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An African Plan To Control Covid-19 Is Urgently Needed

The Lancet

signatory countries. That level of coverage may help with the immediate aim of protecting the most at risk, but it is insufficient to achieve herd immunity. For a virus whose R0 is 2·5, around 60% of the population would need to be vaccinated to extinguish community transmission. A n d t h a t f i g u r e a s s u m e s a p e r f e c t vaccine. For a vaccine with an efficacy of 90%, the proportion of the population to be vaccinated rises to 67%. If a vaccine with an even lower efficacy is used, the proportion will rise still further. The University of Oxford–AstraZeneca partnership has pledged to supply COVAX with “hundreds of millions of doses” of their vaccine, which—importantly for African countries—needs only the standard 2–8°C cold chain. In July, the African Union Commission and the African Centre for Disease Control and Prevention launched a safety-net strategy to secure access to vaccines and treatments for countries on the continent. T h e C o n s o r t i u m

As governments in countries hit hardest by COVID-19 prepare vaccination programmes against severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), other nations face a more uncertain future. I n A f r i c a , f o r example, the pandemic continues to grow, but heterogeneously. Cases are rising sharply in M o r o c c o , Tu n i s i a , Algeria, Libya, Egypt, and South Africa. But in Africa's most populous nation, Nigeria, WHO reports only 1173 deaths from COVID-19.

 Although data are sparse, the first wave of the pandemic seemed to peak in early August. N u m b e r s o f C O V I D - 1 9 d e a t h s d e c l i n e d t h r o u g h September, but the disease has been stubbornly persistent since then, burning slowly through communities throughout the continent. As of Dec 1, WHO reports 1·5 million cases and 33 573 deaths from COVID-19.

 Despite the diversity of the pandemic in Africa, and the fact that many countries appear to have been spared the human calamity that has

afflicted so many nations elsewhere, the continent still needs a vaccination plan. C O V I D - 1 9 i s a global health emergency that demands a global solution. No community is safe from SARS-CoV-2 unless all communities are protected. Further national lockdowns to drive down the prevalence of the virus will not provide a permanent answer to the epidemic threat. With tens of millions of Africans plunged into extreme poverty by COVID-19, further mandates to shut down economies will precipitate humanitarian and health crises.

 COVAX, the Gaviled financing mechanism to provide COVID-19 vaccines to low-income a n d m i d d l e - i n c o m e countries (LMICs), plans to have 2 billion doses of vaccine available by the end of 2021. 9 7 h i g h - i n c o m e countries have now signed up to the initiative and 92 LMICs—including most African countries— will be supported by the plan. COVAX aims to secure enough doses of any vaccine to provide protection to an initial 2 0 % o f p e o p l e i n

Health Watch

f o r C O V I D - 1 9 Vaccine Clinical Trials (CONCVACT) has already set up several Africabased clinical trials of vaccines and scaled up production of both testing and diagnostic facilities. CONCVACT has orchestrated panAfrican cooperation, set up information-sharing platforms, and led the creation of technical capacity for screening and surveillance. D e s p i t e t h e s e advances, the vaccination of two-thirds of Africa's 1·2 billion population will still require huge investment and faces substantial logistical challenges. According to a WHO analysis, the African region has an average score of 33% readiness f o r a S A R S - C o V- 2 vaccine roll-out—far below the necessary 80% benchmark. The estimated cost of delivering a vaccine to priority populations alone is estimated to be around US$5·7 billion— and this figure does not include the additional cost of injection materials and other consumables. Fur ther concer ns include transparency and patent protection. Médecins Sans Frontières

(MSF) points out that the six front-running C OV I D - 1 9 va c c i n e candidates have had $12 billion of taxpayer's money invested in their development. Yet vaccine deals with countries are often “shrouded in secrecy”, MSF argues. There have also been calls to waive intellectual property rights on COVID-19 vaccines. India and South Africa first made the request in October. A waiver would help ensure more equitable access to a vaccine and could be a turning point in the pandemic for nations with few resources. Whether existing initiatives will translate into an effective and universal COVID-19 vaccination programme for Africa remains to be seen. B u t a s t h e governments of wealthy countries push their way to the front of the vaccine queue, their leaders would do well to remember that without a vaccine plan for African countries and other nations with resource constraints, the protection of their citizens from COVID-19 will be an illusory victory

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