Financial Mirror (Cyprus)

Has US damaged Africa’s COVID vaccinatio­n drive?

- By Ebere Okereke Ebere Okereke, Senior Technical Adviser at the Tony Blair Institute for Global Change, is an honorary senior public health adviser at the Africa Centers for Disease Control and Prevention and an associate fellow at Chatham House.

The United States Food and Drug Administra­tion’s recent decision to limit the use of the Johnson & Johnson COVID19 vaccine to adults who cannot or will not get another vaccine will have profound consequenc­es for African countries. The FDA said its move reflected the risk that the vaccine might cause a rare blood-clotting syndrome.

But the decision shows that, even after two years of the pandemic, the needs of people in low- and middle-income countries, and Africans in particular, remain an afterthoug­ht for leading global health authoritie­s.

The FDA’s restrictio­n is not based on new evidence, but rather reflects an abundance of caution in a country with a relatively high COVID-19 vaccinatio­n rate and widely available alternativ­e vaccines. The US has vaccinated more than 65% of its population against COVID-19, predominan­tly with Pfizer and Moderna vaccines. Only 8% have received the J&J vaccine. So, the FDA’s decision will have little material impact in America.

In Africa, on the other hand, the J&J vaccine is widely used. According to analysis from the Tony Blair Institute for Global Change, 42 million J&J doses have been administer­ed in African countries so far.

The fact that it requires only a single shot makes it wellsuited to the logistical and capacity constraint­s of many poorer countries, and it is the vaccine of choice across much of the continent.

Moreover, data from South Africa, where more than 8.5 million doses of the J&J vaccine have been administer­ed – including through the Sisonke study, a vaccine trial involving health-care workers – indicate that the FDA’s extreme caution is unwarrante­d.

And in countries where COVID-19 vaccinatio­n options are more limited, increasing conjecture about the J&J vaccine will significan­tly exacerbate the challenge of immunizing the population.

The FDA’s decision risks triggering a widespread loss of confidence in the J&J vaccine, causing demand to plummet and irreparabl­y reducing the reach of a safe, effective, and widely available means of protection against COVID-19. This will have major implicatio­ns for African countries’ ongoing efforts to stimulate vaccine demand and safeguard their population­s.

The Tony Blair Institute for Global Change estimates that African countries have about 135 million J&J vaccines in stock, approximat­ely 25% of which are donated doses from the US. Vaccine donations are welcome, of course, and African government­s are committed to turning doses into vaccinatio­ns.

But when the donor country deems those vaccines too dangerous for its own population, Africans will resounding­ly refuse to accept them.

Shockwaves from the FDA’s decision will also extend to domestic manufactur­ing of vaccines in Africa. A leading South Africa-based pharmaceut­ical firm, Aspen Pharmacare, is the first African manufactur­er to package, sell, and distribute the J&J COVID-19 vaccine under its own brand. The US advocated for the deal, and J&J had agreed potentiall­y to expand it to cover more advanced versions of the vaccine such as variant-specific shots.

The FDA decision will undermine many of the concrete steps taken by the US and African countries to bolster the continent’s health and vaccine security. It will also affect the ongoing negotiatio­ns between the Africa Centers for Disease Control and Prevention, Aspen Pharmacare, and the COVID19 Vaccine Global Access (COVAX) facility regarding a possible deal to procure and distribute the South African J&J vaccine.


It is particular­ly troubling that the FDA made its announceme­nt without considerin­g the implicatio­ns for other jurisdicti­ons or giving them advance notice so that they could respond appropriat­ely.

Although the South African Health Products Regulatory Authority released a statement reassuring the public of the vaccine’s safety and effectiven­ess, a decision with regional implicatio­ns requires a regional approach. Had the Africa CDC known in advance of the FDA’s decision, it could have addressed anticipate­d concerns across the continent.

Looking ahead, the recently establishe­d African Medicines Agency could take such regional actions. A well-functionin­g AMA, working alongside the Africa CDC, will improve the continent’s capacity to provide speedy evidence-based responses to regulatory decisions elsewhere.

Finally, this episode is symptomati­c of a wider problem in the Global North, where leaders and policymake­rs consistent­ly fail to consider others’ perspectiv­es and to recognize that their actions have wide-reaching effects beyond their own borders.

Africans are global citizens and obtain their informatio­n from the same media sources as Europeans and North Americans. They are thus influenced by messages that may not be relevant to their context. In 2021, for example, some European Union countries’ suspension of the OxfordAstr­aZeneca COVID-19 vaccine hit demand in Africa, likely costing thousands of lives.

The expertise of stringent regulatory bodies such as the FDA, the UK Medicines & Healthcare Products Regulatory Agency, and the European Medicines Agency is globally recognized and respected. These institutio­ns must therefore consider the wider and unintended consequenc­es of their decisions, particular­ly amid a global pandemic.

The FDA’s recent tightening of restrictio­ns on the J&J COVID-19 vaccine is not the first time that a health-related announceme­nt by the US or other authority in the Global North has had far-reaching consequenc­es for Africa, and it will not be the last.

To manage COVID-19 and future pandemics effectivel­y, policymake­rs must collaborat­e now to reduce the frequency and mitigate the impact of such decisions.

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