a great miracle to have these vaccines, now let this miracle be available to all mankind”.

Added WHO’s Tedros:  “If it [a waiver] cannot be used now during this unprecedented condition or situation, then when is there a time when it can be used.”

Image Credits: @WHO.