Africa pivots to J&J jab as continent plays ‘Covid vaccination catch up’

African nations are looking to Johnson and Johnson to supply Covid vaccines amid fears of a slowdown in deliveries of the AstraZeneca jab.

On Thursday, Dr John Nkengasong, head of the Africa Centres for Disease Control, said the African Union was dropping plans to secure the AstraZeneca vaccine from the Serum Institute of India.

It is now in talks with US manufacturer Johnson and Johnson (J&J) to secure additional doses, after announcing in March that it had agreed a deal for 400 million shots of the jab. 

Last month India announced a temporary ban on vaccine exports amid a resurgence of the disease within its own borders. This has hit African countries particularly hard as they are heavily reliant on the AstraZeneca vaccine being manufactured in India and supplied via the Covax vaccine sharing facility

As well as securing vaccines through Covax, African nations are also getting vaccines through the African Union and agreeing separate deals with other vaccine makers, particularly those in China.

The J&J jab is more expensive than the AstraZeneca vaccine, which is being provided at cost to African nations, but it is cheaper than the Pfizer and Moderna jabs. And it can be administered in just one dose, which greatly reduces logistical costs. 

The company has also agreed a deal with Aspen Pharma, a South African-based firm, to “finish and fill” the vaccines meaning the continent is at least partially self sufficient in vaccine manufacture. 

The announcement of the pivot to J&J comes a day after UK and European regulators warned of a link between a rare type of blood clot and the AstraZeneca vaccine. The UK announced that people under 30 would be offered an alternative to the AstraZeneca vaccine. 

Dr Nkengasong said the decision to pivot to J&J was to avoid duplication of supply between the African Union and Covax and it was not related to doubts over the AstraZeneca vaccine. He described the blood clots as a “very rare side effect”. 

In a separate briefing officials from the WHO’s African office warned of a slowdown in vaccine roll out on the continent. 

Dr Matshidiso Moeti, director of the WHO African region, said the continent was playing “Covid-19 vaccination catch up” even before the halt in supplies from India.

On Thursday Unicef, one of the key partners in the Covax facility, said Covax had supplied vaccines to more than 100 economies. 

However, out of the 690 million doses of vaccine administered globally, just 31.6m – less than two per cent – have been given in Africa.

Roll out is patchy, with 93 per cent of doses administered in just 10 countries. And these 10 countries have now used up two thirds of their supply of vaccines, said Dr Moeti. 

“Delays in Covid vaccine shipments are expected to continue this month unfortunately, as India is fighting a severe second wave of Covid-19 and has temporarily banned vaccine exports,” she said.

However, the delay in vaccine roll out is not only down to supply problems, she said. Countries such as Liberia, Sierra Leone and South Sudan have faced delays to their campaigns because of “funding, planning, and human resource shortages”. 

“Operational challenges related to limited preparation to target priority groups and insufficient planning are providing lessons for subsequent rounds of vaccination,” she said. 

Dr Prashant Yadav, senior fellow at the Center for Global Development, a US think tank, said that South Africa’s decision to switch to the J&J vaccine after a trial found the AstraZeneca jab was not as effective against the South African variant, had influenced some countries.

“South Africa moving away from AstraZeneca to Johnson and Johnson is sending a signal to many other countries,” he said. 

Dr Moeti insisted the AstraZeneca jab was safe and urged everyone who has been offered it to take it. Covax hopes to supply two billion doses of vaccine over the course of this year and is in talks with other vaccine manufacturers – however, no other manufacturers can supply the vaccine in such big volumes or at such a low cost. 

Dr Yadav said that African countries were not moving away from the AstraZeneca vaccine.

“I think the right way to think about it is that they are creating a diversified vaccine portfolio for the member states of African Union, diversifying vaccine portfolio means keeping at least a few options open.”

Some experts expressed concern that doubts about the AstraZeneca vaccine could affect vaccination in Africa. Lawrence Gostin, professor of global health law at Georgetown University in the US, told the BBC:

“What saddens me most is that the AstraZeneca vaccine was going to be the primary engine to vaccinate the world because it’s much more easily stored than the mRNA vaccines. And also it’s cost effective and so loss of global public trust in AstraZeneca vaccines could be a huge blow to WHO.”

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