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When soldiers staged a coup in the West African state of Mali in 2012, stealing vehicles and looting petrol stations in the process, professor of epidemiology Samba Sow learned a valuable life lesson.
Fuel shortages threatened to silence the generators that powered the refrigeration equipment in the Bamako lab where Dr Sow carried out his life-saving research into new vaccines.
So he built new, bigger storage units for fuel so that the cold chains keeping vital vaccines and biological samples cool would not be interrupted. Eliminating threats and preparing for an unpredictable future is at the centre of the work of the Centre for Vaccine Development-Mali (CVD-Mali), the infectious diseases lab where Dr Sow is director.
“We have played our part over the years in introducing a number of core vaccines for routine health care, particularly for women and children,” he says, modestly describing work for which he was awarded the prestigious Roux Prize in 2017.
Now the focus has switched to coronavirus and emerging Covid-19 variants, Dr Sow believes that African scientists will be crucial to halting its march. Last year he was appointed one of the World Health Organisation’s special envoys on Covid-19, with a focus on vaccine research.
“I believe African researchers can and must play an important role in the next phase of the Covid-19 pandemic as we try to understand the evolution of the virus, especially with regard to emerging variants,” says Dr Sow, speaking via Zoom from CVD-Mali’s lab – a yellow-painted building set in a leafy compound by the Niger river.
The pandemic laid bare the health inequalities between the world’s richest and poorest. Take vaccines: just 2 per cent of Covid-19 doses have been administered in low-income countries. In Africa, that means that only 3 per cent of the continent’s 1.3 billion residents have been fully vaccinated, compared to rates of 60 to 70 per cent in Europe and the United States.
The unfairness cuts deep with Dr Sow, who, since graduating from the London School of Hygiene & Tropical Medicine in 1999, has devoted his career to improving health outcomes on the African continent and particularly in his home country of Mali, where he served as health minister between 2017 and 2019.
“When the vaccines were being developed and tested, wealthy nations cut deals directly with vaccine makers, securing a disproportionately large share of early supply and undermining a fledgling Covax facility, the WHO-driven initiative to distribute vaccines equitably,” he explains.
“After rich countries reserved much of the vaccine supplies there was little left for Africa. This has meant that Africa has been even more vulnerable to coroanvirus and the Delta variant waves.”
The injustice has lit a fire under efforts to boost vaccine-making capacity in Africa, in the hope of freeing the continent from this life-threatening dependence. Even though 17 per cent of the global population lives in Africa, it is home to less than 0.1 per cent of the world’s vaccine production.
That needs to change: “The only way that we can address most of our health issues globally is through collaboration and equal partnerships. A country, even a continent, cannot go it alone,” says Dr. Sow. “It is entirely in the global community’s interest for laboratories in countries like, like mine, Mali, to see their capacity extended.”
There are signs of the first green shoots. In June, WHO and COVAX partners announced plans for a Covid mRNA vaccine technology transfer hub in South Africa. In Cape Town, the Biovac Institute has struck a deal with Pfizer and BioNTech to “fill and finish” 100 million doses a year of their Covid-19 vaccine for the African market.
In Senegal, the Pasteur Institute is building manufacturing capacity with the hope of producing Covid-19 vaccines later this year. Its goal is to produce 25 million doses per month by the end of 2022.
Dr Sow’s Bamako lab has a strong track record of developing vaccines, from routine childhood inoculations to the emergency development and testing of a vaccine against the Ebola virus. It has now begun the genome sequencing of samples of Africa’s emerging coronavirus variants, the first step to mounting a defence.
The lab is also one of the sites of a multi-country vaccine trial, testing four potential Covid-19 vaccines coming to market, with results expected soon, says Dr Camilla Ducker, a former Notting Hill GP and public health expert who partners with CVD-Mali.
“This is the future – diagnostics and vaccines should all be manufactured on the continent so that Africa is not dependent on the rest of the world and we can start to right the wrongs,” says Dr Ducker, who has supported Dr Sow and his team remotely from London since the pandemic began.
Because different communities respond differently to vaccines, they need to be tested for safety and efficacy in the populations among which they will be used. Africa, as the most genetically diverse continent, cannot be left out of the picture. “Having high quality trials in an African setting is really crucial for vaccine development,” she says.
What is needed is real investment and commitment, not just for this pandemic, but for the future, so that history is not repeated, says Dr Sow: “On our continent, vaccine manufacturing is complex and requires huge financial investment and long term vision. It’s a long distance race, not a hundred-metre dash.”