by Bertha Serwa Ayi, M.D., FACP, FIDSA, MBA
With eyes tightly shut in anticipation of his injection, Dr. Frederick Kwarteng, Head of Department of the Orthopedics, Accident and Emergency at the Korlebu Teaching Hospital in Accra, Ghana became one of the first medical doctors in Africa to receive the first dose of COVISHIELD.
Ghana became the first country to receive its shipment of the AztraZeneca vaccine manufactured under the auspices of The Serum institute in India at a cost of about $3.2 per dose from India, under the COVAX facility on Feb. 24, 2021. The shipment of 600,000 doses launched Phase 1 of the country’s vaccination campaign from March 2 to 8, 2021.
The country’s President Nana Addo Dankwa Akufo-Addo was the first to receive the vaccine in the nation on March 1, 2021 together with his family.
These events are occurring nearly a year after the country announced its first confirmed COVID-19 diagnosis on March 12, 2020. In the months that followed, daily cases averaged 80 a day.
In June 2020 with no vaccine in sight the African Union and its Africa Centers for Disease Control organized a two-day vaccine conference to assess Africa’s capacity and readiness for vaccine production and how it can gain access to COVID-19 vaccines. The summit concluded that financial responsibility of starting vaccine production in the midst of a pandemic will be a stumbling block. They turned to the World Health Organization and partners’ initiative The Access to COVID-19 tools accelerator which had committed to help low income countries gain access to vaccines when they become available. The ACT Accelerator is a global collaboration to accelerate the development, production and equitable access to COVID-19 tests, treatments, and vaccines.
COVAX, the vaccine pillar of the ACT Accelerator, founded in April 2020 aims to guarantee rapid, fair and equitable access to every country in the world. A truly global solution to a global problem. Since 2000 the Global Alliance for Vaccines and Immunization (GAVI- Vaccine alliance) has been helping developing countries procure immunizations at an affordable price. Gavi now vaccinates almost half of the world’s children with all 11 WHO-recommended childhood vaccines at a cost of US $28 compared to $1200 in the United States. COVAX is co-led by Gavi, The Coalition for Epidemic Preparedness Innovations (CEPI) and WHO. The goal is to have the World Bank, United Kingdom, the United States and wealthier countries contribute to the COVAX facility to supply low to middle income countries with enough vaccines to vaccinate at least 20% of their population including high-risk groups, vulnerable people, health and essential workers.
The COVAX facility has made investments across a broad portfolio of promising vaccine candidates and in so doing has pooled the purchasing power of all participating countries to have immediate access to safe and effective vaccines as soon as they receive regulatory approval. More than 190 governments are involved in the COVAX facility. It is designed to benefit all people everywhere both rich and poor. The COVAX Advanced Market Commitment is the financial instrument that will support the 92 low and low-middle income countries participating to gain access to donor- funded vaccines using guidelines developed by the WHO regardless of income or their ability to pay. Canada for example, a G7 country, has donated to the facility but intends to receive an estimated 1.9 million doses from the facility to meet its country goals. The initial goal is to deliver 2 billion doses through the end of 2021 with 1 billion headed to low income countries and 700 million doses headed to Africa. Africa CDC has played a key role in ensuring that there is rapid deployment of vaccines to African countries. As more rich countries donate their excess vaccines to the COVAX facility it is likely some countries may end up receiving more than 20%. It is going to take a vaccine coverage of much more than 20% to achieve herd immunity. Herd immunity — at about 60% vaccine coverage will be critical in ending the pandemic.
Following the delivery in Ghana on February 24 another 405,000 doses also arrived in the Ivory Coast on February 25. On March 2, 2021 3.94 million doses arrived in Nigeria. On March 3, Sudan became the 15th country to receive vaccines, 800,000 of them arriving in the country, while Rwanda became the first country to receive Pfizer vaccines through the COVAX facility with a shipment of 102,000 doses. To qualify to be one of the 92 countries selected for this rollout, COVAX AMC countries had to provide a national deployment and vaccination plan with clear guidelines on which priority groups will be receiving the vaccine. It also included human resources and training, logistics and cold chain planning, how distribution and monitoring for side effects will be ensured, as well as social mobilization and community engagement to ensure confidence in the vaccines. Initial shipments are designed to cover 3% of each country’s population with the intent to protect every health care and social worker on the planet. To date 300 million doses of vaccine is earmarked to be sent to the countries in Africa that fall under this category. The roll out can be tracked at https://www.gavi.org/live/covax-vaccine-roll-out.
By the time the first shipment of vaccine arrived in Ghana, following Christmas celebrations and a presidential election, people diagnosed with COVID-19 had climbed to 700 a day with hospitalizations threatening to overwhelm the healthcare system.
Ghana seems to have done an excellent job at social mobilization given that accompanying the President of Ghana were some members of his cabinet and other leaders of various church groups who hold a strong social clout in the nation in influencing people to get their vaccines. Among the clergy was the Most Reverend Dr. Paul K Boafo the presiding Bishop of the Methodist Church and the presiding chairman of the Christian Council of Ghana. Others present were the chairman of the Church of Pentecost, the President of the Assemblies of God Church, the chairman of the Ghana Pentecostal and Charismatic Churches, as well as the national Chief Imam representing the Muslim Community. In a phone interview Boafo notes, “This is to show leadership and send a clear message that the vaccine is God’s answer to the virus. It will not make you infertile or dehumanize you.” He has not experienced any side effects after receiving the vaccine and will continue to be a champion for COVID-19 vaccination. He hopes to dispel the myths about the vaccine including issues surrounding impotence and infertility.
On March 2, while Kwarteng was receiving his vaccine, Mrs. Afua Akwaah Ofori-Atta, a hospital pharmacist and patient safety advocate was also receiving her vaccine at a local polyclinic. Polyclinics serve as the community health centers in Ghana and are the bedrock of the robust health care system in the nation, and Ofori-Atta’s work included educating people who have doubts about the vaccine, responding to questions and educating her local community. That same day Asuofuo Health Center in the Ashanti Region became the first health center in the world to receive a consignment of a COVID-19 vaccine by drone delivered by Zipline, the world’s first national drone delivery system. By the end of the day Zipline had dropped 36 deliveries to facilitate 4500 vaccinations in Ghana.
As part of the roll out efforts the nation has publicized a list of priority groups and the locations in each community where citizens can show up, be immunized and become proud owners of a COVID-19 vaccination card. This Phase 1 roll out includes healthcare workers, frontline security personnel, persons with underlying conditions who are more than 18 years of age, teachers who are above the age of 50, any person above the age of 60, frontline members of the Executive, Legislature and the Judiciary. Every district in the Greater Accra Region of the country has access to vaccination via designated immunization sites and it appears no eligible person one will have to travel more than 10 miles to get access to a vaccine.
“We are not leaving any stone unturned,” said Mr. Eric Karikari-Boateng, Head of Laboratory Services at Ghana’s Food and Drug Administration speaking via phone on the approval process for the vaccines as the agency reviews the data on each vaccine the country has approved. Currently the COVISHIELD and Sputnik V from Russia have received the agency’s approval in the country. If a vaccine has already received Emergency Use Authorization by the UK’s Medicines and Healthcare products Regulatory Agency, Swissmedic or the US FDA or European Medication Agency or other trusted authority, Karikari- Boateng and his team go by the reliance pathway and review the quality section on the vaccine dossier in addition to reviewing the stability of the product. Some vaccines have received emergency use authorization by the WHO and also go through a local approval process. Vaccines that do not have the stamp of approval by any outside agency will go through a full assessment of all their data prior to approval for use in the country. Karikari- Boateng noted that in addition to the already robust network of Ghana Expanded Program on Immunization there is a toll free number that individuals can call to report side effects related to the vaccine as well as a voluntary reporting site at http://adr.fdaghana.gov.gh/patient.php.
Kwarteng noted that initial hesitancy has given way to enthusiasm for the vaccine. He was impressed by the excitement of people waiting in line and the high vaccine patronage he observed. “Everybody should take steps to receive the jab, if they qualify,” he said, “because it is the only way to bring the pandemic under control.”
One big hurdle in the roll out is how to determine the risk groups. In Ghana, for example the prevalence of hypertension is about 60% in adults older than 18, one study showed that only 19% of patients were aware of their disease (1). Apart from the clear age guidelines, determining those with high-risk conditions may be a challenge. Patients may have to bring their health records with them to prove their medical conditions. In West Africa, diabetes prevalence is about 6% overall and approaches 25% in patients above the age of 60 (2).
By the end of the year, however, more than 1 billion people living in the 92 countries who participated in the COVAX Advance Market Commitment (COVAX AMC) will have been immunized because the world was looking out for each other (3). That is the way it should be. This is a timely intervention as Africa marks 100,000 deaths due to COVID-19.
Bertha Serwa Ayi, MD, FACP, FIDSA, MBA is an adjunct Assistant Professor of Medicine at the Kansas Health Sciences Center, U.S. and an adjunct lecturer at the University of Development Studies, The University of Allied Health Sciences, and Accra College of Medicine all located in Ghana. Dr. Ayi is a member of the case management technical working group of Africa CDC’S African Continental Strategic Plan for COVID-19 Pandemic (AFCOR). She is a graduate of the University Of Ghana Medical School (UGMS Class of 1996) where she graduated with honors and received the Alcon/Paracelsus Award in Ophthalmology. She completed her Internal Medicine Residency training at Good Samaritan Hospital Inc., affiliated with Johns Hopkins University School of Medicine in Baltimore Maryland in 2002. Furthermore, In 2004, she completed fellowship training in Infectious Diseases at a combined training program at Creighton University Medical Center, University of Nebraska Medical Center and the Veterans Administration Hospital in Omaha, Nebraska. She is a Board Certified Infectious Disease Specialist and a fellow of the American College of Physicians (FACP) and the Infectious Disease Society of America, which produces this blog. She is a consultant in infectious diseases at Essentia Health West, Fargo, North Dakota.
- Sanuade OA, Awuah RB, Kushitor M. Hypertension awareness, treatment and control in Ghana: a cross-sectional study. Ethn Health. 2020 Jul;25(5):702-716. doi: 10.1080/13557858.2018.1439898. Epub 2018 Feb 15. PMID: 29448808.
- Sundufu AJ, Bockarie CN, Jacobsen KH. The prevalence of type 2 diabetes in urban Bo, Sierra Leone, and in the 16 countries of the West Africa region. Diabetes Metab Res Rev. 2017 Oct;33(7). doi: 10.1002/dmrr.2904. Epub 2017 Jun 16. PMID: 28444863.
- Accessed on March 5, 2021 https://www.gavi.org/our-alliance/about