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Insights and analysis on international health affairs from Lenias
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Insights and analysis on international health affairs from Lenias
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over plan and over prepare to mitigate SUPPLY CHAIN CHALLENGES during COVID-19 VACCINation campaign5/10/2020 To manage the many challenges of optimally delivering the first vaccine, policymakers should err on the side of caution by over-preparing and over planning to minimize potential disruptions. A Covid-19 vaccine is not yet licensed. However, all indications from experts suggest that the licensing of one of the three leading Covid-19 vaccine candidates is imminent. It is expected that by the end of 2020 or at the latest, by early 2021, an approved licensed vaccine would be available for mass production and mass vaccination. Delivering the first vaccine to make it to market to the population will face many challenges that policymakers and leaders in industry and international organisations should plan for in order to mitigate the risks and deploy the vaccine optimally and effectively. My last week’s briefing on global health, discussed the issue of public trust and confidence in a newly licensed Covid-19. This week’s briefing, addresses some of the potential hurdles that African countries might face in their future efforts to deliver vaccines to the continent. A public discourse on what plans and contingencies governments, public health experts, policymakers and partners are putting in place to deliver vaccine across the region is needed. Policymakers should err on the side of caution by overpreparing and over planning to minimize potential disruptions.
Plan for the same supply challenges seen early during the pandemic The challenges that African nations are likely to face when delivering Covid-19 vaccine are likely to mirror those already experienced by countries globally since the beginning of the pandemic. In particular, many low- and middle-income countries (LMICs) including those in Africa experienced huge challenges in their ability to buy any PPE and IPC products at all. Other countries could not get the supplies they bought because the world was not producing enough products compared to what was needed. The available global supply of infection prevention and control products like test kits, masks, medicines and ventilators far exceeded available demand. Some countries blocked their borders to prevent essential products needed for the national response effort from leaving their borders. The Swiss Global Trade Alert project estimated that more than 90 countries put up restrictions on the export of protective equipment and medical products. There were diplomatic tensions when some countries would not allow products destined to other countries from transiting through their territory. When the Covid-19 vaccine becomes available, countries should plan for similar hurdles in their efforts to distribute Covid-19 vaccine. The best way to deploy the vaccine most effectively is to ensure that the worst affected places get it first. This is what would best serve global public health. However, the most likely scenario is that rich countries will get the vaccine first regardless of public health need. Production will not be enough so it will take time to reach people outside wealthy countries. The Global Challenge of Manufacturing and distributing enough vaccine On a more optimistic note, in order to have enough vaccine to protect all Covid-19 susceptible populations around the world, it would help to know how much vaccine will be needed and to best deploy available production infrastructure towards this target. The absolute vaccine quantity needed to stop the pandemic will depend on whether individuals will need to be immunized with one, two or three shots of the vaccine. If each person needs for more than one injection to achieve adequate immune protection, more vaccine will need to be made. The amount of time needed to get the vaccine to the greatest number of people, including the most vulnerable outside rich countries will even be greater. The leading vaccine candidate, the Oxford-Astrazeneca vaccine, is currently given in two doses, according to Professor Sarah Gilbert, the lead scientist on vaccine. Africa will face greater supply chain challenges Manufacturing and distributing enough vaccine to meet global demand is a challenge facing the global community. Global production capacity will not be enough to meet this unprecedented demand. Existing scientific data from testing for Covid-19 antibodies in individuals exposed to the virus suggests that an estimated 90% of people, (7.2 billion people globally) are susceptible to Covid-19. Data models project that achieving protective immunity within communities would require that an estimated 70% of people are exposed to the virus through vaccination or natural infection will subsequently develop immunity to it. This translates to about 5.6 billion people globally and 910 million in Africa, who will need to be vaccinated or naturally exposed to SARS-Cov-2. Unless enough people have immune protection within any population to interrupt the chain of transmission, viral transmission will not stop. The harsh reality is that without enough vaccine, some people will have to go without and concerns whether Africa and other LMICs can get any vaccines at all are very real. Engage proactively to secure vaccine Africa’s best hope of securing vaccine for its most vulnerable populations like frontline health workers and those with pre-existing conditions will require a unified regional strategy and a proactive approach to securing adequate vaccine stocks to meet its needs. How much Africa can get will depend on how much vaccine can be mass produced and how much there is to spare after the rich are served. Africa can also rely on international mechanisms to secure vaccine stocks on its behalf. However, these organisations are facing significant financial shortfalls that in their efforts to make advance purchases of vaccine for the poor nations. Africa must not entirely depend on these mechanisms. It is necessary that Africa make its own efforts to negotiate its own conditions for accessing to vaccine. A well thought out strategy and contingencies for navigating the current geopolitical environment to secure vaccine for the region will improve Africa’s odds of getting vaccine in a timely manner without having to undergo further lockdowns in the anticipated second and third waves of the pandemic. Vaccines are a high value product that have a greater risk of getting spoiled. Ocean freight takes much too long so vaccines need to be transported in cold conditions and fast using air cargo. The pandemic has overstretched global supply chain and will continue to exert stress on the demand for pandemic products in addition to the regular medical product required to meet the routine treatment needs of populations. The need for additional capacity to transport vaccine will exert greater pressure of global supply chains already struggling to cope. The pandemic has impacted the global economy and significantly reduced the number of international passenger flights which limits the available options for air freight cargo. Major regional airlines like Ethiopian airways that have been moving pandemic products onto and around the continent may not be not have enough capacity to handle the additional needs. Policymakers need to make practical easy to deploy solutions to address limited shipping capabilities in the region. Therefore, Africa must put in place contingency plans to ensure that it can get vaccine to countries in the region whilst managing the risks of spoilage which could lead to huge losses of a very scarce and difficult to secure Covid-19 vaccine.
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