Is Uganda ready for a Covid-19 vaccine?

The world is fast moving towards a Covid-19 vaccine.

Pfizer and BioNTech have announced they expect their Covid-19 vaccine candidate BNT162b2 to be available for use in high-risk populations by the middle of December, after final analyses of a phase III study of the vaccine candidate showed it has a 95% efficacy rate consistent across age, gender, race and ethnicity.

The makers of Moderna, another vaccine candidate for Covid-19, expect it to be ready for use in the general public in the second half of December after it posted efficacy rates identical to Pfizer's  — while the World Health Organisation [WHO] predicts several Covid-19 vaccine candidates, including Oxford's AstraZeneca and Novavax, could prove effective against SARS-CoV 2 and be available for use early next year.      

"This is good news after a year of uncertainty, dipping economies, and lots of deaths," said Denis Kibira, executive director for Coalition for Health Promotion and Social Development or HEPS-Uganda. "Finally, we could have a magic bullet against the [airborne] disease that's killed more than 1.4million people globally."

But, as the road to find a safe and effective Covid-19 vaccine becomes increasingly brighter, the question is whether Uganda and the rest of Africa are ready for this remedy.

A WHO analysis last week indicated all the 47 countries in the WHO Africa Region posted a 33% readiness for a Covid-19 vaccine rollout, which is below the desired benchmark of 80%.

The analysis of the country readiness data indicated only 49% have identified the priority populations for vaccination and have plans in place to reach them, and 44% have coordination structures in place. Only 24% have adequate plans for resources and funding, 17% have data collection and monitoring tools ready and just 12% have plans to communicate with communities to build trust and drive demand for immunization.

"We have lots of issues around vaccine procurement, storage, and distribution in Uganda," said Kibira. "We have issues related to financing, issues related to vaccine hesitancy, where some people are not keen to taking vaccines. Then we know that the immunisation program here has largely centred on children. How will it be adjusted to also include adults and others that may need this vaccine?"

Kibira also talked challenges related to infrastructure.

"The Pfizer vaccine, which has shown a lot of promise, is supposed to be stored under 85 degrees Celsius. Do we have infrastructure that can enable that?" said Kibira.  
"It is projected that about 1.3 billion doses will be produced by all these manufacturers in the coming year. But two countries — the U.S. and the UK — have already booked 1.1 billion doses. So, what will the rest of us get?" he continued.

But Dr. Alfred Driwale, manager for the national expanded programme on immunization [UNEPI] at the ministry of health said the country had established a national coordination committee, which is putting in place a Covid-19 "response and vaccine preparedness plan."

"It is a multi-sectorial committee," said Driwale. "It consists of government ministries, agencies, civil society, development partners, NGOs and the private sector."
Driwale said the ministry has established sub-committees, which are working on "cold-chain and vaccine variance and doses."
 
The ministry has also set up a group, which will train health workers to administer these vaccines.

"We have a committee on monitoring and evaluation, especially in the post vaccination surveillance because we don't want to leave room for dropouts. We will have technologies that can trace vaccine recipients for follow-up."

Driwale said the WHO together with Gavi, the Vaccine Alliance, and Coalition for Epidemic Preparedness Innovation and other partners are working to ensure equitable access to Covid-19 vaccines in Africa and other developing countries through the COVAX facility.

"The WHO and partners have instituted this [COVAX] facility to safeguard against vaccine nationalism because we all know that no one is safe until everybody is safe," said Driwale. "The vaccines will be made available to everybody at once regardless of ones ability to pay."

He said when the vaccines are licensed and approved; COVAX will work to secure enough doses to provide protection to an initial 20% of the African population.

"What is going to happen is that the first available doses or equivalent of 3% will be secured to vaccinate people who are on the frontline [that is the medics and other health workers] in these countries," said Driwale. "Thereafter, 17% will be allocated to people who are in ill health and the elderly, this is the vulnerable group. The goal is to make this 20% available at the cost of the global facility. This means we shall get it free."

Thereafter, the country will now have to buy vaccines to cover other population characteristics up to the level it will need to achieve herd immunity [explain herd immunity].

Here, the focus will be on how the country can pull resources nationally to vaccinate the rest of its population. "Is it from the treasury? Is it through individuals? Is it through cost sharing? These proposals are still under development and they will be discussed at length," said Driwale.

The assistant commissioner for immunization said he wasn't worried about storage of the vaccines.

"The vaccines will likely come in phases, in smaller quantities. So we shall model if we want to invest in cold-chain… what technologies are we looking at and at how much. But we also know that many vaccine options are going to be available to choose from. So you have to choose what you are capable of managing."

The WHO has called African countries to upgrade readiness for Covid-19 vaccination.

"The largest immunization drive in Africa's history is right around the corner, and African governments must urgently ramp up readiness," said Dr Matshidiso Moeti, WHO Regional Director for Africa. "Planning and preparation will make or break this unprecedented endeavour, and we need active leadership and engagement from the highest levels of government with solid, comprehensive national coordination plans and systems put in place."

"Developing a safe and effective vaccine is just the first step in a successful rollout," said Moeti. "If communities are not onboard and convinced that a vaccine will protect their health, we will make little headway. It's critical that countries reach out to communities and hear their concerns and give them a voice in the process."

The WHO estimates the cost of rolling out a COVID-19 vaccine on the African continent to priority populations will be around US$ 5.7 billion. This does not include an additional 15% - 20% cost for injection materials and the delivery of vaccines, which require trained health workers, supply chain and logistics and community mobilization.

But having up to 20% of the Covid-19 vaccine Uganda and Africa needs free of charge is not enough.

"We cannot keep relying on scientists and pharmaceuticals from other countries," said Moses Mulumba, Director at Center for Health, Human Rights and Development [CEHURD]. We need to come together as Africa and improve our manufacturing. We need to support local hubs that are into manufacturing of these vaccines and PPEs [personal protective equipment] and other commodities."

"Access to these vaccines and other therapeutics is very important, but sustainability will depend on our own capacity to manufacture these commodities," said Mulumba. "We [Uganda] are a developing country so some of these patent laws do not apply to us. Can we support our scientists here to reverse engineer what has been manufacture?"

Mulumba called Uganda's vaccines and immunization program — which has been built around children — to be revamped moving forward so it can cater for everybody who needs a vaccine.

Kibira said, "we need to continue this discussion about our country preparedness for this vaccine and other therapeutics."

"The government has made strides when you look at the health budget, but the budget is not growing at the level that is adequate to meet the demands of the population," said Kibira.  "We need more investment and community engagement in access to Covid-19 diagnostics, vaccines and other therapeutics."

But Driwale called for prevention.

Even if we got a vaccine today and have all the money to procure it, it will take more than one year to have a significant number of our population vaccinated," said Driwale. "We need to do what we are good at. Disease Prevention. We need to move with masks longer, move with sanitizers longer, and maintain social distance longer."