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Stop vaccine apartheid, Africa tells EU.

African Union and WHO/African Region officials on Thursday sharply criticized the European Union decision to not grant the Indian version of AstraZeneca’s “Covishield” vaccine, distributed by the global COVAX facility, recognition in the new EU “Digital Green Pass programme” – amidst a growing chorus of global protests over the double standard.

In a related statement, the global COVAX facility, also denounced what it described as “a two-tier system” of green COVID travel passes, which are “further widening the global vaccine divide and exacerbating the inequalities that we have already seen in the distribution of COVID-19 vaccines.

“Such moves are already undermining confidence in life-saving vaccines that have already been shown to be safe and effective,” said the statement, signed by WHO, UNICEF, GAVI, the Vaccine Alliance, and the Oslo-based CEPI initiative supporting vaccine R&D – without referring specifically to the EU COVID certificate, whose rollout began officially 1 July. In a separate comment to Health Policy Watch, WHO said that it remains opposed to vaccine passes altogether for international travel until COVID vaccines become “universally available”. Added the WHO spokesperson, “WHO recommends that the same rules should apply for all individuals” who have received any vaccine with a WHO Emergency Use Authorization, “with no difference in restrictions depending on the product.”

Meanwhile, at an African Centres for Disease Control press conference, officials said that the first shipment of some 80 milion US-donated J&J vaccines is just “days” away from reaching the continent. Africa will pivot even more sharply away from Covishield, the AstraZeneca vaccine produced by the Serum Institute of India (SII), and towards the Johnson & Johnson one-shot alternative in coming months – with a new deal to procure some 400 million J&J doses produced by the South Africa-based Aspen Pharmacare, due to begin deliveries in August.

Disappointment with COVAX – Hope from J&J Alternative

Strive Masiyiwa, African Union Special Envoy and coordinator of the African Vaccine Acquisition Task Team (AVATT).

Strive Masiyiwa, African Union Special Envoy and coordinator of the African Vaccine Acquisition Task Team (AVATT), told journalists that the pivot away from Covishield is due to the ongoing inability of SII and COVAX to meet the promised timeline for the delivery of the doses.

“COVAX told us in January that they will deliver 700 million doses by December, at a rate of 14 million doses a month. You don’t need me to tell you that that hasn’t happened. To date, less than 15 million doses have arrived,” he said. (see related Health Policy Watch story)

But the identification of an intra-Africa vaccine production opportunity also has raised hopes. A recent deal between J&J and the South Africa-based Aspen Pharmacare sets out a roadmap for the expanded manufacture of the single-dose J&J vaccine destined for the African market.

“We have entered into an agreement to purchase 400 million single dose vaccines, just enough to cover 400 million people as they’re not double-dose vaccines. They are manufactured by Johnson and Johnson,” Masiyiwa said.

So far over 50 member countries of the African Union have joined, and made orders for shares of the 400 million J&J vaccine doses produced by Aspen, due to begin delivery in August.

First Shipments of US Donations Days Away from Getting to Africa

Meanwhile, in a race against growing infection rates on the continent, the first shipments of US donations of some 80 million vaccines are now only days away from getting to the first African countries, Masiyiwa said.

He commended the new US government for stepping up quickly to the bat.

“The first US shipments in support of their donations will begin next week to 51 African countries. And they do include Johnson and Johnson and Pfizer vaccines, because these are United States vaccine manufacturers,” he stressed.

At a separate briefing, Gayle E. Smith, US State Department Coordinator for Global COVID-19 Response and Health Security, said vaccines and the urgency of vaccine delivery is at the top of the US government’s agenda for the continent of Africa.

“President Biden has announced that we are sharing 80 million vaccine doses from our own supply, and we will be sharing more. Those vaccines are now in the process of delivery to various countries and will continue to roll out over the coming days and weeks. The President also announced just prior to the G7 summit that the United States is purchasing and will donate 500 million doses of the Pfizer vaccine,” Smith added.

Those donations are being financed through a US$4-billion donation from the US government, and will be channeled through COVAX for distribution in the second half of 2021 and beginning of 2022.

EU Policy – ‘Not Based on Science or Data’

The European digital green pass

The European Union (EU) on the other hand, was coming under fire for both failing to share vaccines as well as failing to recognize Covishield, the most widely-used COVID-19 vaccine in Africa, in the EU-wide COVID digital pass programme, which began rollout 1 July.

In a statement, Africa CDC “noted with concern recent communications regarding the applicability of the EU Digital COVID Certificate “Green Pass” to different COVID-19 vaccines….

“The current applicability guidelines put at risk the equitable treatment of persons having received their vaccines in countries profiting from the EU-supported COVAX Facility, including the majority of the African Union (AU) Member States,” added the Africa CDC statement:

“These developments are concerning given that the Covidshield vaccine has been the backbone of the EU-supported COVAX contributions to the AU Member States’ vaccination programmes.”

At Thursday’s Africa CDC briefing, Director Dr John Nkengasong stressed that the EU’s decision on Covishield was ‘not based on science or data’, noting that the AstraZeneca Covishield vaccine produces very high neutralizing antibodies – and in any case is also a biosimilar of the Vaxzevria version of the vaccine, produced by AstraZeneca in Europe.

“If they were producing less quality neutralizing antibodies, they’ll probably argue based on that, the vaccine was not fit to be recognized,” he added, wryly.

WHO representative in Ghana, Francis Kasolo, on left, with UNICEF’s representative, Anne-Claire Dufay as first COVAX vaccine doses to reach Africa arrive on 24 February in Accra, Ghana, While the deliveries were met with much diplomatic hoopla – formal recognition of the vaccines in Europe has not followed suit.

He enjoined the EU to reverse policy actions that could also sow doubts in the minds of Africans about the validity of vaccines they receive, worsening vaccine hesitancy on the continent.

“We are really calling on the European Union to stay away from such policies that will undermine efforts and make it difficult for us to fight this pandemic, which is a serious pandemic,” he said.

“I was at the airport, together with the head of the European delegation at the African Union, receiving the [first] COVAX vaccines from India that fateful morning, very early in the morning at 6 a.m,” Nkengasong recalled. “So for them to turn around and say they will not recognize the vaccine is very troublesome, and we hope they will reverse that condition very quickly,” (See related Health Policy Watch update on EU Policy).

Europe Faces a Choice: Watching Football without Masks – or Sell & Share Vaccine Doses with Africa

Beyond the bottlenecks created by the vaccine passport, Masiyiwa also accused the EU of not playing a sufficiently active role in supporting Africa in the continent’s COVID-19 vaccination plans, with vaccine doses.

“The EU has vaccine factories and vaccine production centers across Europe. Not a single dose, not one vial, has left a European factory for Africa. We’ve gone to talk to them and they told us that they are completely maxed out,” Masiyiwa revealed.

He noted that while countries in the EU have vaccinated sufficient numbers of people so that venues like football stadiums are now reopening to people without even wearing masks, Africa still lacks vaccines even for the highest priority risk groups.

“Europe has to decide. You can’t say you support us while less than 1% of our population has been vaccinated but they can now watch football without masks. That is just the facts,” he said.

“Now is the time for Europe to open up its production facilities so that we can buy vaccines. We are not asking for donations. The fact is that we have money to buy vaccines. Vaccines are not expensive. When it comes to the minds of our people, the poorest of the poor African countries have all stepped forward and paved the way for us to buy vaccines. But we need those European factories in the Netherlands, Belgium, Italy; they must open them up and sell vaccines. We don’t even ask anyone for donations.”

Reassuring Evidence that Vaccine Mix & Match Boosts Immunity

Richard Mihigo, Immunisation and Vaccines Development Programme Coordinator at WHO’s Regional Office for Africa.

The AU shift to the J&J vaccine comes against the background of reassuring new evidence that mixing Astrazeneca and Pfizer vaccines could boost immunity, both African CDC and WHO officials also added.

“It really produces a very strong reaction, a positive immunological reaction so yes, you can definitely do that,” Nkengasong told Health Policy Watch. “So I think with a shortage, studies now conducted in laboratories and clinical trials have shown that we can do that as well.”

He described this as a solution to the second dose dilemma faced by most African countries (except Nigeria) where the government decided to use shipments of the Astrazeneca vaccine to provide as many people as possible with one dose – rather than holding supplies for two doses of fewer people.

So when the J&J vaccines become available, “Those in short supply of the AstraZeneca vaccine can always get the J&J as their second dose,” he added.

His comments were echoed by Richard Mihigo, Immunisation and Vaccines Development Programme Coordinator at WHO’s Regional Office for Africa: “These are rather good news that are starting to emerge, and potentially alleviate the issue we are seeing now with delays in the shipment of the second goes of AstraZeneca vaccines and allowing people to complete their vaccination doses,” Mihigo said.

Vaccine Desperation Replacing Hesitancy as Third Wave Accelerates

Professor Jean-Jacques Muyembe, Director-General of DRC’s National Institute for Biomedical Research

Meanwhile, there were signs that vaccine desperation might be gradually overcoming vaccine hesitation in a couple of key countries, such as the Democratic Republic of Congo (DRC) and Tanzania.

At Thursday’s WHO Afro Region briefing, Professor Jean-Jacques Muyembe, Director-General of DRC’s National Institute for Biomedical Research, said that new pressures on the country’s health system exerted by the third wave of the pandemic is also accelerating interest among DRC health professionals and the public in getting vaccinated – after widespread vaccine hesitancy thwarted the initial phase of the DRC’s vaccine rollout – prompting the country to return about 1.3 million doses it had received in April.

Now, with COVID-19 cases, hospitalisation and deaths surging across the country, Muyembe said more people are now asking for the vaccines – although tragically doses are virtually unavailable even as the third COVID wave, driven by the Delta variant that was first identified in India, sweeps over the country.

“As we speak today, this Indian (Delta) variant represents 84% of the variants that are circulating in DRC,” Muyembe said.

In Tanzania, as well, the new government has recently expressed interest in joining the WHO COVAX facility, as well as reportedly budgeting some US$ 470 million to purchase COVID-19 vaccines. For the first time in over a year, Tanzania this week also reported data on new COVID infections – more regular reporting of COVID data had been stated as an International Monetary Fund condition for consideration of a a US$ 574 mllion loan request by the country to finance its belated COVID response.

Courtesy: Health Policy Watch
Image Credits: Algorithm Watch.

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