An Evaluation of efforts to fight COVID-19 puts Ghana ahead of many of its peers. Among other steps there has been aggressive testing throughout the Country; Treatment Centres have been opened; Training for Frontline health workers; Incentivizing of Health Workers; Supply of PPEs for Health workers, and Massive education of the General population. Adherence to Protocols for prevention and enforcement of laws on COVID-19 however still requires more efforts.
In recent times, the Country has seen a surge in new infections, Hospital admissions and deaths. Intensive Care Units and Treatment Centres are operating at the limits of their staff and space. More young people appear to be developing severe forms of the disease.
Scientists at the West African Centre for Cell Biology of Infectious Pathogens have confirmed that the United Kingdom variant is now the dominant variant in Ghana based on nationwide genomic surveillance. It is also responsible for 88% of cases in Accra and its surroundings. The UK variant is estimated to be up to 70% more infectious and 65% more lethal than the original strain.
At this point we need Herd Immunity to stop the further spread and mortalities. Having tried almost all solutions, our only hope is the COVID-19 Vaccine. At least 60% of the population needs to be vaccinated for the population to attain Herd Immunity. Fortunately, the Government of Ghana led by the President HE Nana Akufo-Addo promised and initiated the process of procuring 17.6million vaccines for the population to reach Herd Immunity.
However, from a Health Policy Analysis point of view, a number of factors may operate to militate against the Government’s achievement of the end game of Herd Immunity through vaccination.
First of all, the question of what vaccine to procure or choice of vaccine needs to be answered. There are a number of vaccines that have been developed by Manufacturers including AstraZeneca, Pfizer/BioNTech, Covavax, Johnson and Johnson, Moderna and so on.
Recent variants of COVID-19 including the South African, UK and Brazilian variants have rendered some of the vaccines less efficacious. For instance, when pitched against the original strain of COVID-19, the AstraZeneca vaccine has an efficacy level of 62%. However, preliminary data available suggests that the AstraZeneca vaccine when pitched against the South African variant of COVID-19 has seen its efficacy drop to 22%.
The same South African variant in preliminary studies has reduced the efficacy of the Novavax vaccine from 89% to 60%. The effect of the same South African variant on the efficacy of the Pfizer/BioNTech vaccines which has an efficacy rate 95% against the original strain is not yet known, but reduction in efficacy is very likely. In the light of these developments, South Africa has suspended the roll-out of the AstraZeneca vaccine and moving to introduce the Johnson & Johnson and PfizerBioNTech vaccines.(Zoe Hyde 2020, University of Western Australia)
In effect, the AstraZeneca vaccine will still be very useful for countries battling the second waves of COVID-19 caused by the original strain. The differences in efficacy of vaccines matter because if vaccine efficacy falls below a certain level it will not be possible to achieve Herd Immunity.
Having weighed the options, I think it will be best for Ghana to procure the right mix of the vaccines based on the population dynamics, variants of COVID-19, severity of COVID-19 in infected persons, storage conditions necessary etc.
Secondly, it is worth considering the question of how we are going to secure the required number of vaccines. Currently, Ghana and other African Countries do not have individual capacities to negotiate directly with vaccines Manufacturers for COVID-19 vaccines. These Countries are therefore working through the African Vaccine Acquisition Task Team (AVATT) and the COVAX Facility initiative driven by the African Union, supported by the World Health Organization, Global Alliance for Vaccines and Immunization and other INGOs.
Ghana expects to take delivery of up to 968,000 doses of the Oxford AstraZeneca vaccine by the end of March 2021 as part of an initial batch from the COVAX Facility. These first doses have been earmarked for the Nation’s Health workers, Security Agencies and other similar class of people in the population.
COVAX aims to deliver the remainder of this initial tranche of 2.4 million doses by the end of June 2021. This will just be enough to protect a little over 1 million people. Ghana will have to rely heavily on supplies from AVATT to get 60% coverage for Herd Immunity.
With the advent of the South African variant of COVID-19 and other new variants and its known rate of compromising the efficacy of some of the vaccines available, it will be appropriate that Ghana doubles-up its efforts to vaccinate 60% of the population to avoid a derailment in its efforts to reach Herd Immunity. Government needs to lobby AVATT seriously to be allocated the required doses of the vaccines in time to contain COVID-19 in Ghana.
As we aim at getting the required number of vaccines, it is equally important that the question of Storage and Distribution is looked at. Ghana has an enviable record in immunization coverage and cold chain infrastructure. It is hoped that Ghana will leverage on this for appropriate storage and distribution of the vaccines that are received in the Country. There is however some challenges with the current cold chain storage facilities in the Country as far as some of the vaccines are concerned. They lack the capacity to store vaccines manufactured by Pfizer and Moderna because those vaccines require arctic temperatures. This limits the COVID-19 vaccine options available to Ghana (Nana Kofi 2020, University of New York).
Lastly, it is important to consider how to overcome public scepticisms about the vaccines. Preliminarily, there is hullabaloo all over the country about the vaccines and potential side effects, including sterilization, other diseases etc. Public Health Authorities have a lot of work to do regarding these conspiracy theories. This requires public engagements, sensitizations before the vaccines are rolled out. This will require a lot of media support.
In conclusion, Ghana’s strategy to defeating COVID-19 so far has proved effective. However, the above factors must be considered at this stage of the fight, if we desire to make further progress.
Farouk Adam IDDRISU
Health Policy, Planning and Management Specialist
Member of Association of Health Service Administrators-Ghana