As the world lauded the first deliveries of COVID-19 vaccines to African nations through COVAX, we must also recognise that these vaccines need to reach the arms of people living right across the continent, to the last mile. A complex arrangement of logistics and health systems infrastructure needs to be financed and organised effectively to deliver the vaccines to those who need it, including those in humanitarian and crisis situations. Community engagement and ownership is vital to make sure people accept the vaccine.
In low-income countries, addressing all of these issues is no easy task. For many African states, the challenges of preparedness to receive vaccines and implement strategies to fund both vaccine procurement and delivery are steep.
Finance, information and technical assistance are therefore urgently needed to support the practical and effective delivery of COVID-19 vaccines across Africa. Furthermore, the 20% of vaccines pledged to Africa is way off the 60% needed for populations to reach herd immunity. The global community, while currently collaborating in inspiring and productive new ways, needs to do more to support Africa to equitably deliver vaccines including to vulnerable and marginalized populations. The now oft-quoted saying “None of us are safe until we are all safe,” is a warning the world cannot afford to ignore.
These are some of the key messages to come out of the first Africa-led dialogue to be held in the COVID-19 era, where African organisations invited key world players to strategise and shape solutions with African leaders. The high-level meeting was convened on 4 March by CONVINCE Africa and Wilton Park and brought together Ministers of Finance and Health with leaders of key multilateral institutions and senior representatives from the donor community to take a whole-of-Africa led approach to financing access, delivery and uptake for COVID-19 vaccines for the African continent.
Key figures agreed there is a moral imperative to support equitable access to vaccines for African states. The urgent need for collaborative and complementary strategies to finance vaccine acquisition and delivery is clear. With almost four million cases across the continent and emerging new variants posing greater risk of transmission, never before has there been a greater need for such global solidarity to end the pandemic.
“To build a healthier, safe and more prosperous Africa is what we all want. It is an investment that delivers a rich reward,” said Dr Tedros Adhanom Ghebreyesus, Director General, World Health Organisation.
Dr Zwelini Mkhize, Minister of Health for South Africa, made an opening statement on behalf of the President of South Africa HE Cyril Ramaphosa saying that this pandemic requires an all-Africa approach, where social solidarity, collaboration and joint strategies will lead to benefits for all. He also welcomed support from multilaterals, WHO and the donor community, appreciating that a multi-sectoral response including the private sector and civil society is the most beneficial.
Dr John Nkengasong, Director of Africa CDC announced a new initiative, the African Vaccine Delivery Alliance (AVDA), a cross-sectoral governmental coalition whose mission is to coordinate and catalyse support for African countries to accelerate efforts to acquire vaccines and get them to people in communities where they are most needed. This initiative is critical to meet the target of vaccinating at least 60% of the continent’s population. Crucially, AVDA still needs funding to be able to do the work that has been asked of it to get vaccines to Africa’s people.
“This pandemic has taught us three lessons. We are more connected on the planet than we thought, we are more vulnerable than we thought and the inequalities existing between us are greater than we thought. We should not let inequities in the distribution of vaccines exacerbate the inequalities we see already,” said Dr Nkengasong.
Dr Ayoade Olatunbosun-Alakija, Co-Chair of AVDA called on stakeholders to work towards complementary strategies to leverage scarce resources for vaccine acquisition and delivery. “We see concrete commitment to collaboration multilaterally and bilaterally but there is not enough funding. We need more creative and innovative sources of funding,” said Dr Ayoade Alakija.
In other remarks, African Finance Ministers expressed frustrations in lack of clarity and understanding of information about what has been required from national budgets to fund vaccine procurement and delivery. Hon Minister Zainab Ahmed, Minister of Finance, Budget and National Planning, Nigeria said, “We are calling on high-income countries to support this initiative of Africans helping Africa and also to consider the not inconsiderable costs of vaccine delivery. Therefore, I welcome the Africa Vaccine Delivery Alliance AVDA, which will go some way in providing local solutions to meeting the gaps in logistics and delivery across the continent. Not all countries have the capacity to deliver even the donated vaccines.
Hon Minister Zainab Ahmed went on to request financial support to African countries to ensure the effective delivery of vaccines to all people. “Access to vaccine financing should be simplified. We ask for proposals from banks around the table for how countries can access finance mechanisms and support from other sources, and how Ministries of Finance can easily and quickly apply for such funding. Funding needs to be flexible to support purchase and delivery within health systems.”
Professor Baron Peter Piot, Director, London School of Hygiene and Tropical Medicine reminded that at the start of the AIDS crisis in the 1990s, it took seven years for antiretroviral treatments to reach the poorest countries, especially in Africa. Over 12 million people died as a result of this delay. “History must not repeat itself. Let scarcity not be the enemy of equity. How can we do better as a global community?” said Professor Piot.
On the global stage, multilateral institutions offered support and solidarity with Africa. Her Excellency, Jutta Urpilainen, European Commissioner for International Partnerships said, “The race to vaccinate the world is on but we are not racing one another, we are racing together side-by-side.’ Africa and Europe must get through this crisis without losing sight of the long-term goals.”
Hon Minister Dag Inge Ulstein, Minister for International Development, Norway and Co-Chair, ACT-A Facilitation Council encouraged greater global collaboration and engagement of all partners and stakeholders through COVAX and the ACT Accelerator. He also called for a broader finance base from multilaterals and the private sector to bring the pandemic under control, arguing that we could undermine incentives for future crisis management if we fail now.
Catriona Lang British High Commissioner for Nigeria, noted that the UK has been at “the forefront of developing COVAX” and securing pledges from other donors. She also called for innovative financing mechanisms to support the financing of vaccines for Africa.
While dealing with this emergency, long-term goals are also a crucial consideration. Africa imports 99% of its vaccines, and has scarce capacity to manufacture its own vaccination products. This is not a formula to ensure the health of a continent in the future. The pandemic has highlighted this inadequacy and the need to develop local manufacturing and production capacity of vaccines.
Meanwhile, Africa does not currently have enough resources to defeat COVID-19. However, there is hope and strength in multi-lateral collaboration and support. Jeremy Konyndyk, Senior Advisor COVID-19, USAID said, “We do need to collectively expand the ambition of COVAX. We don’t have the luxury of only vaccinating 20%. This means we need to expand supply.”
Key conclusions from the meeting included taking actions to:
1. Strengthen solidarity – there is no global solidarity unless we all have a seat at the table and a voice in the process. Africa has not waited and is ready to lead the way with initiatives such as AVDA.
2. Strengthen alliances for change – COVAX is a crucial alliance as no one stakeholder can do this alone, and needs to grow in strength and ambition.
3.Share vaccines globally – the world must begin preparing to share vaccines, especially high-income countries, which have pre-ordered more vaccines than they may ultimately need
4. Support vaccine deployment – While some African countries are experienced in immunization, many need greater levels of support.
5. Invest in local manufacturing – there is an urgent need and opportunity to invest in African manufacturing. The know-how exists, but the international community needs to support its development.
Other action points from the meeting included the urgent need for a clear road map to ensure vaccines are delivered now and not in the distant future; to increase the amount of vaccines available and increase production capacity; to seek a broader finance base from multilateral institutions and the private sector; and to engage more stakeholders and partners in global collaboration through institutions such as COVAX and the ACT Accelerator.
A further CONVINCE Africa and Wilton Park dialogue will bring together key stakeholders engaged to continue this Africa led, take a whole of society, approach to supporting the delivery of vaccines to populations and the critical engagement with and in communities around the importance of taking up COVID 19 vaccines.