African difficulties in the pandemic go beyond vaccination, says CRIS/Fiocruz researcher

Difficulties faced by African countries regarding COVID-19 are not limited to vaccines. Resources are also needed for the logistics of an immunization campaign, which involves cold rooms and even power generators, explains Augusto Paulo Silva, researcher of the Fiocruz Global Health Center (CRIS/Fiocruz) for African Issues and for cooperation between Africa & Community of Portuguese Language Countries (CPLP in the Portuguese acronym).

“Many countries were forced to return vaccines because they were not able to apply them, due to the lack of funding for vaccination campaigns”, explains Augusto Paulo, who was vice-minister of Health of Guinea-Bissau between 2009 and 2012.

When talking about policies for the region, where only 1.2% of the population (about 15 million people) was vaccinated so far, CRIS researcher also points out the need to launch another view on the region: it is crucial to be able to see the many Africas that exist and not to generalize a continent with 55 countries.

FNA: African countries have been facing difficulties in obtaining help to vaccinate their populations. How does one solve this problem?

Silva: When you think of West Africa, you have 15 countries. Eastern and Southern Africa combined have 21 nations. There is Central Africa. And all over the continent, there are regional and sub-regional organizations. In the imagination of Brazilians, Africa is one single thing. So we need to determine which Africa we will be talking about. The pandemic has different versions within the continent too. Most cases of COVID-19 in the continent are concentrated in six countries. South Africa, Northern African countries - Tunisia, Morocco, Algeria, Egypt - and Ethiopia concentrate more than 80% of all COVID-19 cases, but there are cases reported in Uganda as well. The third wave is beginning, the stain is spreading, and we have no idea where this is going to end. The only way out is to speed up vaccination.

FNA: There is an initiative by the African Union (AU) to obtain vaccines...

Silva: Long before the pandemic, the African Union created CDC Africa (Center for Disease and Control) because it understood, based on the continent’s Ebola experience, a specialized health agency is necessary. WHO Afro (the World Health Organization’s Regional Office for Africa) covers 47 member-states. Maghreb African countries belong to yet another WHO region, the Mediterranean region. So, when you talk about Algeria, Tunisia, Morocco and Egypt, you are talking about one Africa. North Sudan is another Africa. The African Union covers all 55 countries. So does the CDC.

But going back to vaccines, the African Union also adhered to Covax [WHO initiative to obtain COVID-19 vaccines]. But long before Europeans began donating vaccines to Covax, they donated money. That money was never enough, although. China and India were relied on to supply Covax with vaccines. But India saw an explosion in the number of cases, their vaccines were no longer sufficient in number, and Covax went dry for some time.

The AU stepped in with this plan of 400 million doses as a supplement in case Covax failed. But countries will not be receiving those additional doses free of cost. For instance, the African Union used their development banks as bail to guarantee payment. And the World Bank is providing money to the countries so they can purchase these vaccines. But most of the countries are in debt and have their budgetary controls already limited by the World Bank due to structural adjustment programs.

Also, the vaccination issue is much more complex. Every immunization program is backed up by huge logistics issues. These logistics have costs. This is why many of these 55 countries had to return vaccines: they were not able to apply them due to insufficient money to fund their vaccination campaigns. They need cold rooms, power generators. And considering how States are in debt, there is no way they can fund this. These are structural problems that come from way back and were simply made worse by the pandemic. This is why vaccination is proceeding very slowly in Africa: not only because of a lack of vaccines, but also because of the entire infrastructure and logistics chain. Not even 2% of African people have been vaccinated. It is not easy to vaccinate a continent with 1.2 billion inhabitants.

FNA: Do you know of any initiatives that can improve this scenario?

Silva: There is no third option. The first one is Covax. The second is the AU initiative. There are also richer countries, such as South Africa, Morocco, Algeria, which have purchased more doses. It is therefore impossible to generalize.

FNA: There is much talk about South-South cooperation, but how does it work at a moment in which Global South countries are also facing problems to obtain vaccines?

Silva: When it comes to African countries, South-South cooperation works a lot better with China. When the pandemic started, it was only thanks to China that many countries received pharmaceutical ingredients, through the African Union. They rely on China and Cuba, countries with a previous tradition [of cooperation in Africa]. Take the example of my country, Guinea-Bissau: Cuba is there not only with doctors, but also at medical schools, teaching. South-South cooperation in this pandemic is tiny. Brazil was an important actor years ago, and it is doing its part, but it is still too little.

FNA: How about Fiocruz, which has always worked with Portuguese-speaking countries in Africa?

Silva: As an agent of the Ministry of Health, Fiocruz always cooperates in ordinary times. But when a pandemic hit, Fiocruz does not specialize in humanitarian aid. There has been exchanging of information, specialized webinars. Fiocruz could only work as the USA’s CDC if it received a mandate from the Brazilian Government to do that.

Mozambique is the country in which Fiocruz is most present. Fiocruz has trained many people. Even today, Cristiani [Vieira Machado, vice-president of Education, Information and Communication] said that in 10 years, ENSP (Sergio Arouca National School of Public Health) has assembled courses in Mozambique and has made more than 80 masters in public health. Cooperation takes place mostly in teaching, in research, in the networking between schools, institutes...

Just now a large project is being started in Angola with the ABC [Brazilian Cooperation Agency], on maternal mortality. It involves Fiocruz as an execution agency, by means of the Fernandes Figueira Institute (IFF), the ABC, the United Nations Fund for Population Aid [UNFPA], and the National Direction of Public Health, of the Angolan Ministry of Health. It is now in an advanced phase and the agreement is expected to be signed before the year is over. Fiocruz works within UNFPA as an international center for reproductive health, including maternal mortality, to cooperate with all African countries. Angola is like a pilot project.