The Covid-19 pandemic has, once again, exposed the startling disparities between the Global North and the Global South. Moreover, it has revealed sub-Saharan Africa as being at the very back of the queue for access to technologies — in this case, vaccines and medical equipment — that save lives.
Whatever the original causes of this disparity, they aren’t going to be fixed in the next few months — something that bodes badly for African lives while the pandemic rages on. The virus’ rampage through India in May, during which, at one point, more than 4 000 people were dying daily, showed that relatively youthful populations in the developing world are not immune to the disease’s deadly effects.
The truth is Africa needs vaccines and needs them fast. Although the continent’s more than one-billion people is a substantial market globally, Africa imports almost 100% of the vaccines it uses, for all diseases. More than 70% of the pharmaceutical products Africans rely on are manufactured elsewhere. Although there is potential to set up Covid-19 manufacturing facilities (as opposed to mere packaging facilities for vaccines manufactured elsewhere), this will take time. Africa will be reliant on foreign-produced Covid-19 vaccines for years to come.
Encouragingly, we are now making decent strides forward in terms of procuring vaccines for the continent. AU member states — through the African vaccine acquisition trust — recently announced the procurement of around 200-million doses of the Johnson & Johnson vaccine, substantially manufactured overseas with fill-finish activities taking place in South Africa. A further 200-million doses will be supplied to the continent through the Covax initiative. In total, the roughly 400-million doses will allow the vaccination of around 30% of the continent’s people.
But access to vaccine doses in vials is, unfortunately, not the end of the story. The infrastructure and human resources required for getting vaccines into arms remain serious challenges for the developing world — one that Western Europe and North America have barely had to face.
The most serious of these challenges is cold-chain management. All the vaccines that Africa has procured require unbroken refrigeration, from the point at which they arrive in the destination country to when they are ready to go into the arm of a patient.
To illustrate the challenges inherent in keeping vaccines cold, consider the logistics of South Africa’s vaccine roll-out. Once Pfizer vaccines arrive in Johannesburg, they are transferred to provincial distribution centres in thermal shipping boxes designed to keep the vaccines at the required -70°C using dry ice. The dry ice must be replaced every three to five days — something that does go wrong as a result of dry ice supply issues due to larger carbonated beverage sales or, more commonly, when someone forgets to do maintenance. After the vaccines are transported to the vaccination sites, the vaccines are transferred to an ordinary fridge, hoping the power doesn’t go off.
If the cold chain is broken at any point from arrival to administration, the vaccines become ineffective and potentially unsafe.
If there is a power failure (or a dry ice supply chain disruption in an area) tens of thousands of doses stand to be lost each time. While South Africans justifiably spend a lot of time complaining about load-shedding, our electricity supply is, in fact, still more reliable than almost all of the rest of sub-Saharan Africa. Of course, many areas have no access to electricity — let alone dry ice — at all. Additionally, underdeveloped road infrastructure makes even refrigerated trucking difficult.
According to a recent survey of 34 African countries by the World Health Organisation’s (WHO) African regional office:
In 31% of countries, more than 50% of districts have issues with cold-chain capacity that are significantly prohibitive for vaccine roll-out;
In 29% of countries, 20-50% of districts have major cold chain capacity issues; and
In only 40% of countries, are there fewer than 20% of districts with serious cold chain issues.
The good news is that while Africa is a land of challenges, it is also a land of ingenuity and innovation. South African engineers have created a truly remarkable mobile cooling solution for the transportation and storage of vaccines that eliminates reliance on dry ice and mains electricity. Cryo-Vacc, as it is called, relies on liquid nitrogen and long-life batteries, holding contents at the required temperature for up to a month with no maintenance. Cryo-Vacc has longer storage periods, is unaffected by load-shedding, and minimises the risk of human error.
For countries with reliable cell data infrastructure, Cryo-Vacc also offers a sophisticated and instant remote temperature monitoring system. The device records any break in the cold chain through its monitoring system, which is publicly accessible through a mobile app. This means every patient can request the lot number of the vaccine they received, and use it to find out whether their vaccine was correctly transported and stored. This has the upshot of increasing trust in vaccines — addressing a key reason for vaccine hesitancy.
Understanding — and caring about — the unique challenges Africa faces, South Africans are well placed to contributing to the goal of ensuring that lives are not unnecessarily lost on our continent. While cold-chain management is just one — though very crucial — part of ensuring a safe and effective rollout, it is clear that sufficient talent and ingenuity exist in South Africa to ensure that Africa avoids any further suffering from the virus.
We must ensure that the AU and other African stakeholders can rely on home-grown solutions so that we are able to mitigate the effects of vaccine inequality on the African continent.