A new commentary authored by Yale School of Public Health PhD student Natasha Turyasingura, in collaboration with senior researchers from Yale and Columbia University, suggests ways Africa can improve COVID-19 vaccination rates and prepare for future pandemics.
The article, published in the journal Transactions of the Royal Society of Tropical Medicine & Hygiene, emerged from a term paper Turyasingura submitted last year for her class, Frontiers of Public Health. After her professor, Dr. Sten Vermund, reviewed the paper, he thought it was good enough to be published in an academic journal. With Vermund’s guidance, Turyasingura succeeded in getting the commentary published, which she called a “humbling” accomplishment.
“The assignment was to pick a topic that you are passionate about. That was the one point Dr. Vermund kept emphasizing,” said Turyasingura, a second-year student in the Department of Epidemiology of Microbial Diseases. “I feel very fortunate that I get to share this topic that is of great interest to me and one I see myself greatly involved in over the course of my career.”
Throughout the COVID-19 pandemic, vaccines have largely ended up going to wealthy countries, and the number of vaccines promised to Africa has so far remained insufficient. Even though Africans make up nearly a fifth of the world’s population of 8 billion people, just 26 percent of Africans have been fully vaccinated. And global programs for distributing vaccines to low-income countries, like COVAX and the Coalition for Epidemic Preparedness Innovations, have encountered “significant obstacles,” the paper’s authors say.
Those obstacles, which Turyasingura identified with the help of Vermund and Columbia University Senior Research Scholar Wilmot James, a South African leader in vaccine equity efforts, are numerous.
For one, the researchers say, mRNA vaccines — which must be kept in cold environments of between -50°C and -15°C (-58°F and 5°F) during transportation to remain stable — placed a heavy burden on many African countries. Finding enough freezers and preparing the necessary infrastructure to support vaccine storage upon delivery at short notice proved difficult.
In proposing a solution to the problem, the authors suggest that the world’s scientists should continue their efforts to learn how to freeze-dry mRNA vaccines, as it can extend their shelf life.
Another obstacle identified in the paper is unfulfilled vaccine pledges. Despite giving more than a billion vaccines to participating nations, COVAX and other global partnerships have failed to receive the full donations that wealthy countries have promised. The authors write that some of these countries “might be seen as ‘vaccine hoarders,’ purchasing enough doses to vaccinate their populations many times over with inherent vaccine wastage.”
“I’m not saying that we didn’t help low- and middle-income countries secure a vaccine, but it was on our terms, and it was very much after our needs were met and even more,” said Vermund, the Anna M.R. Lauder Professor of Public Health.
Without enough Africa-based research and development, countries in the continent cannot make up the vaccine deficit, the researchers point out. Although Africa-based R&D is a sustainable approach, it also faces its challenges. The low research output from the region is because researchers and workers often emigrate out of Africa, and governments fail to properly enforce intellectual property laws, among other factors.
But there is a way forward, Turyasingura and her co-authors write in the paper.
“Africans need to be stakeholders in this quest for vaccine equity and not merely recipients from benevolent donors,” the authors say.
That means that African companies should facilitate technology transfer and the sharing of research and development within the continent. Governments should make “consistent” investments in infrastructure and workforce development and help reform their regulatory frameworks, according to the commentary.
With these and other solutions, the researchers say the continent will be better prepared to deal with future infectious diseases and health crises.
For Turyasingura, the paper’s first author, the goal is personal.
“I’m in touch with my family and friends in Uganda and I heard about the frustrations they were encountering just to get access to vaccines,” she said. “We may find a way out of COVID, but do we want to be in this situation if another disease like COVID comes around? Are we going to wait? What if I were in Uganda and another disease where a vaccine is needed comes up, am I just going to be waiting, sitting, for a vaccine to drop into my lap?”
“Africans should have a part in this,” she said.
Vermund estimates that only a handful of term papers that he receives in his Frontiers of Public Health class of more than 130 students turn into published articles. Any time that it happens is a treat, he said, because it not only fulfills the Yale School of Public Health’s mission of preparing students for research but also energizes the research community with new ideas.
“Going the extra mile in taking a term paper and transforming it into a publishable article is a non-trivial task,” he said. “It just goes to show how lucky we are at Yale to have students who are motivated to make this extra effort to disseminate their work.”