Rich nations should prioritise first, second doses of COVID-19 vaccine for all, not boosters, says Gavi boss

•Says Africa urgently needs access to stop the spread, new variants, local production would become an essential part of how continent prepares for next pandemic.

Thabani Maphosa is Gavi’s Managing Director of Country Programmes, overseeing Gavi’s operations in 73 countries. Gavi, the Vaccine Alliance is a public-private global health partnership with the goal of increasing access to immunisation in poor countries. Prior to joining Gavi, Maphosa held several leadership roles in World Vision International for over 16 years. In this online interview with The Guardian he urges rich nations to assist low-income countries in vaccinating their population. CHUKWUMA MUANYA writes.

We are concerned that Gavi, which co-leads the COVAX facility together with the WHO and CEPI, is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both high-income and lower-income countries, has failed to meet its targets. Why?
OVER the course of the last year, what we’ve seen is that COVAX can succeed in its mission to help end the acute phase of the pandemic, but it cannot do this alone. We received great support from the international community, which helped us raise over US$10 billion to procure vaccines. What we need urgently now is access to doses if we are to stop the virus from spreading and further variants from emerging. This is why we are asking countries that have pending orders to swap places in the queue with COVAX, and it is why we are asking manufacturers to be transparent as to their production schedules – so we can be sure they are not prioritizing bilateral deals.

Maphosa

Most African countries such as Nigeria have vaccinated less than three per cent of their population compared to over 55 per cent in EU and USA. What is Gavi doing to bridge this gap?
Our message to the international community is clear: the current state of vaccine inequality is not acceptable and needs to be addressed now. Gavi’s donors have pledged over US$10 billion to fund the procurement of vaccines for the 92 lower-income economies in the COVAX Advance market Commitment (AMC) and we need these doses now. This is why we are pressing governments and manufacturers to match their words of support for COVAX with more action.

Some of the vaccines have been associated with adverse side effects to the extent that Japan and some EU countries suspended their use. Please throw more light on this?
All vaccines procured or distributed through the COVAX Facility receive regulatory approval or an emergency use authorization to confirm their safety and efficacy. However, as with all medicines, even vaccines that are approved for general use may, in rare cases, cause serious adverse reactions. So far, there have been very few such events associated with COVID-19 vaccines but we continue to monitor delivery closely as a precaution. COVAX also earlier this year introduced the No-Fault Compensation scheme, which is the first and only vaccine injury compensation mechanism operating on an international scale. The scheme offers individuals in AMC economies a fast, fair, robust, and transparent process to receive compensation for rare but serious adverse events associated with COVAX-distributed vaccines until June 30, 2022.

There are cases of vaccine hesitancy in some African countries such as Nigeria, which threatens to scuttle plans to vaccinate 70 per cent of the continent’s population. Why is that and what is Gavi doing about it?
The pressing need for Africa is a predictable supply of vaccines. That is not to say vaccine hesitancy is a non-issue, but it is also important to put it in perspective.

Vaccine hesitancy is a challenge we face not just in Africa, but also around the world. While factors can vary considerably, one common denominator is the lack of access to high-quality information.

We know family, friends, occasionally politicians, religious leaders, and even doctors often share misinformation, so community-level action forms a critical part of our response. COVAX’s on-the-ground partners, including governments and the United Nations Children Education Fund (UNICEF), work closely with local and religious leaders as well as community mobilisers to engage communities and provide them with the necessary communication tools to help respond to any questions and concerns about vaccines that they may get asked.

We hope in this way that we are able to build trust and confidence in vaccines, which in turn leads to demand. However, we must not overlook the role of social media platforms, which contribute so much to the spread of misinformation. We are seeing platforms step up their efforts to root out untrustworthy content but much more needs to be done. We urge platforms to step up this work.

For sustainability, it is better for African countries to produce vaccines they use. What is Gavi doing to encourage local production of vaccines not just for COVID-19 but other vaccine-preventable diseases?
Supporting immunisation on the continent is a central focus of Gavi’s mission and we have forged strong relationships with institutions such as the Institut Pasteur de Dakar in Senegal, which has significantly contributed to the supply security of the Yellow Fever vaccine.

Our COVAX partners Coalition for Epidemic Preparedness Innovations (CEPI) have also signed a Memorandum of Understanding (MoU) with African Union (AU) to achieve the Africa Vaccine Manufacturing vision to increase local production from one per cent to 60 per cent by 2040.

It is important to note that building manufacturing capacity takes time and requires dedicated and sustained financing, resources, and political will. The continent must seize new opportunities to fast-track the development of vaccine manufacturing capacity and to boost regulatory processes. If we can prioritise these measures, local production will become an essential part of how we prepare for the next pandemic.

What has been the contribution of African countries in terms of finances towards COVAX facility? Please throw more light on how the process is financed?
Last year, the COVAX AMC was created. It is a financial mechanism and a building block within the COVAX facility that funds vaccines for 92 lower-income countries, also known as COVAX AMC participants. The COVAX AMC is largely funded by donor countries, private sector, and philanthropy, and thanks to their contributions the Gavi COVAX AMC has raised US$ 10 billion.

Countries in the COVAX AMC receive doses for free, but contribute to costs for delivery and rollout of the vaccines. However, there is also an opportunity to receive funding and support for delivery through partners such as the World Bank.

For countries that are not part of the COVAX AMC and are self-financing: in Africa, those countries are Botswana, Namibia, Gabon, Libya, South Africa, Mauritius; doses are paid for by the respective governments.

What have been the challenges towards meeting the mandate of Gavi/COVAX facility? Would you say you have made tangible progress?
COVAX has faced a huge number of challenges, from supply of vaccines to logistical and operational hurdles.

It has overcome all of them and is poised to begin its busiest period of the largest and most complex vaccination roll out the world has ever seen. Some of the innovations COVAX has put in place will help us better confront the next pandemic, such as the humanitarian buffer, which ensures access to COVID-19 vaccines for high-risk and vulnerable populations in humanitarian settings. Today, our priority is to get doses to the most vulnerable populations everywhere so that we can end the acute phase of the pandemic. We will not stop until we reach this goal.

What are your assurances to Africans especially around issues of vaccine safety?
It is important that we spread the message that all vaccines listed by WHO for emergency use have been subject to the same checks, balances, and scientific and regulatory rigour as any other vaccine, and they are safe. The data also clearly tells us that COVID-19 vaccines have predictably prevented illness and helped economies and societies start to recover.

While cases on the continent are lower than they were a few months ago, many of us know someone, or of someone who has died due to COVID-19. We must do what we can to stop the virus from circulating, and prevent new variants from emerging, which will happen should vaccination rates remain low.

Africa is a continent of great potential, and our future is bright. But we will have a huge uphill battle to get there, if we do not get the pandemic under control. The vaccines are safe, and remember that by protecting yourself, you are also protecting the people around you.