INTERVIEW: Why Africa is now better prepared to beat COVID-19 – Africa CDC Director

As COVID-19 vaccines are being rolled out in various parts of the world, Africa is counting on COVAX, a WHO and GAVI partnership set up to provide equitable distribution of vaccines and make them available at subsidised rates to low income countries.

Outside the COVAX umbrella, African states are also coming together under the African Union to secure vaccines for its 1.3 billion population.

The African Union through the African Vaccine Acquisition Task Team (AVATT) has secured 270 million doses (at least 50 million being available for the crucial period of April to June 2021). The vaccines will be supplied by Pfizer, AstraZeneca (through an independent licensee, Serum Institute of India) and Johnson & Johnson. This is in addition to the 600 million doses to be provided by COVAX.

In this interview with PREMIUM TIMES’ Chiamaka Okafor, the Director Africa Centre for Disease Control and Prevention (Africa CDC), John Nkengasong, discusses Africa’s Covid-19 journey, challenges and prospects.

Mr Nkengasong holds a Masters in Tropical Biomedical Science from the Institute of Tropical Medicine in Antwerp, Belgium, and a doctorate in Medical Sciences (Virology) from the University of Brussels, Belgium. Below are excerpts from the interview.

PT. With the rise in the number of COVID-19 cases across the continent and the roll out of vaccines in other parts of the world, where does this leave Africa?

Nkengasong: We are all experiencing a second wave including Nigeria and a second wave that is more aggressive than the first wave. In the first wave of this pandemic as a continent, we were recording about 18,000 cases at the peak, the peak was around July/August. Now we are recording about 32,000 cases a day as a continent – that shows you how aggressive it is.

At the peak of the pandemic, again at that same time, we were recording 500 deaths a day but now we are recording over 1200 cases a day. I think it is important we take note of that. Why is this important? It tells us that vaccines will be a game-changer if we have to bring this pandemic under control.

There are three sources of vaccines that we aware of. The COVAX facility out of Geneva is working directly with member states. The second is AVATT, which is the African Vaccine Acquisition Task Force, which you heard last week.

President Ramaphosa as the chair of the Africa Union announced that we have secured 270 million doses of the vaccine, which is great. In the coming days, I think this is strictly privileged information to you, you will hear supplementary announcement that will speak to the fact that we as a continent will start vaccinating our health workers very soon.

But I will keep the details for President Ramaphosa as the chair of the AU to make that announcement, the excitement in me cannot allow me to not share at least some tips with you. We have secured 270 million doses of vaccines.

Is that enough to cover our continent? It is not enough. But if you add what we are going to receive from COVAX and then what we have secured there, we are moving slowly towards our target.

The expected target for our continent, which we at Africa CDC based on science suggested to the leadership of the continent and they agreed to, is 60 per cent of the continent vaccination, so that we thrive to achieve what we call population immunity, community immunity or health immunity. I think that is where we are heading to. Other parts of the world are heading towards even a more aggressive goal of about more than 70 to 80 per cent.

We believe if we can achieve 60 per cent of vaccination in two years, then we can really blunt this virus and deny it the ability to continue to disrupt our economies and kill many people.

PT: How is the continent paying for the COVAX intervention?

Nkengasong: The intervention or the acquisition of vaccines through COVAX will be highly subsidised because it is based on pooling resources from donors, partners to facilitate low-income and medium-income countries to have access to vaccines. I think that is one.

For the vaccines that will come through our platform, the AU platform, they will be having those vaccines at a cost and the range there is from $7- $10. But the financing of this has been also worked out so that countries can work with the Afreximbank to get into an arrangement that can facilitate them to get this vaccine and repay their loans over a long period of time.

We should know that acquiring vaccines is not just a health issue but an economic issue. Look at how damaging the virus has been to our economy. So the only way to relieve that and start working and making our economies to work is to vaccinate as quickly as possible. So taking some grants, some loans to do that quickly so that we can bring back our economies, I think, will be a very wise investment.

PT: Beyond the COVAX intervention, AVATT has made a move to secure 270 million doses of vaccines. Putting this together with the 600 million we are getting from COVAX, this does not come close to enough for the 1.3 billion population of Africa. How do we bridge this gap?

Nkengasong: So that is what I am saying. What we should concern ourselves more now is with timely access so we can start vaccinating. Remember I said our target is 60 per cent, so if COVAX gives us 600 million doses of vaccines and if each individual requires two doses, it means that you can vaccinate up to about 300 million people and then we get 270 million doses of vaccine, I think you begin to build up.

My speculation is that the market will begin to ease up towards the second to third and fourth quarter when the Western world will have vaccinated many people and there will be no scramble for vaccines anymore. The market will open up and many more vaccines will come on.

Remember, we are still talking about Astrazeneca, the Pfizer vaccine and Moderna; Johnson and Johnson will soon be announcing the efficacy of its vaccine and other vaccine candidates are out there. So in the coming weeks and months, we will see that many other vaccines will be available so that it will loosen up the limitations of vaccines and then we can move quickly.

So the key is to get started and if we get started, we put the systems in place to enable vaccination. I think that will get us to where we ought to be. The most important thing is that we have to be prepared for Africa to be able to do something that is historic. The continent has never vaccinated more than 100 million people in one year. I mean this is not childhood vaccination where people take their children at will, we have to vaccinate at scale.

So while waiting for the vaccines to come we should be putting strong programmes in place to enable large scale vaccination.

PT. While we wait for the end of the first quarter when the vaccines will most likely be available to Africa, how do we continue to contain the virus (flatten the curve)?

Nkengasong: The continent is better prepared today than it was one year ago. One year ago, we knew little about this virus. One year ago, we didn’t have the PPE. One year ago, we didn’t have a simple mask even if you had the money. I don’t know where you are based but if you are in Lagos or Abuja, it would not have been possible to get any mask.

We have all of these, we now know how this virus behaves; we know that if you avoid large gatherings, congregation, we deny the virus space to spread. We probably have measures we need to continue to implement and it is working. If you look at the pandemic in Kenya, they went through their first wave, they went through their second wave and they are really down there, they have flattened the curve right down there. So there are many examples out there.

Second thing is, as the pandemic rages, we should be looking at care facilities like oxygen, make sure our hospitals are equipped with oxygen because most people are dying because of basic supply of oxygen. We should equip them so when people are infected, they have basic care and that will reduce mortality.

By doing that, I think it will enable us to get to March and April when we will start to vaccinate. Again I want to say this clearly, vaccines are not going to be the magic bullet but the game changer.

Remember it takes us two doses of vaccines, at least the existing vaccines, for it to kick in, so even with vaccines we will have to keep doing the things that we know. Mask is our best vaccine for now. If I wear a mask and you wear a mask there will be no transmission going on. So we have to make sure to be consistent.

PT: For health workers who will be the first to get vaccinated, besides being the primary health care givers, what is the logic behind starting vaccination with this group?

Nkengasong: There is a strong argument for that because they are not just caregivers for COVID patients but also caregivers to patients with other diseases like malaria, HIV, TB. If we allow COVID-19 to affect our health workers, then we run into a big risk of our health system collapsing because they constitute the backbone and we have a limited number of them. For a continent of 1.3 billion people, we have only about three million health workers; that is not a lot and we have to protect them jealously.

PT: In the rush of production, we have seen a number of vaccine candidates springing up from across the world; are there places the Africa CDC will advise nations to look towards or avoid while trying to acquire vaccines for their population?

Nkengasong: We have developed what we call the African COVID-19 Development and Access Strategy, which is available on our website, that is underpinned by the philosophy we call the Whole of Africa Approach, which means let us work collectively. T

This is a very delicate issue and a competitive area, so if we join hands together, we have a bigger say around the table. We really encourage countries to work with Africa CDC, we have several working groups that are driving this forward.

Secondly, if countries choose to go solo, they need to really follow the guidance we have issued on regulatory (that is on how to access a good vaccine). We cannot control behaviour, but if the use of different vaccines begin to backfire, it fuels the anti-vaccine movement and it becomes difficult as it will impact the existing vaccine programmes we have in countries. That is why we really want to have a coordinated approach with Africa CDC.

Again just to summarise, we have the ‘Whole of Africa’ approach, we respect country sovereignty but we say be careful and watch out when going solo because it could easily backfire.

PT: Is the Africa CDC looking towards repurposing other drugs for COVID-19 in the light of Ivermectin’s emergence?

Nkengasong: Absolutely, we are looking at all options and the options we are encouraging and recommending are no different from the same principles that follow vaccines, which says show the data, show that the intervention is efficacious, show it is safe. All along, we have strongly encouraged that the response strategy should be guided by good science and not just speculation. There is a lot of innovation on the continent but there is also a need to be more transparent with what we are doing and less of sentiments.

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It is our responsibility as a public health agency of the continent to protect citizens and to make sure we are using science. We encourage all innovations to bring the data forward.

Together with WHO Afro, we have established a panel of experts that can review all remedies and claims out there to make sure we are using science to make important decisions and not just speaking from emotions.

PT: Just before we move away from the question of repurposing, some of the drugs have been proven to be effective and have gone through clinical trials, is there a need to have them go through the same trial again?

Nkengasong: Ivermectin is an old drug, you do not need to prove safety of the drug, but you need to show efficacy of the drug for COVID-19. We also need to know the dosing, a drug might be safe but if administered poorly, it becomes harmful.

PT: On the efficacy and effectiveness of vaccines, are there parameters in place to address this? Knowing that efficacy and effectiveness are distinct.

Nkengasong: I think the most urgent thing we need is efficacy. The efficacy of COVID-19 vaccine does not measure whether it prevents infection but its prevention of the disease. Effectiveness part is secondary to what we need now; all we should be concerned about is the efficacy of the vaccine.

PT: How is the Africa CDC going to mobilise member states to address the question of local production of vaccines within the continent?

Nkengasong: Consultations are already underway and I am very pleased with the extent and interest. There are three things Africa CDC is encouraging and have submitted these concepts to the leadership of Africa Union who will be meeting in the first week of February.

We are saying there are three things we need to look at to ensure that our continent is secured: strengthening national public health institutions like the Nigeria CDC, Africa CDC; encouraging continental manufacturing of diagnostics, vaccines and drugs; investing in our workforce development agenda and building trusted partnerships.

We are not waiting for any political declaration, we are already in the mode of facilitating other stakeholders to come together to begin to discuss how to move forward with the local production agenda.

If we do not do these three things, we will continue to rely on external partners to determine our safety which is really not appropriate.

PT: Towards the end of last year, a Belgian minister put out prices for vaccines on Twitter, which she later deleted, and this has become public knowledge. What does this knowledge do for Africa’s bargaining power?

Nkengasong: I am not privy to that tweet. What we are calling for is to have vaccine at a very affordable price for a continent that is not rich and we stand by that and continue to encourage that. There should be transfer of technologies that continental manufacturing can occur.

We still do not know how long this vaccines will work, so in other words, if someone is vaccinated today, he/she requires another vaccine one or two years from now.

PT: What amount of knowledge and information does the continent have around the various vaccines it is looking to purchase?

Nkengasong: We have all the information that is available with the manufacturers. We have a task group that is working on that. Our vaccine strategy, which I should have highlighted earlier, has three pillars: clinical trials, vaccine acquisition and procurement and vaccine delivery. There are scientists working with us across the continent. We are assured that no vaccine will come through that will not be reviewed properly, regardless of if they have been approved elsewhere.

PT: There have been several projections on how Africa will be the worst hit by the virus, but our reality is far from these projections. Is there a scientific explanation for this yet?

Nkengasong: Our reality was different but the second wave is telling us that we truly do not know where we are going yet. That is why the discussion on vaccines is so important. It is possible that so many people have been infected but few counted, some serological studies are pointing in that direction.

Another could be our very young population as compared to other parts of the world. There are also so many things we do not know about the host genetics which could be playing a role, but this we do not know but as time goes on, we will.

PT: It is understandable why all attention is being paid to COVID-19. However, it is important to also draw the attention of Africans to infectious diseases which affect the continent more than COVID-19. These diseases exist, what are they and why should we be concerned?

Nkengasong: We should be concerned because those diseases are still there; HIV, Malaria, Tuberculosis did not disappear with the advent of COCID-19. We should also remember that a combination of these diseases kills about 1.2 million Africans yearly. Many more deaths may occur on the continent not because of COVID-19 but due to COVID-19: many people may die from other diseases because they are unable to access health care.

PT: Any word of encouragement?

Nkengasong: Vaccines will be here, Africa CDC and Africa Union with the WHO are working very hard to bring vaccines. These vaccines are safe, efficacious. I will be the first person to get my vaccine once they arrive. I will not be ahead of the curve but when my turn arrives I will take the vaccine without hesitation. So I urge the population to cooperate and work closely with respected public health agencies.