By Ajong Mbapndah L
The continent of Africa has not actively contributed to the research that has gone into the current crop of vaccines on the market, and this has created a ripe environment for the thriving of misinformation, and growth of the distrust of western therapeutics, says Zacharia Kafuko, 1Day Africa Director.
Discussing COVID-19 perspectives in Africa, Zacharia Kafuko says if the continent is able to reach a point where African researchers will conduct research and conduct clinical trials where Africans will participate and all this carried out on the African continent, vaccine trust will be realized.
While this future as envisioned by 1Day Africa is still work in progress, Zacharia Kafuko urged Africans to massively get vaccinated to ease the impact on health care systems and economies across the continent.
Could we start with an introduction of your organization 1Day Sooner and 1Day Africa?
1Day Africa is the African Chapter of 1Day Sooner, an international non-profit organization that advocates for people who want to participate in high-impact medical trials, including COVID-19 challenge trials.
The African Chapter of 1Day Sooner works to implement strategic goals of 1Day Sooner that are applicable to the unique context of the continent. Africa faces many healthcare system challenges that have only been exacerbated by the COVID-19 pandemic, and highlighted the need for future pandemic preparedness on the continent. One of the critical observations that have been highlighted in this pandemic is that Africa as a continent has not contributed its fair share to medical research and clinical trials even for medicines being used on the continent. This is where the mission of our organization lies. 1Day Africa aims to improve the continents contribution to medical research by encouraging participation of Africans in medical research and clinical trials both as researchers and as trial volunteers.
What do you consider as high-risk trials and what benefits do people get from participating in medical trials?
High risk trials are clinical trials where participants are inevitably exposed to adverse effects as a result. The actual adverse effects can vary depending on the type of trial involved but generally are interpreted in terms of possibility of hospitalization and the possibility of mortality. Covid-19 challenge trials are an obvious example of a high-risk trial. I should mention here that all clinical trials are designed to have the very least possible risk of a fatality. This risk is assessed based on a multi-factor-variables system. At 1Day Sooner for example, our research department worked on an interactive risk model which estimates the probability of hospitalization or death for participating in a Covid-19 challenge trial.
The benefits of participating in high-risk clinical trials (and all medical trials in general) must be understood from the perspective of altruism. That means on the part of the trial participant, they are effectively contributing to ending diseases. This is achieved first by helping scientists understand the disease better which translates into better care, prevention, detection and testing for that particular disease. The second is by helping researchers come up with better, safer and effective drugs for diseases (preventive and curative). Something that ultimately benefits the wider population. Just as a reminder, each one of the Covid-19 vaccines we are now using were tested for safety and efficacy using clinical trials where trial volunteers participated in. It is important also to emphasize that ending diseases means researching them and conducting clinical trials for their treatments. We have diseases that have lingered for decades especially in Africa – and part of the reason is the slow pace of the research in such diseases.
May we have an overview of the COVID 19 situation in Africa today especially with the new variant?
The Covid-19 situation in Africa is not very different from what is obtaining in other parts of the world. Most of the new infections now being reported are due to the omicron variant (B.1.1.529) which was first detected in and reported in South Africa. This variant has gone on to spread across the continent of Africa where surges are being reported. This variant is spreading like no variant has done prior and while it is true that it is less virulent and hence less fatal, the situation is still very delicate as it is straining the continent’s already fragile health care system. With about 9.9 million total infections and more than 220, 000 deaths – these are figures that should prompt all of us to think about what needs to be done.
For all the issues that Africa has in a broad sense with its healthcare infrastructure, the number of casualties remain low compared to the rest of the world, what do you think accounts for this?
This has been a recurring point of conversation and inquiry for a while now. There are obviously several factors that have been given to explain this, but the majority of those proposed factors have not scientifically been researched on to quantitatively and confidently create credibility. The most persuasive argument which was actually researched on suggested that the reason for the low cases and mortality is the continent’s demographic age structure. We already know that Covid-19 is severe in older people, especially those above the age of 65, but the age demographic structure of Africa is much lower than that. For example, the median age of sub-Saharan Africa is at 18 years while the median age for North and South America, Europe and Asia ranges from 32 to 42.5 years.
Further, it is worth mentioning that Africa also lacks sufficient testing capacity which means that several cases go undetected and hence unreported. It is therefore a good practice to be overly cautious when looking at the continent’s statistics because, there are lots of rural communities where access is extremely limited and even in urban areas many people have not been tested, creating an under-reporting of the extent of infections and the severity.
Recently there was a proposal from members of 1Day Sooner Africa for a Pandemic Insurance Fund to the World Health Assembly, how did this come about?
1Day Sooner as an organization has very strong vaccine equity principles which have led to several efforts to not only engage with the global community on issues of vaccine access beyond the human challenge trials but also take steps to mitigate the impact of unequal access to vaccines in the face of vaccine nationalism. This proposal was a collective one from a team that was constituted following efforts to replicate the pattern that helped solve the Ebola crisis of West Africa in 2014 as led by Mosoka Fallah. The idea was to have the Ebola veterans (those who worked to end the 2014 outbreak in various capacities) lead the plea for assistance to the international community. It was decided that the petition as carried through the open letter would better be addressed by the World Health Organization. Specifically, our believe was and still is that all countries of the world need to come together to end the pandemic – especially the wealthy countries and those that have been producing vaccines. The way to get all the countries to agree and commit themselves to the ethical principles of vaccine equity and now future pandemic preparedness through a pandemic insurance fund was to have these countries vote on the record during the World Health Assembly. That is how we re-aligned our efforts towards that crucial goal.
May we know the reaction of the WHO and other leading global stakeholders to the proposal?
The first thing to mention is that this campaign is still ongoing and the WHO at this stage has not officially written to us in response or reaction to this proposal. We do know that the principles and the requests being made in this proposal also resonate with the WHO and we acknowledge the heavy amount of work being put into similar efforts. We remain convinced and confident of the ultimate global benefit of having a pandemic insurance fund set up to gear the world to respond better to pandemics in the future and ensure that health equity is achieved. We are hopeful that during the next sitting of the WHA, a positive will be achieved. In the process of this effort, we have received great support from leading global experts from all the continents in the world. Additionally, the West African Health Organization has both supported this open letter and has partnered with us to work towards its success. As for other global stakeholders like pharmaceutical companies we hope they will join this effort.
In addition to advocating for the creation of a pandemic insurance fund, the letter from to the WHO called upon all countries with surplus vaccines to donate them to COVAX or directly to countries in need and calls upon pharmaceutical companies to set up vaccine development facilities in low- and middle-income countries, has there been any progress on this front?
It is safe to say that a lot has happened on this particular front. Indeed, a good number of wealthy countries have in recent months made several donations of vaccines to LMICs. I cannot say that these donations are a direct response to the open letter but, this is still an important step towards the removal of barriers to vaccination in LMICs. The United States of America has made donations of millions of vaccine doses around the world and continues to do so. Other countries are equally making similar efforts using vaccine diplomacy. Over 90 million doses have been donated to COVAX by different countries, the European Commission donated 100 million doses and the US has donated 140 million doses and pledged 500 million more.
Pharmaceutical companies have been making steady progress in expanding vaccine manufacturing to the continent. Moderna announced in October of 2021 that it will set up a vaccine plant in Africa which are all positive indications.
In follow up to the vaccine issue, it is one thing to have them available, it is another thing altogether for people to take them, what do you make of the strong resistance and skepticism that some Africans have against vaccines?
It is true that Africa has seen a high case rate of vaccine hesitance and it is true that having the vaccines is one thing and people taking them is another. Part of the reason that has gone into this unfortunate situation is something I hinted on at the outset. The continent of Africa has not actively contributed to the research that has gone into the current crop of vaccines on the market. This has created a ripe environment for the thriving of misinformation and growth of the distrust of western therapeutics
. This is why our organization recognizes this lack of African researchers and African trial participants in clinical research as a hindrance both to health autonomy and vaccine acceptance on the continent. Beyond this mistrust, misinformation and conspiracy theories, the fact remains that, vaccination is important and safe. Even the recent omicron-aided surge of cases in Africa, they have been found to be predominantly among the unvaccinated. The same fact holds for other parts of the world. If the continent is able to reach a point where African researchers will conduct research and conduct clinical trials where Africans will participate and all this carried out on the African continent, vaccine trust will be realized. This is the future we as 1Day Africa envision for the continent, but for now let us all get vaccinated as we have seen the impact of the pandemic if not on health care systems, then on economies.
What other recommendations do you have as African countries grapple with Covid 19 related challenges?
Covid-19 is a global pandemic and at the very least, it is international – our response must likewise be global or international. There is need for collaboration and fairness in implementing response strategies. Finally, I call upon the African Union to create continental medical research facilities to conduct research on diseases that are affecting the African population – some of which are endemic and have continued to exist for decades and in the process cash-strapping the national health budgets in an effort to contend.
