Africa Watch – Securing the supply

Africa’s top public health agency has agreed a memorandum of understanding with Pfizer to bring supplies of the pharmaceutical firm’s Paxlovid antiviral COVID-19 pills to the continent, its director said on Thursday. Data from a mid-to-late stage study in November showed Paxlovid was nearly 90% effective in preventing hospitalisations and deaths compared to placebo, in adults at high risk of severe illness.

John Nkengasong, head of the Africa Centres for Disease Control and Prevention (CDC), also said it was still talking to Merck about obtaining supplies of its molnupiravir COVID pill and a call was scheduled for this week about that. “For the Pfizer situation, we have the MOU. The memorandum of understanding is with the legal office at the AU (African Union),” said Nkengasong.

The Africa CDC is an AU agency. “Once that is cleared, we will formally make an announcement with Pfizer and provide details,” he told an online media briefing. A World Health Organisation panel last week backed the use of molnupiravir for high-risk patients such as the immuno-compromised, the unvaccinated, older people and those with chronic diseases.

Merck’s pill has been in lower demand than the Pfizer medication because of comparatively low efficacy and potential safety issues for certain groups. South Africa’s government has said it was not planning to buy Merck’s pill for cost reasons, despite the drug gaining approval from the country’s health regulator. Nkengasong said African countries should be using a combination of public health measures, vaccines, testing and the Pfizer and Merck treatments in their efforts to overcome the COVID-19 pandemic this year.

With new variants and sub-variants, multiple local outbreaks and new records being set across the world, coronavirus has clearly come to stay. China is currently implementing regional lockdowns affecting almost forty million people. South Korea reported almost a million new cases on multiple days this week. Japan and parts of Europe are reporting record case numbers while Hong Kong is in the vice grip of its deadliest wave of case fatalities. In contrast to this, Canada, parts of Southeast Asia and much of Western Europe are lifting COVID-19 travel restrictions.

This points to one thing, the coronavirus will not be extinct in the next few years and it is important to properly manage the illness. Although Africa has been the least hit continent, accounting for only 2.7% of confirmed cases and 4% of deaths as a result of the illness, this effort to make the drugs available will go a long way to further prevent deaths, especially among high-risk adults and the immunocompromised.

This is also important as vaccination rates remain low with as many as 83 percent of the population not receiving a single vaccination dose, which means there is still a significant risk of disease spread. While vaccination is the most efficient way of managing the illness, it is important that Africa simultaneously maintains a steady supply of vaccines while securing access to other mechanisms of COVID-19 case management.

There are obvious advantages that a pill has over a vaccine – issues of complex supply chain management such as cold storage, specialised transport and devoting state resources to administrative functions are all but eliminated with deploying pills over the shelf. For African countries saddled with formidable logistical and transport challenges, the convenience that the Pfizer pill provides is very attractive. This is not to say that all bets are off on a vaccination strategy.

The EU’s pledge at the European Union-African Union Summit to provide more support to African countries in fighting the pandemic, and the twin announcements of a global mRNA hub in South Africa and a technology transfer agreement with six other African countries to boost in-continent production means a vaccine-first approach will endure for some time. The pill provides a useful second option. Ultimately, the combination of these efforts should go a long way to more adequately prepare the continent to grapple with any future COVID-19 case surges.