Shortage of vaccine doses threatens Africa’s COVID-19 immunisation program

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Panic is spreading in Kenya as coronavirus vaccine doses are running low and many people are unable to get their second jab on schedule. Kenyan health authorities have said that less than two percent of the country’s population of more than 52 million has been vaccinated so far, with further supplies of the two-shot AstraZeneca COVID-19 vaccine delayed at least until June. While South Sudan recently decided to send 72000 doses of the vaccine to Kenya over fears Juba will not be able to administer them on time, the shortfall is still important. Some 900,000+ Kenyans vaccinated to date are at risk of failing to receive their essential second dose within the recommended window.

The shortage is the direct consequence of a vaccine export freeze by the Serum Institute of India (SII), the world’s largest vaccine manufacturer. Kenya – along with many other African nations – has been counting on receiving millions of doses from the global vaccine sharing initiative, COVAX, via the SII. However, India’s damaging ‘second wave’ has led to an export restriction and the SII has announced that vaccine shipments won’t resume until the end of this year.

Vaccine shortages abound across poorer nations

Kenya’s predicament is a microcosm of what’s happening across Africa, the world’s least vaccinated continent. Despite accounting for 14 percent of the global population, its countries have had only 1 percent of administered doses globally. Vaccination targets of a third of Africa’s population by the end of 2021 now look hopelessly optimistic in the face of supply shortages.

Largely priced out of costly mRNA vaccines – like those developed by Pfizer and Moderna – because they require special handling, developing countries had been counting on SII-produced doses of the cheap and accessible AstraZeneca jab. But ‘vaccine nationalism’ has diminished COVID-19 vaccine supply chains and left poorer countries like Kenya facing shortages.

The vaccine delays are especially worrying in the light of data on the spread of Covid-19 across Africa: over 4.7 million confirmed cases and 128, 000 deaths have been recorded since the outbreak of the pandemic, according to the Africa Center for Disease Control and Prevention (CDC). In Africa, less than 2 percent of the population has received one vaccine dose compared to more than 80 percent in some high-income countries.

No-one’s safe until everyone’s safe

The freeze has once again made two things clear: that the fight against the coronavirus won’t be over until countries around the world have vaccinated the lion’s share of their populations; and that the world needs as large an arsenal of COVID-19 vaccines as possible, from a variety of manufacturers and with different prices and handling conditions.

More than a billion vaccine doses have so far been injected worldwide, with just 0.2% administered in the 29 lowest-income countries which represent 9 percent of the global population. COVAX aims to channel vaccines to the 90 countries that have signed up to receive the donated doses. So far, around 65 million shots have been distributed, many of them to Africa.

The United States has pledged to share 20 million doses of the Pfizer, Moderna and Johnson & Johnson vaccines via COVAX in the next month, in addition to 60 million AstraZeneca shots already promised to other countries. The EU also plans to ramp up COVAX donations in the second half of 2021; member states have already shared more than 11 million doses.

UNICEF – along with other charities – is calling on richer nations to donate their surplus doses to COVAX. Its calculations show that G7 countries could donate more than 150 million doses by sharing just a fifth of their available supply over the next three months, while still meeting commitments to vaccinate their own adult populations.

A new generation of vaccines could change the outlook

At the same time, there have been calls in the international community for vaccine patents to be lifted to allow countries in Africa to manufacture them locally. Time is of the essence, though; Kenya has ordered 30 million vaccines from Johnson & Johnson in the hope that the majority of its adult population can be vaccinated by 2022.

Fortunately, a second generation of Covid vaccines is already starting to take shape, which could be a gamechanger for countries like Kenya.

Massachusetts-based Akston Biosciences, for example, is carrying out Phase I/II trials in the Netherlands on its candidate AKS-452, which demonstrated promising results in primate trials, is shelf-stable even at high temperatures and could be manufactured rapidly and cheaply. In fact, thanks to the standard antibody-manufacturing techniques used, the company claims that a single production line could be capable of producing over a billion doses per year. As the trial’s lead investigator, Dr. Schelto Kruijff, stresses: “From my volunteer work in Malawi and Kenya, I understand how important it would be to have a vaccine like this, which can be transported and stored for months without refrigeration.”

At the same time, US-based HDT Bio and Indian partner Gennova have begun Phase III trials on an mRNA-based vaccine that is cheaper and more stable than the well-known jabs produced by Pfizer and Moderna. The trick is that its RNA payload is supposed to amplify itself in the body of the vaccinated person, thereby activating the immune system with a lower does than existing mRNA shots, which leads to a significant decrease in manufacturing costs – and, by extension, of the jab’s shelf price.

With more than 115 vaccines in development (according to the New York Times), the hope of developing countries like Kenya now rests on the fact that these second-generation jabs will be able to overcome the hurdles associated with the first ones that hit the market in late December. But until then, Nairobi can only grit its teeth and hope that the shipments from South Sudan and COVAX will arrive on time.