First Covid vaccines arrive in Accra at launch of Covax global rollout

Francis Kasolo, WHO's Ghana representative with UNICEF's Anne-Claire Dufay as first Covid vaccine doses arrive Wednesday in Accra. (Credit: WHO Ghana)

Under cloudy skies, the first precious doses of Covid-19 vaccines to be distributed by the WHO co-sponsored Covax global facility touched down in Accra, Ghana on Wednesday morning.

The arrival of some 600,000 doses at Accra’s Kotoka International Airport marks a milestone in nearly a year-long effort by WHO, UNICEF, Gavi and other partners to ensure that scarce and often pricey Covid-19 vaccines are distributed more equitably.

“This day is the culmination of many months of planning, research, negotiation & coordination,” tweeted WHO director general Tedros Adhanom Ghebreyesus, who co-launched Covax initiative nearly a year ago. “But it's just the beginning. We still have a lot of work to do to realise our shared vision for [#VaccineEquity] by starting vaccination in all countries within the first 100 days of the year.”

His words came just as the first palettes of Oxford/AstraZeneca vaccine doses, manufactured by India’s Serum Institute, were being unloaded on the Accra airport runway.

Ghana was selected as the first African recipient of vaccines after demonstrating that its health-care teams and cold chain equipment would be poised for quick vaccine distribution.

WHO’s Ghana office, known for its efficiency and close collaborations with the Ghana Health Service, was also regarded as a reliable flag bearer for the ambitious initiative’s kick-off, WHO insiders say.

“This is a momentous occasion,”  declared WHO’s representative in Ghana Francis Kasolo in a joint statement with UNICEF’s representative, Anne-Claire Dufay. “This is an unprecedented global effort to make sure all citizens have access to vaccines.”

“After a year of disruptions due to the Covid-19 pandemic, with more than 80,700 Ghanaians getting infected with the virus and over 580 lost lives, the path to recovery for the people of Ghana can finally begin, as the arrival of the Covid-19 vaccines into Ghana is critical in bringing the pandemic to an end.”

Ghana has a population of over 31 million. The goal is to vaccinate 20 million people - two thirds of the population - beginning next week, Kwame Amponsa-Akyianu, Ghana programme manager for immunisation, told reporters on Sunday.

The initial vaccine shipments will first be used to vaccinate frontline healthcare workers, adults over the age of 60, and people with underlying health conditions, according to WHO and Ghanaian health authorities.

Africa CDC also welcomes deliveries. John Nkengasong, director of Africa Centres for Disease Control and Prevention (Africa CDC), sounded a similar note. "These first deliveries of Covid-19 vaccines through Covax are a critical moment in Africa's fight against the virus,” he said.

Nkengasong described the first deliveries as  “an important step towards our continental goal of immunising at least 60 per cent of Africa's population with safe and efficacious vaccines against Covid-19."

The African Union (AU) has been trying to help its 55 member states buy more doses in a push to immunise 60 per cent of the continent’s 1.3 billion people against Covid-19. To that end, it has so far secured some 670 million doses of the AstraZeneca, Pfizer and Johnson & Johnson vaccines - in addition to promised 90 million doses from Covax this year.

Russia also has offered to supply 300 million doses of its Sputnik V vaccine to the AU scheme, along with a financing package for the vaccine - which showed 91 per cent efficacy in the Lancet publication of results recently. China also has donated small batches of its Sinopharm vaccine to countries including Zimbabwe and Equatorial Guinea - although the vaccine has not yet undergone independent review.

“So far, 210 million doses of vaccine have been administered globally, but half of those are in just two countries,” said Tedros on Tuesday in Geneva. The WHO chief has repeatedly cried out against vaccine hoarding and so-called ‘'vaccine nationalism”. According to a recent report, high-income nations have snapped up a total of one billion more vaccines than they need for their populations.

Africa’s reported Covid-19 death toll surpassed 100,000 last week, a fraction of those on other continents but rising fast as a second wave of infections overwhelms hospitals.

The South African variant - a risk for Ghana vaccine drive? Against the jubilation over the AstraZeneca vaccines’ arrival, there are lingering questions about how well it will work on the ground. Ghana is among the eight African countries that have confirmed cases of the B.1351 variant that first emerged in South Africa, and which is proving to be more resistant to vaccines generally.

In a small South African trial, experts recently found that the AstraZeneca vaccine had virtually no efficacy in reducing mild or moderate Covid cases among people infected with that virus strain - leading health authorities in Pretoria to cancel the vaccine’s rollout and switch to an alternative vaccine developed by Johnson & Johnson - which had shown efficacy against the variant in Phase 3 trials.

On 10 February, WHO said it recommended AstraZeneca’s use - even in African countries reporting the variant. WHO scientists contended that the AstraZeneca vaccine is still likely to reduce incidence of severe Covid cases among people stricken with the B-1351 strain - despite the poor showing in preventing mild or moderate cases.

But only a day later, on 11 February, the African Union issued slightly different guidance, stating that countries where the B.1351 variant is “dominant” would best shift gears to another vaccine.

Against these ongoing uncertainties, experts will be closely eyeing Ghana’s AstraZeneca rollout to see how the vaccine performs both overall, and against variants there.

Africa interest in Johnson & Johnson vaccine now pending FDA approval. The arrival of the AstraZeneca vaccine batches in Ghana also coincides with big news of a likely US Food and Drug Administration (FDA) emergency approval of the Johnson & Johnson vaccine as early as Friday following today’s positive FDA expert panel review of Phase 3 trial results for the novel one-shot vaccine.

Those Phase 3 trial results also included a South African arm, where the Johnson & Johnson vaccine held up well, albeit with slightly reduced efficacy as compared to trials in the US and other countries that aren’t facing the B-1351 variant.

The FDA review found that the Johnson & Johnson vaccine had a 66 per cent average efficacy in preventing moderate and severe disease in Phase 3 trials involving some 44,000 people from the US, South Africa and Latin America.

The Johnson & Johnson vaccine was still 64 per cent efficacious in preventing moderate and severe disease in the South African trial arm. More improtant, the vaccine was 85% in preventing severe disease - 82% in the South African arm of the trial. While that is not as good as the 90 per cent or better showings for more high-tech mRNA vaccines by Pfizer and Moderna, it still exceeds WHO and FDA benchmarks for efficacy.

The Johnson & Johnson vaccine also has the advantage of being a one-shot vaccine, which can be stored at refrigerator temperatures rather than deep freeze. And those factors would significantly help rollout in countries with less cold storage capacity and where access to health facilities is more difficult.

AstraZeneca dominates Covax facility vaccine portfolio, although a recent 1 billion commitment by Novavax will add diversity. (Source: Covax Global Supply Forecast, January 20 2021, Gavi)

The FDA Johnson & Johnson approval will pave the way for a WHO green light to Covax to begin rolling out the vaccine - as soon as commercial supplies are available.

The question is whether that may also lead to more pressures on Covax from African countries - to swap out AstraZeneca for Johnson & Johnson doses.

In addition to deals with the AU, Johnson & Johnson has already committed to provide 500 million doses of its vaccine through the global Covax facility. However, with some 720 million doses committed, the AstraZeneca vaccine still comprises the lion’s share of the Covax global vaccine facility’s portfolio.

The bottom line is that while the jury is still out on AstraZeneca’s performance against the B-1351 variant, the Johnson & Johnson trial data already shows clear efficacy in preventing serious disease in an African setting, where other vaccines have not been widely tested or tried.

So even as the Covax rollout takes off finally, WHO and its partners in Covax will face a whole new set of challenges in a constantly evolving landscape of science, big pharma deals and geopolitics.