By Dr. Mosoka P. Fallah,MD,PHD

Supply agreements for Covid-19 vaccines to help protect people in African countries are far from adequate, without enough doses to vaccinate enough of the continent’s population to provide herd immunity. The question remains how cash-strapped African governments will fund this.

Participant in South African trial receives dose of AstraZeneca/Oxford vaccine at Baragwanath hospital in Soweto on 24 June 2020.
Participant in South African trial receives dose of AstraZeneca/Oxford vaccine at Baragwanath hospital in Soweto on 24 June 2020. © AFP – Siphiwe Sibeko

African states have three main ways of securing supplies for Covid-19 vaccines – directly with pharmaceutical companies, through the COVAX facility, a global initiative, and the African Vaccine Acquisition Task Team (AVATT) set up by the African Union regional bloc.

Few cash-strapped African countries have the financial means to compete with rich countries also battling to obtain vital coronavirus vaccines. Plus, there are few big pharma companies based on the continent, putting Africa at a disadvantage in negotiating contracts, while other countries leverage a home advantage.

“On their own at the current market price, there will be very few African countries that will be able to procure the vaccine,” Mosoka Fallah, a public health specialist who worked on Liberia’s Ebola outbreak, told this week’s Africa Calling podcast.

countries have the financial means to compete with rich countries also battling to obtain vital coronavirus vaccines. Plus, there are few big pharma companies based on the continent, putting Africa at a disadvantage in negotiating contracts, while other countries leverage a home advantage.

“On their own at the current market price, there will be very few African countries that will be able to procure the vaccine,” Mosoka Fallah, a public health specialist who worked on Liberia’s Ebola outbreak, told this week’s Africa Calling podcast.

Collective bargaining

The COVAX facility, which is designed to provide equitable access to vaccines for all participating nations, recently announced their estimated distribution forecasts for what is essentially a kind of procurement consortium.

“This planned rollout is a critical first step in ensuring that the continent gets equitable access to vaccines,” said Dr Matshidiso Moeti, Africa director for the World Health Organisation (WHO).

Few cash-strapped African countries have the financial means to compete with rich countries also battling to obtain vital coronavirus vaccines. Plus, there are few big pharma companies based on the continent, putting Africa at a disadvantage in negotiating contracts, while other countries leverage a home advantage.

“On their own at the current market price, there will be very few African countries that will be able to procure the vaccine,” Mosoka Fallah, a public health specialist who worked on Liberia’s Ebola outbreak, told this week’s Africa Calling podcast.

Collective bargaining

The COVAX facility, which is designed to provide equitable access to vaccines for all participating nations, recently announced their estimated distribution forecasts for what is essentially a kind of procurement consortium.

“This planned rollout is a critical first step in ensuring that the continent gets equitable access to vaccines,” said Dr Matshidiso Moeti, Africa director for the World Health Organisation (WHO). WHO leads the COVAX facility alongside Gavi and the Coalition for Epidemic Preparedness Innovations (CEPI).

“Africa has indeed watched other regions start Covid-19 vaccination campaigns a little bit from the sidelines,” added Moeti, in a recent press briefing.

COVAX will provide 88.7 million doses of the AstraZeneca/Oxford and Pfizer-BioNTech vaccines to 47 African countries.

Delivery of the AstraZeneca/Oxford vaccine, manufactured by the Serum Institute of India and South Korea’s SK Bioscience, will start in February, with all the doses expected to be distributed by the first half of 2021.

The Serum Institute of India will deliver 75 million doses of the AstraZeneca/Oxford vaccine to 38 African countries – at least 26 million doses by the end of April, and 49 million by the end of June, according to a calculation by RFI based on the COVAX interim distribution forecast.

A further nine African countries will receive some 13 million doses of the SK Bioscience manufactured AstraZeneca/Oxford vaccine, with 2 million doses delivered before May, and more than 7.5 million by 30 June. The remainder will be supplied in the second half of 2021.

Rigorous requirements for Pfizer-BioNTech

Cabo Verde, Rwanda, South Africa and Tunisia have been selected by COVAX to receive almost 320,000 doses of Pfizer-BioNTech vaccines, which has stricter cold storage requirements.

“We are extremely glad that we are part of a few countries getting this Pfizer vaccine,” Dr. Daniel Ngamije, Rwanda’s health minister, told journalists. “This is an indicator of the performance of the health sector because we were able to meet all the tough requirements.”

Some African countries are self-financing their participation in COVAX, while the vast majority are eligible for donor-funded support to pay for vaccines.

Equatorial Guinea and Gabon signalled their intention to participate in COVAX, with a non-binding confirmation of intent before 15 December, however, they are not included in the interim forecast, presumably because they no longer want to take part.

Burundi, Eritrea, Madagascar and Tanzania, all classified as low income countries, could have had vaccines doses supported by COVAX, but decided not to enter into the facility.

Authorities in Burundi say they do not need vaccines, the government in Antananarivo says it prefers local treatments and in Tanzania, the health ministry says it has no plans to accept vaccines since it does not have the virus.

Few cash-strapped African countries have the financial means to compete with rich countries also battling to obtain vital coronavirus vaccines. Plus, there are few big pharma companies based on the continent, putting Africa at a disadvantage in negotiating contracts, while other countries leverage a home advantage.

“On their own at the current market price, there will be very few African countries that will be able to procure the vaccine,” Mosoka Fallah, a public health specialist who worked on Liberia’s Ebola outbreak, told this week’s Africa Calling podcast.

Collective bargaining

The COVAX facility, which is designed to provide equitable access to vaccines for all participating nations, recently announced their estimated distribution forecasts for what is essentially a kind of procurement consortium.

“This planned rollout is a critical first step in ensuring that the continent gets equitable access to vaccines,” said Dr Matshidiso Moeti, Africa director for the World Health Organisation (WHO). WHO leads the COVAX facility alongside Gavi and the Coalition for Epidemic Preparedness Innovations (CEPI).

“Africa has indeed watched other regions start Covid-19 vaccination campaigns a little bit from the sidelines,” added Moeti, in a recent press briefing.

COVAX will provide 88.7 million doses of the AstraZeneca/Oxford and Pfizer-BioNTech vaccines to 47 African countries.

Delivery of the AstraZeneca/Oxford vaccine, manufactured by the Serum Institute of India and South Korea’s SK Bioscience, will start in February, with all the doses expected to be distributed by the first half of 2021.

The Serum Institute of India will deliver 75 million doses of the AstraZeneca/Oxford vaccine to 38 African countries – at least 26 million doses by the end of April, and 49 million by the end of June, according to a calculation by RFI based on the COVAX interim distribution forecast.

A further nine African countries will receive some 13 million doses of the SK Bioscience manufactured AstraZeneca/Oxford vaccine, with 2 million doses delivered before May, and more than 7.5 million by 30 June. The remainder will be supplied in the second half of 2021.

Rigorous requirements for Pfizer-BioNTech

Cabo Verde, Rwanda, South Africa and Tunisia have been selected by COVAX to receive almost 320,000 doses of Pfizer-BioNTech vaccines, which has stricter cold storage requirements.

“We are extremely glad that we are part of a few countries getting this Pfizer vaccine,” Dr. Daniel Ngamije, Rwanda’s health minister, told journalists. “This is an indicator of the performance of the health sector because we were able to meet all the tough requirements.”

Some African countries are self-financing their participation in COVAX, while the vast majority are eligible for donor-funded support to pay for vaccines.

Equatorial Guinea and Gabon signalled their intention to participate in COVAX, with a non-binding confirmation of intent before 15 December, however, they are not included in the interim forecast, presumably because they no longer want to take part.

Burundi, Eritrea, Madagascar and Tanzania, all classified as low income countries, could have had vaccines doses supported by COVAX, but decided not to enter into the facility.

Authorities in Burundi say they do not need vaccines, the government in Antananarivo says it prefers local treatments and in Tanzania, the health ministry says it has no plans to accept vaccines since it does not have the virus.

The interim distribution forecast by COVAX covers just 3.3% of the total population for the 145 participants globally, but the facility says it is on track to deliver at least 2 billion doses by the end of the year, with at 1.3 billion for 92 lower income countries, covering 20% of each countries population.