This week, Ghana will begin the implementation of its ambitious plan to achieve herd immunity of its populace against COVID 19 by vaccinating some 17.6 million Ghanaians by the middle of this year, this translating to the requisite 60 percent of the population, the minimum threshold needed to stop the communal spread of the global pandemic across the country.
The commencement of what promises to be the most complex and challenging nationwide logistical exercise ever embarked on by the Ghanaian state has been made possible by the delivery, on Wednesday last week, of 600,000 AstraZeneca doses of the vaccine made by the Serum Institute of India and delivered by Unicef to Accra’s Kotoka International Airport. The delivery was made under the auspices of the COVAX initiative put together by the World Health Organization.
Ghana is the first country to receive vaccines under the global COVAX initiative.
COVAX is one of three pillars of the Access to COVID-19 Tools (ACT) Accelerator, which was launched in April by the World Health Organization (WHO), the European Commission and France in response to this pandemic. It brings together governments, global health organisations, manufacturers, scientists, private sector, civil society and philanthropy, with the aim of providing innovative and equitable access to COVID-19 diagnostics, treatments and vaccines; its objective being to ensure that people in all corners of the world will get access to COVID-19 vaccines once they are available, regardless of their wealth.
It is being coordinated by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the WHO. COVAX will achieve this by acting as a platform that will support the research, development, and manufacturing of a wide range of COVID-19 vaccine candidates, and negotiate their pricing. All participating countries, regardless of income levels, will have equal access to these vaccines once they are developed. The initial aim is to have two billion doses available by the end of 2021, which should be enough to protect high risk and vulnerable people, as well as frontline healthcare workers.
Ghana is among 92 countries to have signed up to the programme, Some of them are relatively well off countries who are paying for their doses – signing up to the programme is simply a way of ensuring they get the medicines in the absence of sufficient direct bilateral deals with vaccine manufacturers. But most of the member countries of the initiative are relatively low-income countries such as Ghana who are receiving vaccines on concessionary basis, funded by international donor governments institutions and corporations. This is key for Ghana’ efforts as the cash strapped government will be providing its citizens with vaccines for free.
Ghana’s vaccination campaign will begin on March 2 and will be conducted in phases among prioritized groups, beginning with, among others, health workers, adults over 60 and people with underlying health conditions.
The country has recorded 81,245 cases and 584 deaths since the beginning of the pandemic, according to figures from Ghana health officials.
However a number of external factors still have to overcome in order to secure the doses it needs to reach its mid-year target.
Unlike developed nations, countries like Ghana have limited bargaining power to negotiate directly with manufacturers. As a result, it is principally relying on two multilateral initiatives to procure COVID-19 vaccines – the COVAX facility and the African Vaccine Acquisition Task Team. Combined, they have secured 1.27 billion vaccine doses for African nations.
While Ghana has shown its astuteness and determination by securing the enviable position of being the very first country to benefit from the COVAX global initiative, as with the other participating low- and middle-income countries it will only receive enough vaccines to cover a maximum of 20% of its population.
Ghana expects to take delivery of up to 968,000 doses of the Oxford-WAstraZeneca vaccine by the end of March 2021 as part of an initial batch from COVAX. These first doses have been earmarked for the nation’s health care workforce of about 108,000.
COVAX aims to deliver the remainder of this initial tranche of 2.4 million doses by June 2021. This should be enough to protect about 1.2 million Ghanaians with the two-jab Oxford-AstraZeneca vaccine. But reaching President Nana Akufo-Addo’s target will require about four times that amount.
This means that Ghana will have to lean heavily on vaccine supplies from the African Vaccine Acquisition Task Team – an initiative being driven by the African Union. It aims to bridge the gap between the 20% population coverage promised by COVAX to participating African countries and the 60% coverage they need to attain herd immunity.
The African Export-Import Bank and the World Bank are supporting the strategy with about US$7 billion in cash advancements to vaccine manufacturers on behalf of AU member states. The African Vaccine Acquisition Task Team has so far secured 270 million doses of the Pfizer, Oxford-AstraZeneca and Johnson & Johnson vaccines. Deliveries are scheduled to begin later this month.
In early February the director of the Africa Centers for Disease Control announced that 16 African nations had applied to the task team for vaccine supplies totalling 114 million doses. While the final allocations are yet to be published, Zambia, Kenya and Nigeria are set to receive 42.7 million.
It is not yet known if Ghana is one of the remaining 13 although it likely is – nor how many doses it intends to order from the African Vaccine Acquisition Task Team.
Ghana’s Presidential Advisor on Health, Anthony Nsiah-Asare, recently hinted that the country was also procuring vaccines through bilateral deals with some of its development partners. But these supplies are likely to be a negligible fraction of the 15.2 million additional doses required to meet the June target.
This means that Ghana’s supplies from the African Union initiative are likely to determine the nation’s ability to reach its mid-year goal of 17.6 million doses.
But getting the requisite number of doses is only half of the impending challenge. The other half comprises, in part, putting an efficient and effective distribution system in place – which is made all the more problematic because most of the vaccines being developed and approved so far require storage at close to freezing temperatures, meaning that a nation-wide cold chain is needed – and in part convincing Ghanaians to take the vaccines as they become available.
Firstly Ghana needs a storage and distribution plan that prioritizes speed and minimizes waste; the vaccines that need to be kept cold lose their efficacy and thus become useless when the temperature at which they are kept rises beyond a certain level. Public health authorities have assured Ghanaians that a comprehensive plan exists – although it has not yet been made public – to make use of the country’s existing cold chain infrastructure for vaccine distribution.
But there is indeed cause for hope. Enthuses Nana Quakye, a research fellow at the New York University: “This infrastructure supports Ghana’s enviable record in immunization coverage that has helped reduce infant mortality and the incidence of vaccine-preventable diseases such as measles. In 2019, immunization coverage for essential vaccines was in excess of 90 percent. Ghana has not recorded a single death from measles since 2003. In addition, it was certified as having eliminated maternal and neonatal tetanus in 2011.”
But his positivity comes with a warning: “There are gaps. Ghana’s current cold storage facilities lack the capacity to house vaccines like those manufactured by Pfizer and Moderna because of the arctic temperatures required to store them. Both use a technology known as mRNA.
“This limits the COVID-19 vaccine options available to Ghana. It also matters because these vaccines can be adapted to target new SARS-CoV-2 variants relatively quickly compared with other vaccine technologies. Having access to them could therefore determine how fast nations are able to respond to the emergence of new variants.”
Even after getting through this and delivering the vaccines where they are needed, convincing the targeted Ghanaians will be yet another challenge.
Here Ghana faces a potentially bigger stumbling block: public sceptism about COVID-19 vaccines.
“Anxieties and uncertainties about their safety underlies considerable hesitancy in Ghana towards the COVID-19 vaccines” asserts Nana Quakye. “The proliferation of fake news and misinformation on social media and in certain quarters of the popular press are fanning those embers.
“To meet this challenge public health authorities will have to be laser-focused on identifying and addressing both legitimate apprehensions and conspiracy theories. They will also have to be proactive in monitoring digital platforms because of the dynamic and viral nature of vaccine misinformation.”
“It will also be important to measure progress towards public acceptance of the vaccines” he adds. “One route would be to conduct a series of public surveys to assess the evolving landscape of knowledge and attitudes. This would enable the government to identify specific misinformation that allows for more focused communication about vaccine safety and efficacy.”
Much of that will also depend on media coverage. It is therefore crucial to engage the media on its role in combating misinformation.
To be sure, this problem is not peculiar to Ghana. Indeed similar misinformation in America has added to the widespread reticence in Ghana. The American media has made a meal out of reporting the draw backs – both real and imagined – of taking the vaccine. The inevitable side effects of the vaccine have often been blown out of proportion and even more damaging has been a false correlation drawn up between taking the vaccine and dying thereafter. This supposed correlation however ignores what should be obvious, if not that it gets in the way of the sensationalist reporting that is the bread and butter of many an unambitious – but unprofessional – journalist: that because most of the first wave of vaccines have been administered to the elderly and to people who already have health challenges, these being the most susceptible to COVID 19 fatalities, the incidence of death among these groups is already fundamentally higher than among the general populace as a whole.
In the case of COVID-19 vaccines, all data suggest both the Moderna and Pfizer-BioNTech vaccines are safe — despite the 1,170 reports of post-vaccine deaths across the United States from December 14 to February 7, says Lynn Sutfin, a spokesperson for the Michigan state health department.
“These vaccines have undergone the most intensive safety monitoring in U.S. history,” Sutfin says.
Dr. David Gorski, a professor of surgery at Wayne State University School of Medicine who has written extensively on vaccine safety as managing editor of Science –Based Medicine explains why some deaths following COVID-19 shots are to be expected.
“When you roll out a mass vaccination program on this scale, which is pretty much unprecedented now, by the law of large numbers there are going to be quite a few reports of people who die or have something bad happen to them after getting vaccinated just by random chance alone,” Gorski says.
“And it takes careful investigation and epidemiology — basic science — to determine if there is a safety signal or if there is an actual adverse event, or if this adverse event is happening at a higher rate than we would expect, than the baseline rate. … The baseline death rate of 90-year-olds is high because they’re 90 years old.”
Deaths among the more than 55 million Americans who have already gotten at least one dose of the vaccines are not higher than deaths among the general population, says Dr. Arnold Monto, a professor of epidemiology and global public health at the University of Michigan.
“Sudden death has not been reported as a consequence” of COVID-19 vaccines, he says.
Instructively, among the 27 Michiganders who have died after getting a jab in the arm, the average age was 78. The majority had underlying health conditions such as diabetes, cancer, heart or lung disease, Alzheimer’s disease and even COVID-19. Most of those who died were residents of long-term care facilities; some were in hospice care, a Free Press analysis of the data shows.
“When you’re vaccinating an older population, this is always going to happen,” says Monto, who chaired the FDA committee that recommended emergency use authorization for both of the COVID-19 vaccines now available in the U.S. “The way we look at this is to compare frequencies in the vaccinated with those who were not vaccinated and see whether there’s excess. So individual reports should raise concerns if they are repeated and if they are in excess of what you would expect.
“The purpose of all this reporting is to look for red flags to follow up.”
Severe allergic reactions have been observed in only about five people per 1 million doses of the Pfizer vaccine, with nearly three-quarters of those anaphylactic reactions occurring within 15 minutes of getting a shot, according to the Centre for Disease Control. For the Moderna vaccine, severe allergic reactions occurred in 2.8 people per 1 million doses.
These are very low odds but since the danger exists at all, doctors recommend that patients should be screened for allergies prior to getting an immunization and asked to wait at least 15 minutes following an injection to be sure there’s no allergic reaction. Those who administer shots should have emergency medicine such as epinephrine on hand to treat severe reactions.
With all these challenges, the national vaccination effort that begins this week will inevitably be fraught with problems. However, the fact that Ghana is the very first country to receive vaccines under the COVAX initiative, ahead of 97 others indicates the seriousness with which government is going about its task. If other stakeholders – the medical community, the cold chain transportation and storage industry, the media, and the general populace itself – live up to their responsibilities, Ghana stands the chance of eventually being upheld as an African model for nationwide COVID 10 vaccination, just as it has been applauded as exemplary in its handling of the initial outbreak of the global pandemic last year.