The emergence of the Omicron variant has underlined yet again the necessity of a global vaccination programme. Otherwise in the poorly vaccinated parts of the world the virus will continue to mutate, eventually spreading beyond a country’s borders. And repeatedly closing borders is neither practical nor ultimately effective for the world. This is true especially of Africa, where in densely populated urban areas the virus can run unchecked.
However, what is less clear is that it is not just a question of vaccine supply. It needs a credible plan led by African nations, supported by the international community, for distribution, logistics, testing, genomic sequencing and countering vaccine hesitancy, with the aim of vaccinating the entire African continent by the middle of next year.
At present progress is stalling. Only 10.4 per cent of people in Africa have received one dose, compared with 64 per cent in high-income parts of the world and, as of October, a mere 0.4 per cent of the 3.5 billion tests performed globally were in low-income countries. This means many cases going untested and, consequently, unsequenced.
For much of the crisis, the wealthy part of the world has been shamefully slow at providing vaccines for the less developed nations and it is right to question the unmet commitments of western governments and ad hoc donations of near-expired vaccines.
But supply is no longer the most critical challenge. Instead, it’s the ability to get vaccines into people’s arms — so-called absorption capacity.
There is stark evidence of this across the continent. Thirty African countries have administered 80 per cent of doses received, while some, including Djibouti and the Democratic Republic of the Congo, administered fewer than 20 per cent of doses received. South Africa has stockpiled more than 15 million doses and the country is turning away vaccines, yet its vaccination rates remains stubbornly under 40 per cent. Across the continent, modelling from my institute shows there would need to be a four-fold increase in absorption capacity to keep pace with incoming supply, given the welcome news that the Serum Institute has resumed exports to Covax and that the US will ship 17 million Johnson & Johnson doses on top of the 55 million doses it has delivered to date.
A credible pandemic plan must cover all the elements necessary and that’s what my Institute has called for in its paper, The Urgent Need for Universal Genomic Sequencing: Vaccine Supply Is Not the Only Challenge Facing Africa.
Strategically vaccinating African populations will require diligently addressing a complex range of issues. Many countries lack the logistical capacity to do large scale-adult vaccination programmes and they urgently require international support and help in mobilising the people and systems to do so. But there is also huge vaccine hesitancy, with the internet fired up with false stories of vaccine damage and the absence of a strategic and coordinated communications campaign to counter this menace, including correcting misleading information about the AstraZeneca vaccine, which the evidence shows is effective, safe, durable and easy to store.
There is also a critical need to supercharge our most important warning system against new variants: PCR tests and strategic sequencing of samples.
Currently, fewer than a quarter of countries are sharing genomic sequencing data at the level needed to provide a clear understanding of the virus.
Even in the United States, the sequencing is sporadic and focused in a few states. Therefore, a credible global pandemic plan must see testing capacity bolstered in every country, with a minimum of 100 PCR tests per 100,000 people and a minimum commitment on sequencing. All data should feed into a cloud-connected surveillance software, such as the global pathogen analysis system, led by Oxford University.
This requires additional support to developed and developing countries for genomic sequencing, but it also requires reciprocal data sharing and a reasonable reaction to countries that share data.
While travel restrictions following discovery of a new variant are understandable as nations seek to limit the spread of the virus, the danger is they harm pandemic response by disincentivising the testing and early identification of variants. As is now becoming plain, South Africa has been wrongly penalised for drawing attention to the problem, as though it were the source. Without the world-class sequencing in South Africa and their steadfast commitment to protecting the public health of all countries, the Omicron variant would have been discovered far later and potentially caused even more damage.
Genomic sequencing should be the ambition for every country, supported by a global system that rewards those who contribute to the betterment of public health and brings along those who need help. Widening coverage of genomic sequencing is an absolute imperative but cannot possibly happen unless organised at scale.
Of course, a plan is just another piece of paper without clear-sighted, global leadership. There is a complex web of hundreds of global, regional, and country-level bodies working to vaccinate the world. Each is doing admirable and important work, but it’s critical that they are greater than the sum of their parts. Previous pledges and drives haven’t delivered for Africa. We therefore advocate an Africa pandemic plan, coordinated through the Africa Centres for Disease Control and Prevention, and with tangible backing by partners in the global north and G20. This should link to wider global efforts both to vaccinate the world to avoid future variants and put in place agreed protocols to respond when they do arise.
The rhythm of cases rising and falling will suck up the ailing reserves of energy and enthusiasm needed to address the challenges faced by the global community as we live in constant fear of a variant deadlier or more transmissible than the last, risking a neverending cycle of travel bans and lockdowns that do serious damage to economies and individuals’ wellbeing in richer and poorer countries alike.
The reality is that vaccinating Africa as soon as possible should be at the top of the global agenda. “Virus anywhere means virus everywhere” is the brutal truth about Covid-19. We need to act on it.
This article originally appeared in The Sunday Times.