John Nkengasong on Africa's Vaccine Game Plan

John Nkengasong is the Director of the Africa Centers for Disease Control and Prevention. He is also the WHO special envoy for Africa. John spoke to CovidHQAfrica desk about a range of issues including his vision for the vaccines in Africa, and his greatest worry.

Africa is in a second wave of the virus, what should we be doing?

Avoid gatherings, and do face masking as much as possible. I think if we do all of those things then increase our testing and then we at least have the public health measures in place.  Second is to be aggressive with the vaccine. There is no way we are going to completely eliminate this without vaccination to achieve health immunity which targets 60% of the population. The third thing we need to do is to put in measures for care. That is essentially dramatically increasing oxygen. We need availability of oxygen because a lot of the mortality that we are seeing is because of the lack of very basic needs like lack of oxygen.

Why has the variant hit South Africa so hard and not the rest of us. Is it a matter of time?

I think the variant has hit South Africa hard because they are sequencing in a very systematic way. The hypothesis and assumption is that you already have this variant all over the continent. It is just that it is not being sequenced. Like now we know that we have the same variant in Botswana and Zambia and I am sure, if it is sequenced, in Namibia, Zimbabwe, Swaziland too. You will see the variant across the continent. So, it is just because South Africa has the tools and has a stronger sequencing system there. The same measures for the new variant apply: wear your mask, wash your hands, and sanitise. That will get rid of the variant.

What is your vision for the vaccination plan in Africa. How do you go about vaccinating 60% of a billion people?

I am happy you start with a 60%, that is a target and that is a target we believe will allow us to achieve community immunity or heard immunity. I think that is very important and the thing is that we truly don't have a choice. We have to get ourselves into a mode where we use all means possible to get to that target in a very short period of time. So, it is not a choice of whether we do it or not. We have to do it and do it at scale. Now, What we need to do to get there is that we need to use a phased approach. If you look at the epidemiology of a pandemic a lot of infections are of course in a major city, that is where you start. You start with setting up vaccination centers which of course are tied to the health centre around them, say for example in Nairobi, It is very possible that if you can put 20 vaccination centers, which means 4 things you have to put in place.

One,  if you have a minus 70 refrigerator, back that up with a generator so that your vaccine does not suffer any shock when electricity goes off.  Two, train your health care workers.  I mean a lot of them so that doctors, nurses are all trained to deliver that shot. Three, create a register to track people, because remember all the vaccines that we have for now require that you vaccinate and then you come back after three to four weeks. So, you really need a close follow up. Four, the community.  Make sure that you intensify community vaccine literacy which means that the radio, the media, social media are all engaged in explaining to the population why they must return to complete their second dose. Otherwise your loss that will follow out will be significant and your vaccine program will fail. Do this for a few months, then other companies will come with their own vaccines that require normal cold chains like two to four degrees to eight degrees and we can begin to use that to expand that into more and more areas of the country. So, Let's not make this look like it is some rocket science, no. We have rolled out anti-retroviral therapy across Africa massively. We know how all these things work is just a question of devoting and applying ourselves to it.

What worries you the most?

What worries me most is that the continent doesn't get its vaccination program in a timely fashion. That means we have to pursue an aggressive process not a passive process. If we are passive, our economies will continue to be shattered, the death toll would increase significantly and virus may become more widespread in Africa. Lastly I would not be surprised that by the end of the year or in the middle of the year when Europe and the United States have finished their vaccination, they would issue a requirement that you will have to have a covid vaccine certificate to fly. That would become a tough thing for the continent of 1.3 billion people to move around. The second thing is the lack of availability of oxygen on the continent. As you get more cases, more people are sick and they are going to the hospitals to seek care and overwhelming the hospitals. It would help if oxygen was available, and you can actually divert traffic from the hospitals to the local health centre. Availability of oxygen to manage mild to severe cases is very important as access to vaccines in a timely fashion is critical. I think those are the two things that will begin to change as we manage the second wave of the pandemic.