Article Category: About the vaccine
Open letter to G20 Heads of State and Government
We are writing to you on behalf of the millions around the world struggling to survive the COVID-19 pandemic far from home. Some have been forced to flee wars, conflict, persecution and human rights violations. Others are on the move to escape socioeconomic hardship or the consequences of climate change.
As strangers far from home, many are at risk of exclusion or neglect. Owing to their living situation, many face barriers accessing vaccinations, testing, treatment, care, and even reliable information.
It is a stark reality that some of the world’s poorest countries shoulder the greatest responsibility for supporting displaced people and other people on the move. They need a reliable and adequate supply of vaccines and other critical supplies to stabilize their fragile and over-burdened health systems, to help save the lives of their citizens, migrants, as well as refugees and other displaced people they host.
Yet the current vaccine equity gap between wealthier and low resource countries demonstrates a disregard for the lives of the world’s poorest and most vulnerable. For every 100 people in high-income countries, 133 doses of COVID-19 vaccine have been administered, while in low-income countries, only 4 doses per 100 people have been administered.
Vaccine inequity is costing lives every day, and continues to place everyone at risk. History and science make it clear: coordinated action with equitable access to public health resources is the only way to face down a global public health scourge like COVID-19. We need a strong, collective push to save lives, reduce suffering and ensure a sustainable global recovery.
And while vaccines are a very powerful tool, they’re not the only tool. Tests are needed to know where the virus is, treatments including dexamethasone and medical oxygen are needed to save lives, and tailored public health measures are needed to prevent transmission.
As the leaders of the world’s largest economies, you have the power and responsibility to help stem the pandemic by expanding access to vaccines and other tools for the people and places where these are in shortest supply.
We welcome the fact that this weekend’s summit in Rome will call for “courage and ambition” to tackle some of the greatest challenges of our time, and specifically the need to recover from the pandemic and overcome inequality. We collectively call on you, G20 leaders, to commit to:
- Increase vaccine supplies for the world’s poorest: We call on the world’s leading economies to fully fund and implement the Strategic Plan and Budget for the ACT Accelerator, and to distribute vaccines, tests and treatments where they are needed most. If we are to recover from the pandemic, we must — at a minimum — meet the targets to vaccinate 40 per cent of the world’s population by year-end – and 70 per cent globally by mid-2022.
- Ensure access to vaccines for all people on the move: We call on every country to ensure that everyone on its territory regardless of legal status – including refugees, migrants, internally displaced people, asylum-seekers, and others on the move – have access to COVID-19 vaccines, tests and treatment for COVID-19. They should adopt concrete measures to remove barriers to vaccination for everyone on their territory — for example the need for specific documents, geographical barriers, the requirement in some settings that health care seekers are reported to immigration authorities, high fees — and fight misinformation that fuels vaccine hesitancy.
- Support low- and middle-income countries to combat COVID-19 with all available means: Low- and middle-income countries need comprehensive support – financial, political, technical, logistical – to vaccinate people quickly and effectively to expand access to tests and treatments, to implement tailored public health measures, and to build more resilient health systems to prepare for, prevent, detect and respond rapidly to future health emergencies.
We urge you to take swift action to ease the pandemic’s devastating human toll.
The Independent Allocation Vaccine Group (IAVG) was established by the WHO in January 2021 and is composed of 12 members who serve in their personal, independent capacities to review and assess Vaccine Allocation Decision (VAD) proposals generated by the COVAX Facility Joint Allocation Taskforce (JAT) on the volumes of vaccines that should be allocated to each participant under COVAX within a given time frame.
The IAVG continues to be very concerned about the evolution of the pandemic, and its health, social and economic impacts, and offers its full support to COVAX Partners to ensure that critical messages are channelled to the relevant fora to raise the awareness of governments, manufacturers and stakeholders of challenges in access to COVID-19 vaccines.
The IAVG is concerned about the 25% reduction in supply forecast for the fourth quarter of 2021. It is also concerned about the prioritization of bilateral deals over international collaboration and solidarity, export restrictions and decisions by some countries to administer booster doses to their adult populations.
During its last meeting on 17 September, the IAVG revisited issues previously raised pertaining to vaccine supply, vaccine allocation, and vaccine administration and offers the following perspectives:
The IAVG continues to be concerned by the low supply of vaccines to COVAX, and reiterates the need for manufacturers, vaccine producing and high-coverage countries to prioritize vaccine equity and transparency, the sharing of information about manufacturing capacity and supply schedules to COVAX, as well as vaccine access plans. While recognizing the need for additional doses to protect certain vulnerable, immune-compromised populations, the IAVG suggests countries collect and review more evidence before implementing policies regarding the administration of booster doses to their populations.
The recent exceptional allocation round at which the recommendation was made that the October COVAX supply be fully dedicated to those countries with a low population coverage, after accounting for all sources of vaccines, is a step forward in achieving equitable access. The IAVG supports the decision of prioritizing COVAX supply for those countries most likely relying solely on COVAX for access to COVID-19 vaccines and supports the continuation of this approach in future rounds.
The IAVG notes that so far only three manufacturers have waived indemnification and liability for use in humanitarian settings, and none have been waived for use at country level. This has consequences for vaccines allocated to the humanitarian buffer, as well as potentially setting precedents for future use.
The IAVG has considered the information and data on absorptive capacity in countries with low total population coverage and brings the following issues to the attention of the COVAX Partners for further consideration:
- Continued advocacy for equity is needed in international and regional fora to address the lack of political will in several settings that is blocking the implementation of equitable access and the development of well-resourced vaccination programmes at country level.
- Countries must be able to access funding for vaccine implementation. Continued awareness of the need for such funding as well as the provision of technical support to countries to develop requests for assistance must be prioritized, especially by the World Bank and other multilateral development banks. Funding should also be considered for third party actors (NGOs and civil society) willing to support countries in vaccine implementation.
- Donations to COVAX are an important source of vaccine supply; however, these should complement rather than replace vaccine procurement by COVAX given the high transaction burden and costs in managing these donations. Additionally, IAVG strongly encourages high-coverage countries to swap their delivery schedules with those of COVAX so that COVAX contracts can be prioritized by manufacturers.
- The IAVG reiterates the need for countries which are sharing doses with COVAX to reduce/remove all earmarking and ensure the donated vaccines have an adequate remaining shelf life to allow for their use.
- Several programmes have been put in place to increase confidence in COVID-19 vaccines and address vaccination hesitancy. These must be tailored to local contexts and the engagement of local communities and civil society is critical to ensuring their effectiveness.
- Some regions and/or countries are experiencing civil unrest, conflicts and natural disasters that are impeding or slowing the implementation of vaccination programmes. Global solidarity and cooperation are needed to ensure they are supported in such critical situations.
COVAX remains the main global access mechanism able to serve all countries and ensure equitable access. The IAVG stands strongly behind this initiative.
The IAVG (https://www.who.int/groups/iavg) acknowledges that the role of the WHO within COVAX is to provide guidance on vaccine policy, regulation, safety, research and development, vaccine allocation, and country readiness and delivery, in partnership with UNICEF. As of today, the IAVG has validated allocation through COVAX for a total of 362.8 million doses of vaccines.
Brazzaville — The World Health Organization (WHO), a South African consortium and partners from COVAX, are working to set-up a technology transfer hub for mRNA vaccines in South Africa to help boost and scale up vaccine production in Africa.
The initiative marks “a major advance in efforts to build vaccine development and manufacturing capacity that will put Africa on a path to self-determination,” said South African President Cyril Ramaphosa, at the launch of the initiative in June.
Yet making mRNA vaccines is a complex business, there are many steps to take before safe and effective mRNA vaccines can be made in Africa. Dr Bartholomew Dicky Akanmori, Regional Adviser for Vaccine Research and Regulation with the WHO Regional Office for Africa, explains.
What is the technology transfer hub?
The technology transfer hub in South Africa will teach African manufacturers how to make mRNA vaccines, like the Pfizer and Moderna COVID-19 vaccines, here in Africa.
Foreign manufacturers will share techniques with local institutions and WHO and partners will bring in production know-how, quality control and will assist with the necessary licenses.
There will be a training centre with all necessary equipment in place for African manufacturers to learn. The manufacturers will pay for their staff to receive training, which must be completed before they can start production.
Several partners have signed up take part, including the Medicines Patent Pool, Afrigen Biologics, the Biologicals and Vaccines Institute of Southern Africa, the South African Medical Research Council and the Africa Centres for Disease Control and Prevention.
Hubs like this exist all over world. For example, scientists at Oxford University shared their techniques with AstraZeneca, which then made the AstraZeneca COVID-19 vaccines. The hubs show producers the formulas needed to make quality, safe and effective vaccines.
Can’t African countries already manufacture vaccines?
The vaccines being made in Africa, like those for yellow fever or tetanus, use a simple technology in which scientists take the bacteria, grow the toxin from the bacteria, and then make it incapable of acting.
New technologies are needed to make mRNA vaccines. It is far more complex process and there is no room for error, so the correct transfer of knowledge is absolutely crucial. This is why we need technology transfer hubs.
When will mRNA COVID-19 vaccines be made in Africa?
It’s hard to say. We started working to set up the hub in South Africa earlier this year and this work is still going on. It depends on several factors, including funding, a willingness to transfer technologies and the ability of local institutions to absorb knowledge.
However, the assumption is that knowledge transfer will move faster than we’ve seen before, in the same way that COVID-19 vaccines were developed in record time.
Once all the elements are together, we expect the training to take at least six months.
What is the long-term vision for vaccine manufacturing in Africa?
The long-term plan is self-sufficiency, for a future where Africa makes enough vaccines for its own people, but right now Africa imports around 90% of its vaccines.
The technology transfer hub will help to change this, helping African manufacturers to move to more advanced levels of production where they can make mRNA vaccines from start to finish without any outside support.
Many other vaccines use the same mRNA technology that we’ll be transferring, such as vaccines against Ebola, Lassa Fever and Marburg, and eventually this mRNA technology could even be used to produce vaccines against HIV or tuberculosis.
The hub has a research and development arm, which can identify new ways to use this technology. There are also plans to establish a second hub in another African country.
Yaoundé – Local leaders, working with over 2300 community mobilizers and 1450 vaccination teams, were crucial to the success of a rapid COVID-19 vaccination drive that saw 52 000 people vaccinated across Cameroon in just five days in July.
Community leader Jean Calvin Nama-Ntse works to build trust in COVID-19 vaccines in the Nkomassia and Nkolbisson communities in the capital Yaoundé. A life-long community member, he is a traditional Chief, Chairman of the Nkolbisson Health District and Chairman of the Management Committee at Nkolbisson’s Integrated Health Centre.
Tell us about the communities you work with?
Here in northern Yaoundé we have both rural and urban areas. We have more than 80 000 people that come from across Cameroon and other African countries like Mali, the Republic of the Congo, Burundi and Central African Republic. With a mix of different religions, we respect the right to worship freely. We’re not a rich community and most people live off small businesses or informal trading.
What are the biggest challenges in fighting COVID-19 and demand for vaccines?
Our population is quite young and although we are generally well informed, not everyone is aware of all the risks from COVID-19, so not everyone sticks to the prevention measures or are keen to get vaccinated.
Despite the flood of information on COVID-19, there is still fear, doubt and scepticism around vaccination. Rumours and misinformation spreading on social media and dreamed up by certain people sow doubt and reluctance to get vaccinated, which leaves people at greater risk.
What are the key lessons from your work?
In my experience, people who have had the disease or seen others suffer with it are far more aware of the risks and are much keener to get vaccinated. If we use more of these people as educators I’m sure they will raise the uptake of vaccines.
Also, when leaders get vaccinated in public other people follow, especially big media personalities, artists and religious leaders. As a community leader I made a point of getting vaccinated in public.
Putting vaccination points in public spaces like markets, at crossroads or near churches also builds confidence in the community and leads to more people coming for vaccination.
Tell us about the support you received from WHO and partners?
I joined workshops on how to mobilize communities and to advocate and access more resources for immunization campaigns. These were run by the Ministry of Public Health, with
the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the German Agency for International Cooperation (GIZ).
I also joined City Council meetings led by District Health Officers. These help us raise demand for COVID-19 vaccines in our communities. About 300 people have been covered by these trainings so far and more are planned for this year.
From these we learned to work more closely in our communities, giving talks on COVID-19 and the need for vaccination in local markets and public spaces. We’ve visited families to speak intimately with them. We’ve given talks to local associations and worked with local media. We’ve also worked with religious leaders and local government authorities on spreading prevention messages as they are trusted and people listen to them.
These days I only use information from trustworthy sources, including from the government, WHO and of course from my own life experience.
Brazzaville – Africa is set to miss the urgent global goal of vaccinating the most vulnerable 10% of every country’s population against COVID-19 by the end of September. Forty-two of Africa’s 54 nations—nearly 80%—are set to miss the target if the current pace of vaccine deliveries and vaccinations hold, new data from the World Health Organization (WHO) shows.
Nine African countries, including South Africa, Morocco and Tunisia, have already reached the global target set in May by the World Health Assembly, the world’s highest health policy-setting body. At the current pace, three more African countries are set to meet the target. Two more could meet it if they speed up vaccinations.
“With less than a month to go, this looming goal must concentrate minds in Africa and globally. Vaccine hoarding has held Africa back and we urgently need more vaccines, but as more doses arrive, African countries must zero in and drive forward precise plans to rapidly vaccinate the millions of people that still face a grave threat from COVID-19,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.
Almost 21 million COVID-19 vaccines arrived in Africa via the COVAX Facility in August, an amount equal to the previous four months combined. With more vaccines expected from COVAX and the African Union by the end of September, we could see enough doses delivered to meet the 10% target.
While many African countries have sped up COVID-19 vaccinations as vaccine shipments ramped up in August, 26 countries have used less than half of their COVID-19 vaccines.
Over 143 million doses have been received in Africa in total and 39 million people—around just 3% of Africa’s population—are fully vaccinated. In comparison, 52% of people are fully vaccinated in the United States of America and 57% in the European Union.
“The inequity is deeply disturbing. Just 2% of the over five billion doses given globally have been administered in Africa. Yet recent rises in vaccine shipments and commitments shows that a fairer, more just global distribution of vaccines looks possible,” said Dr Moeti.
Countries must continue to address operational gaps and continually improve, adapt and refine their COVID-19 vaccination campaigns. Of the 30 countries that have submitted data to WHO on operational readiness, one in two have not conducted intra-action reviews, which are key to assessing and fine-tuning progress. One in three countries have not updated their National Vaccine Deployment Plans, which instruct all COVID-19 vaccination actions in each country.
WHO is providing tailored policy advice and technical guidance and support to African countries to help enhance their logistics, planning and monitoring capacities. WHO is also working to share valuable lessons and experiences between countries.
COVID-19 cases are declining slightly in Africa but remain stubbornly high. A rising number of new cases in Central, East and West Africa pushed case numbers up to nearly 215 000 in the week ending on 29 August. Twenty-five countries—over 45% of African countries—are reporting high or fast-rising case numbers. Over 5500 deaths were reported in the week ending on 29 August.
“ Although Africa’s third wave peaked in July, the decline in new cases is at a glacial pace — far slower than in previous waves. The pandemic is still raging in Africa and we must not let our guard down. Every hour 26 Africans die of COVID-19.”
The highly transmissible Delta variant has been found in 31 African countries. The Alpha variant has been detected in 44 countries and the Beta variant in 39.
The C.1.2 variant has been identified in 114 cases in South Africa. Single cases have been found in four other African countries, and very low case numbers have been reported internationally. While first reported to WHO in July, the prevalence of this new variant remains very low. To be identified as a variant of concern there must be evidence of an impact on transmissibility, severity or immunity. This is not the case for the C.1.2 variant, yet more data is required.
“We are closely monitoring the spread and evolution of all reported variants of COVID-19, including C.1.2. Mask wearing, physical distancing and regular hand washing will help keep you safe from all variants,” said Dr Moeti.
Dr Moeti spoke during a virtual press conference today facilitated by APO Group. She was joined by Dr Nicholas Crisp, Deputy Director General, National Health Insurance, Department of Health, South Africa, and Dr Assan Abdoul Nasser, Director of Immunizations, Ministry of Public Health, Population and Social Affairs, Niger.
Also on hand to respond to questions were Dr Richard Mihigo, Coordinator, Immunization and Vaccines Development Programme, WHO Regional Office for Africa, and Dr Thierno Balde, Regional COVID-19 Deputy Incident Manager, WHO Regional Office for Africa.
Brazzaville – As the COVAX Facility is forced to slash planned COVID-19 vaccine deliveries to Africa by around 150 million this year, the continent faces almost 500 million doses short of the global year-end target of fully vaccinating 40% of its population. This shortfall comes as Africa tops 8 million COVID-19 cases this week.
With the cutback COVAX is now expected to deliver 470 million doses to Africa this year. These will be enough to vaccinate just 17% of the population, far below the 40% target. An additional 470 million doses are needed to reach the end-year target even if all planned shipments via COVAX, a multilateral initiative aimed at guaranteeing global access to lifesaving COVID-19 vaccines, and the African Union are delivered.
“Export bans and vaccine hoarding have a chokehold on vaccine supplies to Africa. As long as rich countries lock COVAX out of the market, Africa will miss its vaccination goals. The huge gap in vaccine equity is not closing anywhere near fast enough. It is time for vaccine manufacturing countries to open the gates and help protect those facing the greatest risk,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa.
As export bans, challenges in boosting production at COVAX manufacturing sites and delays in filing for regulatory approvals for new vaccines constrain deliveries, COVAX has called for donor countries to share their supply schedules to give more clarity on deliveries.
COVAX has also called for countries with enough vaccines to give up their place in the queue for deliveries.Manufacturers must deliver to COVAX in line with firm commitments, and countries that are well-advanced with vaccinations must expand and accelerate donations, ensuring doses are available in larger, more predictable volumes and with longer shelf lives.
About 95 million more doses are set to arrive in Africa via COVAX throughout September, which will be the largest shipment the continent receives for any month so far. Yet even as deliveries pick up, Africa has been able to fully vaccinate just 50 million people, or 3.6% of its people.
Around 2% of the nearly 6 billion doses given globally have been administered in Africa. The European Union and the United Kingdom have vaccinated over 60% of their people and high-income countries have administered 48 times more doses per person than low-income nations.
“The staggering inequity and severe lag in shipments of vaccines threatens to turn areas in Africa with low vaccination rates into breeding grounds for vaccine-resistant variants. This could end up sending the whole world back to square one,” said Dr Moeti.
WHO is ramping up support to African countries to identify and address gaps in their COVID-19 vaccine rollouts. WHO has assisted 15 African countries in conducting intra-action reviews, which analyse all aspects of their vaccination campaigns and offer recommendations for improvements. The reviews have shown that vaccine supply security and uncertainty around deliveries has been a major impediment for many African countries.
With over 300 staff in place across Africa supporting the COVID-19 response, WHO is deploying experts and producing support plans in specific areas where countries need tailored assistance, including securing staff, financing, strengthening supply chains and logistics and boosting demand for vaccines.
As of 14 September 2021, there were 8.06 million COVID-19 cases recorded in Africa and while the third wave wanes, there were nearly 125 000 new cases in the week ending on 12 September. While this is a 27% drop from the previous week, weekly new cases are still at about the peak of the first wave and 19 countries continue to report high or fast-rising case numbers.
Deaths fell by 19% to 2531 reported in Africa in the week to September 12th. The highly transmissible Delta variant has been found in 31 African countries. The Alpha variant has been detected in 44 countries and the Beta variant in 39.
Dr Moeti spoke during a virtual press conference today facilitated by APO Group. She was joined by Dr Ayoade Olatunbosun-Alakija, Co-Chair of the African Vaccine Delivery Alliance (AVDA), Ms Aurélia Nguyen, Managing Director, Office of the COVAX Facility, Gavi, the Vaccine Alliance.
Also on hand to respond to questions were Dr Richard Mihigo, Coordinator, Immunization and Vaccines Development Programme, WHO Regional Office for Africa, and Dr Thierno Balde, Regional COVID-19 Deputy Incident Manager, WHO Regional Office for Africa, Dr Humphrey Karamagi, Senior Technical Officer, Health Systems Development, WHO Regional Officer for Africa.
- The generic group of ChAdOx1-S [recombinant] vaccines includes AstraZeneca/AZD1222 and SII/Covishield vaccines. For prolonged efficacy using ChAdOx1-S vaccines, WHO recommends two standard doses (0.5ml) administered with an interval of 8 to 12 weeks between doses.
- Clinical trials have demonstrated that after vaccination with a single 0.5ml dose, an efficacy as high at 76.0% (95% CI 59.3–85.9) could be expected against laboratory-confirmed Covid-19, as measured from 22 days after vaccination through 12 weeks.
- Evidence has demonstrated sustained vaccine efficacy after a single 0.5ml dose for a period of up to 12 weeks (3 months), yet antibody concentrations declined by 34% through 90 days. 2 Limited data is available on the duration of efficacy or rapidly waning immunity past 12 weeks, and a second dose has been shown to maintain high efficacy.
- Unpublished mathematical modeling demonstrates that when supply is very limited during the initial introduction period, vaccinating more people in the highest priority population group with one dose as opposed to vaccinating half that number with two doses, would substantially increase
the number of deaths prevented, if the 1-dose vaccine efficacy is at least 50% of the 2-dose efficacy.
- In view of the evidence suggesting the potential for disease rates to be reduced following administration of the first dose and data from mathematical modelling, national immunisation programmes faced with limited supply of AstraZeneca/AZD1222 or SII/Covishield vaccine might
elect a strategy of vaccinating a maximum number of persons within a higher number of priority groups with a first dose and preferentially planning for the second dose to be provided at 12 weeks (3 months) later, or as soon as possible thereafter.
- Given the equivalence of AstraZeneca/AZD1222 and SII/Covishield to ChAdOx1-S, the two products are interchangeable.
Purpose: This document provides an overview of the scientific basis and key programmatic considerations to guide national decision-making for countries on optimising the deployment of AstraZeneca/AZD1222 and SII/Covishield vaccines under circumstances where vaccine supply is constrained, and future quantities and delivery dates cannot be reliably predicted. Further details on the available evidence and key studies are available at the SAGE website, while resources for implementation and training are available at the COVID-19 vaccine introduction toolkit webpage.
Context: Currently, the global market supply of AstraZeneca/AZD1222 and SII/Covishield vaccines, both provided under the COVAX Facility, does not fully meet global demand.5 While supply is expected to increase through the second half of 2021, the frequency of shipments to countries remains uncertain in the near to medium term and residual shelf life at the time of delivery may be as short as three months. Countries receiving fewer doses than required to fully vaccinate all highest priority groups will be challenged to strike the proper balance across key objectives:
- Maximizing immunity against COVID-19 in the highest priority groups according to the recommended schedule;
- Reaching as many people within as many priority groups as quickly as possible, with at least one dose; and
- Fully administering all doses available prior to their lot expiration date.
WHO SAGE interim recommendations on the AstraZeneca COVID-19 vaccines refer to a generic group of ChAdOx1-S [recombinant] vaccines against COVID-19. The ChAdOx1-S [recombinant] vaccine uses a DNA adenovirus vector to elicit antibodies to the SARS-CoV-2 spike protein. WHO recommendations apply to the AZD1222 product developed jointly by Oxford University (United Kingdom) and AstraZeneca, as well as to ChAdOx1-S [recombinant] vaccines produced by other manufacturers, namely AstraZeneca/AZD1222 (produced by AstraZeneca-SKBio in the Republic of Korea) and SII/Covishield
(produced by the Serum Institute of India). Each of these products rely on the AstraZeneca core clinical data and demonstrated equivalence in their regulatory and WHO reviews. Conditional marketing authorization (CMA) by the European Medicines Agency (EMA) of the AstraZeneca/AZD1222 vaccine was
received on 29 January 2021. WHO granted Emergency Use Listing (EUL) for both products on 15 February 2021.6 Current estimates on product efficacy are drawn from the pooled analysis of data from four randomised, controlled clinical trials conducted in the United Kingdom (two studies), Brazil, and South Africa, involving
approximately 24,000 adults aged 18 year and older. As the examined interval lengths between dose 1 and dose 2 varied across the different studies, inter-dose efficacy described below has been estimated. 7 For the purpose of describing the scientific evidence supporting these products, the generic name of ChAdOx1-S will be used in the table below. It should be noted that given the equivalence of AstraZeneca/AZD1222 and SII/Covishield to ChAdOx1-S, the two products are interchangeable.
Mathematical modelling. Current unpublished mathematical modeling demonstrates that when supply is very limited during the initial introduction period, vaccinating more people in the highest priority population group with one dose as opposed to vaccinating half that number with two doses would substantially increase the number of deaths prevented, as long as the 1-dose vaccine efficacy is at least 50% of the 2-dose efficacy. As supply increases and the highest priority populations all receive one dose, a decision about using supply to vaccinate that group with a second dose or advance with first doses to the next risk group is needed. The decision depends on the relative risk of mortality between the priority
risk groups, the relative vaccine efficacy of 1-dose and 2-doses, the durability of the 1-dose efficacy over time, and the supply pace.
As supply increases and the rollout moves to ever lower risk groups, the model indicates that the highest risk groups should be prioritized to complete their vaccination with a second dose in lieu of continuing to offer first doses to a lower priority group. The specific point at which this blended strategy should occur depends on supply volumes, pace, population sizes, relative disease risks, and vaccine efficacy characteristics. Prioritising first dose administration at the outset of the programme to highest priority groups is expected to provide greater benefit when supply is very limited; this holds true even when supply is insufficient to administer the second dose in a timely manner, as long as waning of first dose immunity is not very rapid.
Given the short timelines from vaccine development to EUL, the available stability data for the AstraZeneca/AZD1222 and SII/Covishield vaccine only permit authorization with a shelf life of six months, as is the case for other COVID-19 vaccines. This is a much shorter shelf life than vaccines normally handled in the EPI programme, so any vaccination strategy with AstraZeneca/AZD1222 or SII/Covishield requires careful planning and accelerated implementation by countries to ensure that the vaccines can be administered prior to the lot expiration date.Given the global production constraints and unpredictable nature of the frequency and quantity of future shipments, each country will need to properly evaluate what is operationally relevant in their national context. A range of programmatic factors are cited below for consideration; many of the factors are interlinked and cannot be viewed independently. It is recommended that the NITAG plays a central role in thedecision-making process, actively participating in the assessment of the risks and benefits of each
alternative under consideration.
In view of the evidence suggesting the potential for disease rates to be reduced following administration of the first dose, national immunisation programmes faced with limited supply of AstraZeneca/AZD1222or SII/Covishield vaccine might elect a strategy of vaccinating a maximum number of persons within a higher number of the priority groups with a first dose and preferentially planning for the second dose to be provided at 12 weeks (3 months) later, or as soon as possible thereafter. Data supporting an extension beyond three months has yet to become available. It should be noted that clinical trials did not assess the impact on antibody response if the interval between administration of dose 1 and dose 2 is extended beyond 12 weeks, nor what impact this would have in relation to protection against any circulating SARS-CoV-2 virus variants. As further research on vaccine effectiveness is undertaken and risk monitoring associated with SARS-CoV2 viral mutations allows for a better assessment of required responses, further information will be made available.
Director-General Dr Tedros Adhanom Ghebreyesus and a group of global health leaders today issued an urgent call for vaccine equity globally and in Africa in particular. The leaders stressed that the worst pandemic in the last hundred years will not end unless and until, there is genuine global cooperation on vaccine supply and access. They also reiterated the WHO’s global vaccination target for 70% of the population of all countries to be vaccinated by mid- 2022.
Dr Tedros was joined by Dr Seth Berkley, CEO Gavi, Strive Masiyima, AU Special Envoy for COVID- 19, Dr John Nkengasong, Africa CDC Director, Professor Benedict Oramah, President and Chairman of the Board of Directors, Afreximbank, Dr Vera Songwe, UN Under- Secretary- General and Executive Secretary of the Economic Commission For Africa and Dr Matshidiso Moeti, WHO Regional Director for Africa.
The press conference followed two days of meetings among the leaders, with Richard Hatchett, Chief Executive Officer of CEPI joining the meetings as well.
Dr Tedros Adhanom Ghebreyesus: Director-General, WHO
“More than 5.7 billion doses have been administered globally, but only 2% of those have been administered in Africa.”
“This doesn’t only hurt the people of Africa, it hurts all of us. The longer vaccine inequity persists, the more the virus will keep circulating and changing, the longer the social and economic disruption will continue, and the higher the chances that more variants will emerge that render vaccines less effective.”
Strive Masiyima, AU Special Envoy for COVID- 19
“Vaccine sharing is good but we shouldn’t have to be relying on vaccine sharing. Particularly when we can come to the table, put structures in place and say, we also want to buy.”
“American taxpayers, European taxpayers, they financed some of this intellectual property and it should be for the common good. So, it is not wrong that we say there should be waivers, it was for the common good. 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.”
Dr John Nkengasong, Africa CDC Director
“We will not be able to achieve 60% of our population fully immunised if we do not fully explore and deploy the power of partnership, the power of cooperation, and the power of solidarity” … “We all have acknowledged now that vaccines are the only solution for us to get out of this pandemic collectively. That has to be done quickly.”
Dr Vera Songwe, UN Under- Secretary- General and Executive Secretary of the Economic Commission For Africa
“For every one month of lockdowns in the continent cost us $29 billion of production that was lost. For [the African continent], when we say that COVID-19 is an economic issue and we need to respond to it, to be able to recover and reset our economies, it is real. And for that we need financing and we need to see how we can bring together global financial structures to ensure that we can actually respond to this crisis”.
“We know that scarcity means increased cost, and we cannot afford today as a continent that kind of scarcity.”
Professor Benedict Oramah, President and Chairman of the Board of Directors, Afreximbank
“Africa did not want to once again be at the bottom of queue in regard to vaccines because it was well known to everybody that economy recovery meant bringing the virus under control.”
“It is important that we do this for the simple reason that countries want us to make sure that we do not fail, and make it difficult for us to recover quickly.”
Dr Seth Berkley, CEO Gavi
“Today’s meeting is important, as it symbolizes the spirit of partnership between COVAX, the African Union and AVATT: Africa needs more doses and together we will get them.”
“We’re poised to embark on the busiest period of what is the largest and most complex vaccine rollout in history. We’ve demonstrated that COVAX can work at scale, but it’s really time for the world to get behind it.”
Dr Matshidiso Moeti, WHO Regional Director For Africa.
“The question is sometimes asked do African countries have the capacity to absorb the vaccines? The simple answer is yes. The continuous challenge is that global supplies are not being shared in ways that will get the world out of this pandemic.”
“Hundreds of WHO staff are on the ground, ready to support countries to expand vaccination sites and to manage the complexities of small deliveries of a variety of vaccines“.
“What’s more, African countries have done this before – successfully implementing massive vaccination campaigns against polio, yellow fever and cholera.”
Notes for Editors
- WHO’s targets are to vaccinate at least 10% of the population of every country by September, at least 40% by the end of the year, and 70% globally by the middle of next year. These are the critical milestones we must reach together to end the pandemic.
- Almost 90% of high-income countries have now reached the 10% target, and more than 70% have reached the 40% target. Not a single low-income country has reached either target.
- Globally, 5.5 billion vaccine doses have been administered, but 80% have been administered in high- and upper-middle income countries.
- High-income countries have now administered almost 100 doses for every 100 people. Meanwhile, low-income countries have only been able to administer 1.5 doses for every 100 people, due to lack of supply.
- The world should spare no effort to increase vaccine supply for lower-income countries: this can be done by removing all the barriers to scaling up manufacturing including waiving IP, freeing up supply chains and technology transfer. As part of these efforts, in June, WHO and COVAX partners announced the first COVID mRNA vaccine technology transfer hub, to be set up in South Africa.
- High-income countries have promised to donate more than 1 billion doses, but less than 15% of those doses have materialised and manufacturers have promised to prioritize COVAX and low-income countries.
- The supply through COVAX and other sources will increase substantially in the coming months of this year. Countries need to prepare for this ramp up of available doses, for example with microplanning, expanded cold chain equipment, logistics, funding, and trained staff in place.
- COVAX has shipped more than 236.6 million doses to 139 participants as of 6th September 2021. Some 41 participants started their first campaigns thanks to COVAX.
- Safe and effective vaccines alone cannot solve the pandemic: Robust surveillance supported by rapid diagnostics, early clinical care and life- saving therapeutics, provided by well-trained health workers who are able to work in safe conditions. Public health and social measures are also vital to end the pandemic and accelerate global recovery.
Accra – Fast-spreading misinformation online is hard to measure, but the 10 organizations and 10 African fact-checking groups that make up the Africa Infodemic Response Alliance are working to track and debunk dangerous myths on the pandemic and COVID-19 vaccines.
Data collected regularly since March 2021 in 20 African countries show that false claims around COVID-19 vaccines are by far the most widespread myths around the pandemic and that a fear of side-effects is the main driver for people’s reluctance to get vaccinated.
African fact-checking organizations say they have debunked over 1300 misleading reports throughout the pandemic. Rabiu AlHassan, the Managing Editor at Ghana Fact, Ghana’s first independent fact-checking platform and a member of the Africa Infodemic Response Alliance, is on the frontlines in the fight to debunk myths and spread facts that save lives.
What are the main drivers of mis-and-disinformation around COVID-19?
Several factors fuel the spread of health mis-and-disinformation in West Africa and in Ghana in particular. People are overwhelmed by the flood of information around COVID-19, and after well over a year of the pandemic they are also tired of it. Yet as we are all still learning about this new virus this can also cause confusion. The trickling in of videos of coronavirus sceptics from western countries also hampers our efforts.
Other factors fuelling the spread of the infodemic are rooted in religious beliefs, while there also seems to be a growing and worrying false sense of security among the public after watching recent European football games with stadiums filled with cheering fans. Yet many European countries have vaccinated high numbers of their people, unlike here in Africa.
Another important point that needs mentioning are the occasionally contradictory messages from certain leaders. Some don’t seem to practice what they preach regarding COVID-19 protocols. Much of the misinformation we see is circulating on social media, but even worse is that false claims are thriving offline in closed circles.
Can you share examples of damaging myths that GhanaFact has debunked?
We have debunked wild conspiracy theories around COVID-19 vaccines made by renowned pastors with huge follower bases across West Africa. Also western COVID-19 sceptics are producing videos that are reaching people and gaining traction here. All this contributes to denial that virus exists and can add to vaccine hesitancy.
Another bizarre example is the claim that recipients of the vaccine were injected with microchips and magnets. The initial video on this seems to have been made in Europe. That video then went viral in Ghana and inspired locals to produce their own versions that make similar false claims. Other dangerous falsehoods are related to unproven local remedies and false cures to COVID-19. There seems to be quite widespread confidence in these false remedies and we face the risk of people trying to treat serious symptoms themselves.
What more can we do to help stop the spread of mis-and-disinformation?
We need to reach large sections of the population with credible COVID-19 information in their own local languages and we must do more to reach them offline. It is crucial to work with respected local leaders and opinion leaders to influence these communities.
Political leaders must be consistent in their commentary on COVID-19 and their observance of the protocols if they are to remain credible voices in the fight against the virus. Social media companies must pay equal attention to tackling false information in Africa. They must recognize that false information does even more harm here due to the lower rates of digital and misinformation literacy.
On social media and in chat apps, we can all pause for a second and take a closer look at claims around the pandemic and COVID-19 vaccines. We can check if the information is from reputable sources like the World Health Organization before sharing it with our networks and we can challenge it if it seems spurious.
Accra – Ghana’s COVID-19 vaccine rollout has been hailed as exemplary for its planning, speed and high-level leadership, but dig a little deeper and there are yet more crucial lessons in working with far-flung communities and building up trust in the vaccines.
“We have a migratory population that travels routinely from north to south across the country so their animals can graze,” says Dr Francis Kasolo, WHO Representative in Ghana. “Just as we have done with routine immunization, vaccination stations along their travel routes have been set up so that these populations can also access COVID-19 vaccines.”
Many best practices from decades of delivering immunization campaigns, particularly for measles, were worked into Ghana’s comprehensive plans for mass COVID-19 vaccinations.
“Measles was a particularly devastating disease here, and citizens understand how measles vaccines reduced mortality. So we used this as a base for our advocacy efforts with the public to build confidence and drive uptake,” says Dr. Kasolo.
Ghana also used drones to deliver vaccines to areas without roads and sent vaccinators out into communities to stay with them for periods of time while administering the vaccines.
“Rather than wait for citizens to come to us, we made the effort and went out to them,” explains Fred Osei Sarpong, WHO Immunization Officer in Ghana.
“Information on vaccination points was shared on every channel, including national television, radio, social media and chat apps like WhatsApp, as well as through networks of district and community leaders and organizations.”
The creation of a real-time, online data management system with key information on inoculation rates and the availability of vaccines has also helped build up confidence.
Ghana was the first country in the world to receive vaccines through COVAX in late February, and just 20 days later, the country had reached over 470 000 people in areas with the highest number of COVID-19 cases, including around 90% of all health workers.
“We identified 43 areas where high transmission of the virus was evident, and started with those districts, sending out mobile teams to administer vaccines,” notes Osei-Sarpong.
On 7 May, the country benefited from a further 350 000 doses redirected from the Democratic Republic of the Congo, which is testament to Ghana’s rapid, efficient and coordinated response to the public health crisis and ability to swiftly roll out vaccines.
To date, Ghana has fully vaccinated around 2.7% of its population. Vaccination rates across Africa remain low due to supply constraints: just 1.6% of the continent’s population has been fully vaccinated so far.
The strong and visible commitment to getting vaccinated from Ghana’s leaders, with the President, First Lady and Vice President and Second Lady all vaccinated live on national television at the outset of the campaign, all helped drive up demand.
Yet according to WHO Representative in Ghana Dr Kasolo, as a devastating follow-on wave of new cases hit the country in recent months, death rates have also played a big role.
“About four weeks ago I visited Kumasi [the capital city of the Ashanti Region, in southern Ghana], which has had the highest COVID-19 related mortality rates. There were huge queues of people waiting to be vaccinated there. When I talked to them, I realised that some had lost relatives to the virus and suddenly it had all become very real for them.”
“This was definitely driving up the appetite for vaccination. They were no longer being told about the devastating effects of COVID-19, they were living through them.”
Ghana continues to battle misinformation, which remains a constant challenge in ensuring public trust in the vaccines.
“COVID-19 information overload and fatigue, the novel nature of the virus itself and the trickling in of videos from the West showing coronavirus sceptics, to mention just a few challenges, are hampering the efforts to fight the virus,” says Rabiu Al-Hassan, Managing Editor of the Accra-based fact-checking organization Ghana Fact.
“Other factors are rooted in religious beliefs, while a false sense of security seems to be growing after watching European football games with cheering fans in attendance, while many European countries have vaccinated most of their adult populations.”
Ghana expects many more doses to arrive in the coming months and is building up its ultra-cold chain capacity to handle a range of vaccines. It is also looking at how to move these facilities closer to remote communities.
Reflecting on the success of the rollout to date, WHO’s Dr Kasolo attributes the high absorption capacity to efficient planning, driven by a strong national coordination mechanism.
“Chaired by the President, the inter-ministerial task force included both government and independent players. While our regulatory authorities imparted critical advice about the safety and efficacy of vaccines, the inclusion of independent partners helped boost confidence among the population, so reduced vaccine hesitancy,” he explains.
“Vaccine availability is now a real challenge for Ghana, but we have been given assurances that hundreds of thousands of doses are likely to reach us by about August,” he says.
Offering his best advice to neighbouring African countries, Dr. Kasolo explains that one of the most important lessons Ghana learnt early on was to involve everyone, from the President and the government right down to communities.