African governments have shown firm resolve in fighting COVID-19 jointly, but the next stage of the continent’s response — a rapidly accelerated vaccination campaign — will rely largely on decisions made in other parts of the world, said Africa Centres for Disease Control and Prevention Director John Nkengasong.
Less than 2 percent of Africa’s 1.2 billion people have received a COVID-19 vaccine dose, compared to more than half of Americans, illustrating inequities in the distribution of the life-saving shots around the world and the need to rethink global health structures in a more inclusive way, he said during a panel discussion during day two of the World Affairs Council of Atlanta’s annual Atlanta Global Health Summit.
“The health security architecture of the world that we live in has to be redesigned so that you regionalize it and decentralize it as much as possible,” said Dr. Nkengasong, who argued in favor of a controversial push to waive vaccine patents to speed up the pace of vaccine manufacturing and distribution around the world.
Watch the full event:
India, South Africa and other countries have appealed at the World Trade Organization in favor of three-year waivers on intellectual property protections for COVID vaccines, and the U.S. shocked the world when President Biden signaled his support for the waivers last month.
Drug makers and other countries, including some in the European Union, argue the move would lessen incentives for innovation without addressing other hindrances to the global vaccine rollout, like a lack of cold storage and a dearth of trained health care workers.
Dr. Nkengasong welcomed the move from the Biden administration, noting the Africa CDC is under no illusions that IP protections amount to a magic bullet, and besides, the WTO discussion are far from over.
“We don’t want to kill innovation, but we’re saying that it is important that we come to an arrangement — that in times of crisis like these, the world, humanity, should benefit from it,” Dr. Nkengasong said.
While the pandemic made global health matter like never before, he worries some countries remain at the mercy of multilateral systems that disempower a localized response.
He praised African political leaders for entrusting his relatively young organization with pandemic response. More than 40 African health ministers convened within weeks of the first recorded case of COVID-19 on the continent in February 2020. Within a week, a common strategy was reached.
“I never saw a situation where that reaction happened,” said Dr. Nkengasong said, who worked on HIV/AIDS research continent-wide for nearly 30 years. “We reacted to that with almost no data. We said to the leadership of the continent, ‘We are going to be hit like a storm by this.’”
Africa’s young population — 70 percent under 30 — may have helped shield the continent from the horrors that India is facing amid its second wave, but health ministries are preparing their health systems for surges, bolstering oxygen supplies and readying the latest treatment options just in case.
But vaccines remain the long-term way out, and the continuing at the current peace could mean COVID-19 sticks around for years to come in Africa.
“Our greatest concern is timely access to vaccines on the continent,” Dr. Nkengasong said, noting that “fairness, speed and scale” are the guiding principles the Africa CDC is looking to see drive the effort to reach Africa. “We set up ourselves to vaccinate cat least 60 percent of our population by 2022. At this speed we’ll probably never reach that target and we clearly would move toward the endemicity of the virus in Africa which would be at best a disaster for the continent.”
He added: “We really hope that a new public health order will emerge from this pandemic.”
The U.S. Perspective
Rochelle Walensky, the new director of the U.S. Centers for Disease Control and Prevention in Atlanta, said that while vaccines so far are proving effective against known SARS-CoV-2 variants that have emerged in the United Kingdom, South Africa and Brazil, the longer the disease circulates the greater the chance one mutates in a way that makes the vaccines less effective.
“That’s really a component of ‘no one is safe until everyone is safe,’” she said.
The U.S. is not only sharing surplus vaccine doses — 80 million committed to the rest of the world by the end of June — but it’s also “teaching a man to fish” by upping technical assistance, providing oxygen and helping with immunization strategies now that the country has some (literal) breathing room.
She seconded Dr. Nkengasong’s call to invest in public health for the long haul. The U.S., she said, had lost 60,000 health workers amid a spell of disinvestment that left it unprepared for the crisis even as threats like Zika, H1N1 and others proliferated.
“Our public health infrastructure was never equipped to handle this,” she said. “We were not upskilled, we were not trained, and we didn’t have community health workers that came from the communities where they needed to serve,” she said in a keynote discussion. A data and technology plan was also lacking, and test results were coming into health departments via fax machine.
New public health labs, genomic surveillance, wastewater surveillance and more were put in in response to COVID, and they shouldn’t be disposed of, she said.
“We have this history of having the disaster goes away and then the funding goes away. We can’t be doing that,” she said.
Dr. Walensky explained what she said was the new scientific rationale behind the CDC’s recent change to mask guidance, which now says vaccinated people can stop wearing masks indoors in most situations after more than a year of harping on the importance of masking as a prevention measure. The move was based on evidence that vaccines were working well in the real world and data that suggested asymptomatic transmission was not likely among the vaccinated.
Dr. Walensky, who declared racism a public health threat in April, added that the uneven progress in the pandemic across the U.S. remains a concern, especially in areas where lack of access to information and care persists.
While she is hopeful that the increasing rate of vaccinations makes future surges unlikely, vaccine hesitancy and gaps in access also portend pockets of infection around the country.
“What concerns me is the heterogeneity of where we are across the country, because this virus is going to be an opportunist,” she said. “it may not go to places in California that are 70 percent vaccinated but it may well go to places in Georgia that are 20 percent vaccinated, and these are preventable sicknesses and deaths.”
During a subsequent panel where Dr. Nkengasong spoke, Heidi Larson, founding diretor of the Vaccine Confidence Project, London School of Hygiene & Tropical Medicine outlined ways to combat disinformation.
Carlos del Rio, distinguished professor at the Emory University School of Medicine and a prominent local voice, said a big problem in Georgia and the broader U.S. has been the politicization of health measures like mask-wearing.
He added that the U.S. should also extend help to Latin America, which in some countries is seeing a per capita case count higher than in India.
“If we don’t address the local pandemics happening right here in our continent, we have a problem,” he said. “It’s not charity, it’s actually in self-interest, and trying to control this pandemic is something we all need to work together to achieve.”
See the keynote with the U.S. CDC director here.