“The need to vaccinate 70% of the African population against Covid-19 deserves debate”

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Vaccination against Covid-19 in Johannesburg, December 15, 2021.

Will Africa be able to massively vaccinate its population in 2022? Barely 10% of adults today benefit from vaccine coverage against Covid-19, a far cry from the officially set target of 70%. While this threshold has already been exceeded by many European countries, the World Health Organization (WHO) continues to condemn this “Vaccine inequality” which could moreover, according to its director Tedros Adhanom Ghebreyesus, favor the appearance of new variants, like Omicron identified in November in South Africa.

Read also Covid-19: in Africa, a slow and complex vaccine deployment

At the same time, the pandemic is less deadly in Africa than elsewhere in the world, with 230,000 deaths for a population of 1.3 billion inhabitants, according to official figures. This reality out of step with the slaughter announced at the start of the health crisis prompted researchers from the Epicenter network, the research center of the NGO Médecins sans frontières, to conduct seroprevalence surveys to better analyze this African exception.

The results obtained in seven countries and made public on December 16 confirm a strong circulation of the virus with a health impact still limited compared to other regions of the world. For Professor Yap Boum, representative of Epicenter, this situation should raise questions about the need to pursue a broad and uniform vaccination objective.

From the first months of the pandemic, Epicenter launched seroprevalence studies to measure the exposure of populations to SARS-CoV-2. Can you tell us how they were carried out?

Make Boom We embarked on this research to try to understand what was incomprehensible for us between the disaster that had been predicted and what we saw on the continent. We wanted to go beyond the officially recorded data in terms of contamination, transmission and mortality. Also with the objective of being able to make recommendations to adjust national responses.

We set up these studies by relying on our network: in Niger and Uganda where Epicenter has a research center, in Cameroon where our regional office is located and in other countries where MSF operates such as the Democratic Republic of the Congo. (DRC) or Sudan.

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In total, we worked in seven countries, on target populations such as blood donors in Mali or Kenya, health personnel in Niger, refugee camps in Sudan, on the general population of the city of Abidjan in Côte d’Ivoire and nationally in Cameroon. In these two countries, we went door-to-door on a random basis. This is the most robust, but it is expensive and it requires a large organization in terms of personnel with some 200 investigators to deploy in the field. We can’t do better except screen everyone.

We had a very pragmatic strategy depending on the country. In Niger, for example, which is one of the countries with comparatively fewer cases and the fewest deaths, we tested MSF’s highly exposed health workers to put themselves in the worst possible situation. The results confirmed the vulnerability of these frontline workers with prevalence rates ranging from 40% to 80%.

Your studies show that SARS-CoV-2 has circulated extensively even where the declared contamination levels are low?

Yes, we found relatively high prevalence levels in all of our studies. 24% among blood donors with rapid tests but 70% with more detailed tests. Between 40% and 80% among health workers. 10% “only” in Cameroon, but this still represents 2.5 million people infected while the official figures after the third wave only count 100,000 people. Thus, the extent of contamination by SARS-CoV-2 is 20, 30 or even 50 times higher than what has been reported by the countries.

However, few infected have developed serious forms of Covid-19 or died from it. This leads you to wonder about the vaccine strategy proposed to the continent. Why ?

The figures reveal an African population, the vast majority young, which has been highly exposed to the virus without developing severe forms in numbers. We can then wonder about the need to administer vaccines uniformly, the reason for which is above all to avoid the most severe pathologies.

Read also Covid-19: African champions in the fight for access to vaccines

Vaccines are essential for those most at risk, that is, the elderly or people with co-morbid factors. But for the rest of the population and in a context where other health priorities exist, is this solution, the difficulties of which we can clearly see in implementing it, really justified? This is the message of our study in favor of more targeted responses according to local contexts.

What do you say to those who warn, like the WHO, against an under-vaccinated Africa and the risks of seeing new variants emerge?

This debate is not settled and we must be careful with such a statement. Molecular biologists disagree that there is a direct causal link between the emergence of variants and vaccination rates. Omicron has been identified in South Africa, but it has not been shown to have emerged there. The vaccine helps reduce severe forms. It does not stop the transmission of the virus.

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The proof: Europe is currently facing a fifth wave with vaccination rates above 70% and the number of cases continues to increase. The virus continues to circulate and certainly to mutate. The more accurate statement would be to say that it is necessary to be able to stop the transmission of the virus and that the countries where transmission continues are countries where variants can emerge. This can be in Africa as elsewhere. The vaccine does not give us that guarantee.

Under these conditions, how do you explain that the goal of 70% vaccination does not raise any discussion when it is for many countries very difficult to achieve?

Why would there be debate? The implementation of these vaccination campaigns has advantages. First by allowing fragile populations to have access to it, but also by offering an always useful strengthening of health systems. Cameroon was thus able to set up a cold chain with the receipt of Pfizer vaccines. This explains why countries do not come into resistance with the WHO and the major donors. At the current rate, the 70% target won’t be met until 2024, but that’s not a major issue.

2024 is a calculation based on the amount of vaccine currently delivered to the continent. The recall campaigns carried out in rich countries risk delaying this deadline …

Those who need two doses or three doses must have them. In France, the United States or Africa. Now, let’s take a serious look at what a 70% target means for a country like Niger, for example. Half of the population is under 15 years old. At what age should you start immunizing to reach 70% of the population? We can see that this target is impossible. Except to include children.

Isn’t the resistance of populations to vaccination a dimension insufficiently taken into account?

It is difficult to convince someone who does not feel their health is threatened to go for a vaccination. This is a fact despite the efforts of communication and awareness. Europeans have faced huge death tolls and have seen their hospitals overcrowded. In Africa, this did not happen. This is another reason that should prompt us to wonder about the need to have the same ambition for all.

Do you fear that this priority given to the fight against Covid-19 will continue to weigh on the management of other more deadly diseases in Africa?

This is an obvious risk: 47,000 additional people have died of malaria due to the imbalance introduced by the coronavirus in health policies. One of the major axes of governments must be to ensure the continuity of health services. The money raised against Covid-19 must also be able to be used for other diseases. However, it must be recognized that these financial trade-offs are made more at the level of major donors than of governments. Rebalancing is necessary.

Africa in 2022

How will the security situation in the Sahel evolve? How far will Chinafrica go? Do we really need to vaccinate 70% of Africans? How to get out of the recession? Does feminism have its place on the continent? Can the school emerge stronger from the crisis?

To turn the page of the past year and project oneself into the one that is beginning, The World Africa publishes a series of interviews on the major debates that animate the continent.

Episode 1 “The need to vaccinate 70% of the African population against Covid-19 deserves debate”

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“The need to vaccinate 70% of the African population against Covid-19 deserves debate”