The challenges and successes of vaccinology in Africa
- FHS Communications
Vaccines can prevent serious illness, disability, and death from diseases such as measles, polio, pneumococcal disease and rotavirus. On the African continent, an increase in vaccine coverage has reduced infant mortality by half and, according to the World Health Organization (WHO), saves 800 000 lives every year.
Appearing on the Sabin Institute podcast “Getting to Zero”, hosted by Dr Nginache Nampota-Nkomba, recipient of the 2021 Sabin Rising Stasssr award, Professor Shabir Madhi discussed the successes and challenges in vaccinology on the African continent and future opportunities.
Prof Madhi, Dean of the Faculty of Health Sciences and Director of the Vaccines and Infectious Disease Analytics (Wits VIDA), said, “I think we have very much of a success story over the past decade or so when it comes to confidence around vaccines and [their] uptake.”
Despite these accomplishments, he noted multiple challenges that vary by country, including vaccine stock-outs, limited access to basic health facilities, and migration and civil unrest. He says the COVID-19 pandemic highlighted Africa’s dependency on external vaccine procurement.
To ensure access to existing and new vaccines, Prof Madhi said, “For us to make that leap, it requires African governments to take greater ownership of the immunisation programs. But in addition to that, governments need to become much more involved in the actual procurement of vaccines. We do recognise that there are resource constraints across many African countries, and there’s a need for prioritisation.”
Return on vaccine investment
Prof Madhi highlighted that vaccination is one of the most cost-effective health interventions that contributes to lifelong health in a population. “When you're investing a dollar, [their] return to economies to $20.00. From a financial perspective, it's a no-brainer that governments need to invest in ensuring a healthy population, which leads to healthy children, and which leads to productive individuals later in life. So for me, one of the big issues is government needs to take on greater responsibility.”
In addition to vaccine hesitance among some parents in Africa, he also emphasised that limited access to vaccines is a barrier: “Access speaks to having a robust procurement system as well as a proper primary health care system where children can be vaccinated.”
To address this, access to vaccines should be part of the long-term vision for the development of societies - not a short-term political view. He urged the need for engagement between the scientific community and politicians to convey the public health and economic benefits of vaccination programmes. Further engagement of scientists with community advocates is crucial for holding government accountable, “[They] become the voice that is required to ensure that government pays due attention to ensure that life-saving vaccines are made available as quickly as possible,” said Prof Madhi.
Vaccine research excellence in Africa
Describing academic institutions across Africa as “pockets of excellence”, he emphasised the need for governments to consciously support research and development at these institutions by allocating funding for researchers, be it for vaccinology or research in general.
The research capacity for TB, HIV, malaria, Ebola and other pneumococcus vaccines has advanced, leading to what Prof Madhi describes as an “exponential explosion of researchers” making their mark in vaccinology in Africa. He encouraged African scientists to “own the research agenda” and ensure that the research conducted is relevant and addresses the priorities of their context.
“During the course of the COVID-19 pandemic, we have really seen African researchers take leadership roles in the research that's been done in the field of vaccinology on the African continent, which, for me, [is] extremely promising in terms of the future outlook,” said Prof Madhi.
Pandemic preparedness
Lessons from the COVID-19 pandemic, a crucial period for the field of vaccinology, were also discussed. Over the past two decades, scientists have been involved in vaccine research on various diseases (such as respiratory viruses and HIV) across the continent. This experience and expertise, combined with their participation in collaborative research networks, enabled them to address the crisis. For example, Wits VIDA conducted clinical trials in South Africa for two COVID-19 vaccines.
In reflecting on the pandemic, Prof Madhi shared the important lessons learnt from it “…had we not done the studies on the African continent, we would not have been able to make informed decisions as to how to use the vaccines on the African continent, where the epidemiology did differ compared to in high-income countries.”
Building vaccine capacity is a shared responsibility
When asked about the continent's priorities and future opportunities in vaccinology, he highlighted the need to first address the existing “major gaps” in basic research, vaccine development, and vaccine manufacturing. While “seedlings have been sown” for the local manufacturing of vaccines across the continent, the way forward requires increased investment in the people involved across the entire vaccinology value chain. “We cannot afford to go into another pandemic and not have vaccine manufacturing capacity available on the continent, in multiple countries.”
Of equal importance, says Prof Madhi, is the implementation science of vaccination. “Vaccines don't work unless you get them into the arms of children. We have to figure out how to do the necessary community engagement. We need to figure out where we’re coming short in terms of ensuring that we get our vaccine coverage above 90%, 95%, which is achievable,” he explains.
Prof Madhi concluded by reiterating the call for collaboration, saying, “We need the scientists to work together with the government, with the politicians, in partnership with a common vision that what we're trying to achieve is we’re trying to improve life, trying to save lives. And the only way we can do that is to ensure that you get vaccines into the arms of children.”
Watch the full discussion here.