The African Union (AU) through the Africa Centres for Disease Control and Prevention (Africa CDC) is set to launch the Eastern regional co-ordination center in Kenya come October 1.
The East African RCC will be launched under the theme of “Ensuring effective preparedness and response to current public health threats in the context of COVID-19 and beyond.” The RCC serves as a hub for Africa CDC surveillance, preparedness, and emergency response activities, and coordinates regional public health initiatives by Member States in consultation with the Africa CDC headquarters.
Speaking at the weekly briefing on September 23, the Director of the Africa CDC, Dr. John Nkengasong, confirmed that the institution will be launching its Eastern regional collaborative center in Kenya very soon.
“We will be launching our regional collaborating center in Kenya. There are five regional collaborating centers, i.e. Egypt, Kenya, Nigeria, Zambia, and Gabon. These centers have been operating, but some of them have not been officially launched. This occasion will be for launching the center in the presence of several ministers from the republic of Kenya and we invite you (the media) to be part of that ceremony in Kenya.”
Approval of the ECF/EFF enables immediate disbursement of about US$307.5 million, usable for budget support. This follows Fund emergency support to Kenya in May 2020 (100 percent of quota, equivalent to US$739 million at the time of approval.
Kenya was hit hard at the onset by the COVID-19 pandemic. With a forceful policy response, the economy has been picking up heading into 2021 after likely posting a slight contraction of 0.1 percent in 2020. Even with this recovery, challenges remain in the return to durable and inclusive growth, and past gains in poverty reduction have been reversed.
The COVID-19 shock also exacerbated the country’s pre-existing fiscal vulnerabilities. Kenya’s debt remains sustainable, but it is at high risk of debt distress. To address debt-related risks, the authorities have taken action to hold the fiscal deficit and debt ratios to 8.7 and 70.4 percent of GDP, respectively, this fiscal year. Fiscal and balance-of-payments financing needs remain sizable over the medium term. Support from the G-20 under the Debt Service Suspension Initiative (DSSI) and development partners will contribute to closing the financing gap in 2021 along with financing from capital markets.
The authorities’ program would set a basis for a resurgence of growth and shared prosperity. Building on critical steps already taken, it aims to reduce debt vulnerabilities through a multi-year fiscal consolidation effort centered on raising tax revenues and tightly controlling spending, safeguarding resources to protect vulnerable groups. It will also advance the structural reform and governance agenda, including by addressing weaknesses in some state-owned enterprises (SOEs) and strengthening transparency and accountability through the anticorruption framework.
The fund will strengthen the monetary policy framework and support financial stability. Against the backdrop of extraordinary uncertainty, the program incorporates flexibility, including by recognizing near-term challenges related to tax yields in the current stressed economic environment and possible contingent liabilities from the SOE sector.
At the conclusion of the Executive Board’s discussion, Ms. Antoinette Sayeh, Deputy Managing Director and Acting Chair, stated:
“The authorities’ program charts a clear path to reduce debt-related risks. It will bring the primary balance below its debt-stabilizing level during the EFF/ECF arrangements and restore tax revenue – which had been falling even before the COVID-19 shock – back to levels achieved in recent years. The authorities should continue to provide necessary support to the economy and secure space for social and development spending even as they have appropriately reversed some extraordinary measures, including the temporary tax cuts which ended in January, 2021.
“The near-term reform agenda should also focus on urgent structural policy challenges. As financial weaknesses in some state-owned enterprises (SOEs) have emerged as a key source of fiscal risks, the ability to manage these risks should be strengthened while ensuring that any support provided to SOEs is consistent with Kenya’s limited fiscal space. Fiscal structural reforms should prioritize revenue administration, spending efficiency, and fiscal transparency. Continuing improvement in the anti-corruption framework through steps to enhance transparency and accountability and the AML/CFT agenda are also essential.
“The Central Bank of Kenya’s (CBK) proactive policy stance has provided essential support during a very challenging period. Monetary policy should remain accommodative in the context of the inflation targeting regime, the exchange rate should continue to function as a shock absorber, and close supervision of credit risks and provisioning should be maintained.
“The program supported by EFF/ECF arrangements with the Fund provides a strong signal of support and confidence. It is also subject to notable risks, including from uncertainty about the path of the pandemic, and steadfast pursuit of the program objectives will be essential also considering the upcoming political calendar. The Kenyan authorities have demonstrated strong commitment to fiscal reforms during this unprecedented global shock, and Kenya’s medium-term prospects remain positive”.
Ghana, like many of its counterparts on the continent, is contending with the fallout from the rapid spread of SARS-CoV-2 variants. Of particular concern is the B.1.1.7 variant first identified in the UK. It is estimated to be up to 70% more infectious and 65% more lethal than the ancestral strain.
Scientists at the West African Centre for Cell Biology of Infectious Pathogens have confirmed that B.1.1.7 is now the dominant variant in Ghana based on nationwide genomic surveillance. And that it is responsible for 88% of cases in the capital city.
The ongoing surge in new infections, hospital admissions and deaths has refocused public attention on a situation that the Ghana Medical Association describes as “dire”. Intensive care units are operating at the limits of their staff and space constraints. And more young people appear to be developing severe forms of the illness.
This means that the rollout of COVID-19 vaccines in Ghana cannot come quickly enough. But what is the country’s COVID-19 vaccination strategy? And how well advanced are plans to execute it?
Potential pitfalls
At least 60% of Ghana’s 31 million residents will need to be vaccinated for the population to attain herd immunity. The goal of the president, Nana Akufo Addo, is that every Ghanaian will be vaccinated. But a timeline for this remains elusive as no plan has been made public.
The president has promised to procure and administer 17.6 million COVID-19 vaccine doses in the first half of 2021 as part of an initial push. But there is uncertainty even around this target.
Firstly, how the country will secure this number of doses is not yet clear.
Secondly, there are questions around how the doses will be stored and distributed, as well as the capacity of the country’s existing cold chain infrastructure.
And there will be a final major hurdle to clear – convincing many sceptical Ghanaians that the vaccines on offer are safe and effective.
Constraining factors
A number of external factors are hampering Ghana’s efforts to secure the doses it needs to reach its mid-year target.
Unlike developed nations, countries like Ghana have limited bargaining power to negotiate directly with manufacturers. As a result, it is principally relying on two multilateral initiatives to procure COVID-19 vaccines – the COVAX facility and the African Vaccine Acquisition Task Team. Combined, they have secured 1.27 billion vaccine doses for African nations.
COVAX is a global initiative co-led by the World Health Organisation, Gavi and the Coalition for Epidemic Preparedness Innovations. It aims to develop, manufacture and distribute COVID-19 vaccines to all nations on a fair and equitable basis. It operates as a funding mechanism that uses the collective purchasing power of participating nations to obtain competitive prices.
Nevertheless, participating low- and middle-income countries will only receive enough vaccines to cover up to 20% of their populations.
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 COVAX. These first doses have been earmarked for the nation’s healthcare workforce of about 108,000.
COVAX aims to deliver the remainder of this initial tranche of 2.4 million doses by June 2021. This should be enough to protect about 1.2 million Ghanaians with the two-jab Oxford-AstraZeneca vaccine. But reaching the president’s target will require about four times that amount.
This means that Ghana will have to lean heavily on vaccine supplies from the African Vaccine Acquisition Task Team – an initiative being driven by the African Union. It aims to bridge the gap between the 20% population coverage promised by COVAX to participating African countries and the 60% coverage they need to attain herd immunity.
The African Export-Import Bank and the World Bank are supporting the strategy with about $7 billion in cash advancements to vaccine manufacturers on behalf of AU member states. The African Vaccine Acquisition Task Team has so far secured 270 million doses of the Pfizer, Oxford-AstraZeneca and Johnson & Johnson vaccines. Deliveries are scheduled to begin later this month.
In early February the sirector of the Africa Centers for Disease Control announced that 16 African nations had applied to the task team for vaccine supplies totalling 114 million doses. While the final allocations are yet to be published, Zambia, Kenya and Nigeria are set to receive 42.7 million.
It is not yet known if Ghana is one of the remaining 13, nor how many doses it intends to order from the African Vaccine Acquisition Task Team.
Ghana’s Presidential Advisor on Health, Anthony Nsiah-Asare, recently hinted that the country was also procuring vaccines through bilateral deals with some of its development partners. But these supplies are likely to be a negligible fraction of the 15.2 million additional doses required to meet the June target.
This means that Ghana’s supplies from the African Union initiative is likely to determine the nation’s ability to reach its mid-year goal of 17.6 million doses.
The groundwork
Ghana’s COVID-19 vaccination drive will face other challenges that ought to be addressed urgently.
One is a storage and distribution plan that prioritises speed and minimises waste. Public health authorities have assured Ghanaians that a comprehensive plan exists – it has not yet been made public – to make use of the country’s existing cold chain infrastructure for vaccine distribution.
This infrastructure supports Ghana’s enviable record in immunisation coverage that has helped reduce infant mortality and the incidence of vaccine-preventable diseases such as measles. In 2019, immunisation coverage for essential vaccines was in excess of 90%. Ghana has not recorded a single death from measles since 2003. In addition, it was certified as having eliminated maternal and neonatal tetanus in 2011.
But there are gaps. Ghana’s current cold storage facilities lack the capacity to house vaccines like those manufactured by Pfizer and Moderna because of the arctic temperatures required to store them. Both use a technology known as mRNA.
This limits the COVID-19 vaccine options available to Ghana. It also matters because these vaccines can be adapted to target new SARS-CoV-2 variants relatively quickly compared with other vaccine technologies. Having access to them could therefore determine how fast nations are able to respond to the emergence of new variants.
Ghana faces a potentially bigger stumbling block: public scepticism about COVID-19 vaccines.
Anxieties and uncertainties about their safety underlies considerable hesitancy in Ghana towards the COVID-19 vaccines. The proliferation of fake news and misinformation on social media and in certain quarters of the popular press are fanning those embers.
To meet this challenge public health authorities will have to be laser-focused on identifying and addressing both legitimate apprehensions and conspiracy theories. They will also have to be proactive in monitoring digital platforms because of the dynamic and viral nature of vaccine misinformation.
It will also be important to measure progress towards public acceptance of the vaccines. One route would be to conduct a series of public surveys to assess the evolving landscape of knowledge and attitudes. This would enable the government to identify specific misinformation that allows for more focused communication about vaccine safety and efficacy.
Much of that will also depend on media coverage. It is therefore crucial to engage the media on its role in combating misinformation
The Division of Parasitic Diseases and Malaria Centre for Global Health (DPDM) is working with partners in countries in Africa, South and Central America and Asia to conduct surveillance for vaccine preventable diseases, malaria, and neglected tropical infections.
Young child sleeps peacefully under an insecticide-treated bed net in Kenya. Photo credit: David Snyder
Multiplex bead assays (MBA) allow for simultaneous detection of antibodies to multiple antigens using small sample volume, making it possible to simultaneously measure exposure to several diseases and assess disease burden and vaccine coverage.
In Nigeria, a collaboration between Nigeria CDC, the Nigerian Ministry of health and multiple divisions at CDC–along with support from the Global Fund, PMI and the Bill and Melinda Gates Foundation–has supported establishment of laboratory capacity to conduct additional testing of samples from a large HIV impact survey: the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS).
Despite restrictions on travel and limitations on laboratory work because of the COVID-19 pandemic, technical staff from DPDM have provided remote support and the lab has completed testing for more than 40,000 samples. The results are already being used to inform immunization and malaria control activities.
CDC has a long history fighting malaria. To prevent a spike in malaria deaths or COVID-19 complications due to malaria, core interventions to prevent and control malaria can help reduce the overall strain on health systems and should continue.
National Institute of Health researchers have reported the largest genomic study of type 2 diabetes (T2D) in sub-Saharan Africans, with data from more than 5,000 individuals from Nigeria, Ghana and Kenya.
About 422 million people worldwide have diabetes, a number likely to more than double in the next 20 years. Photo credit: WHO
Researchers confirmed known genomic variants and identified a novel gene ZRANB3, which may influence susceptibility to the disease in sub-Saharan African populations. The gene could also influence the development of T2D in other populations and inform further research.
In a study published in the journal Nature Communications, researchers analyzed genomic data available on participants through the Africa America Diabetes Mellitus study, the single largest diabetes genomic association study conducted on the continent. Using the information available from 5,231 people, they found many genomic variants to be significantly associated with T2D.
The findings replicate results for many of the variants which other research studies have already implicated in T2D in mostly European ancestry populations. The work was funded by the National Human Genome Research Institute (NHGRI), the National Institute of Diabetes and Digestive and Kidney Diseases and the Office of the Director at the National Institutes of Health.
“Africa is the original cradle of all humanity, to which all humans can trace their genetic origin,” said Francis S. Collins, M.D., Ph.D., co-author of the paper and senior investigator with the NHGRI Medical Genomics and Metabolic Genetics Branch. “Thus, studying the genomes of Africans offers important opportunities to understand genetic variation across all human populations.”
To better understand how ZRANB3 was involved in T2D, the researchers studied its effects on zebrafish pancreas. The pancreas is one of the key organs involved in T2D, because their β-cells release insulin as a response to rising glucose in the bloodstream.
“In the early days of large-scale genomic studies, we did not know the effect of genes we found through our statistical tests,” said Dr. Adebowale Adeyemo, NHGRI researcher and first author of the paper. “But with the availability of new genomic tools, our next step was to ask: What does ZRANB3 do? How does it confer risk for T2D, and by what mechanisms does it act? That is the knowledge that will help the results become actionable for patients.”
Working with Dr. Norann Zaghloul of the University of Maryland, the researchers used a CRISPR-Cas9 DNA editing system to make the ZRANB3 gene inoperative in zebrafish (called a ‘knockout’). They also used biological tools to reduce the expression of the ZRANB3 gene in different zebrafish. In both cases, researchers observed a reduction in β-cell numbers in the developing zebrafish embryo. They realized it was because the β-cells were being destroyed when the ZRANB3 gene was inactive.
To follow up on these results and identify the consequence of such β-cell death, the researchers took β-cell cells from mice and performed a similar knockdown of the ZRANB3 gene as in the zebrafish model. They found that cells with ZRANB3 knockdown released much less insulin in the presence of high glucose than normal mouse β-cells.
Although the role of ZRANB3 in T2D was discovered in African populations (which have been vastly underrepresented in genomics research), it is possible that the same gene may also influence the development of T2D in other populations as scientists study the biology of this gene further, according to the researchers.
This is because the function of genes is, for the most part, universally same. However, differences in sequence variations in a gene as well as how they interact with lifestyle, behavior and other factors may influence the impact of a gene on disease in a given population.
“The findings of this study further demonstrate why it is important to study all human populations. By doing so, we have the opportunity to make novel discoveries that will not only help the specific population but also people all around the globe,” said Dr. Charles Rotimi, senior author of the paper. “The biology then becomes generalizable, and that much more impactful.”
The next steps for the researchers will be to return to the human participants who have T2D as well as the variant for ZRANB3. The question is: could the presence of the ZRANB3 variant in T2D patients help predict whether these individuals will require insulin early in the course of their diabetes treatment? Providing insulin to such people early may be advantageous because that could help delay the exhaustion of their β-cells over time. This could someday be a simple, yet vastly effective way of treating T2D in a personalized manner.
The Government of Malawi has launched the world’s first malaria vaccine in a landmark pilot programme aimed at combating one of the world’s leading killers.
Malaria remains one of the world’s leading killers, claiming the life of one child every two minutes.
The landmark programme on Tuesday made the country the first of three in Africa in which the vaccine, known as RTS,S, will be made available to children up to 2 years of age; Ghana and Kenya will introduce the vaccine in the coming weeks.
Financing for the pilot programme has been mobilized through an unprecedented collaboration among three key global health funding bodies: Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid. Additionally, WHO, PATH and GSK are providing in-kind contributions.
Malaria remains one of the world’s leading killers, claiming the life of one child every two minutes. Most of these deaths are in Africa, where more than 250 000 children die from the disease every year. Children under 5 are at greatest risk of its life-threatening complications. Worldwide, malaria kills 435 000 people a year, most of them children.
Dr Seth Berkley, CEO of Gavi said Malaria is still one of the biggest killers of children worldwide, taking the lives of over 200,000 children every year. “These pilots will be crucial to determine the part this vaccine could play in reducing the burden this disease continues to place on the world’s poorest countries”.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said the malaria vaccine has the potential to save tens of thousands of children’s lives, adding “We have seen tremendous gains from bed nets and other measures to control malaria in the last 15 years, but progress has stalled and even reversed in some areas. We need new solutions to get the malaria response back on track, and this vaccine gives us a promising tool to get there”.
Thirty years in the making, RTS,S is the first, and to date the only, vaccine that has demonstrated it can significantly reduce malaria in children. In clinical trials, the vaccine was found to prevent approximately 4 in 10 malaria cases, including 3 in 10 cases of life-threatening severe malaria
“Malaria is a constant threat in the African communities where this vaccine will be given. The poorest children suffer the most and are at highest risk of death,” saidDr Matshidiso Moeti, WHO Regional Director for Africa. “We know the power of vaccines to prevent killer diseases and reach children, including those who may not have immediate access to the doctors, nurses and health facilities they need to save them when severe illness comes.”
“This is a day to celebrate as we begin to learn more about what this tool can do to change the trajectory of malaria through childhood vaccination,” she added.
The pilot programme is designed to generate evidence and experience to inform WHO policy recommendations on the broader use of the RTS,S malaria vaccine. It will look at reductions in child deaths; vaccine uptake, including whether parents bring their children on time for the four required doses; and vaccine safety in the context of routine use.
The vaccine is a complementary malaria control tool – to be added to the core package of WHO-recommended measures for malaria prevention, including the routine use of insecticide-treated bed nets, indoor spraying with insecticides, and the timely use of malaria testing and treatment.
(l-r) Hon. Abdul Kargbo, Sahr Nyaama, Onanah Jalloh and Hon. Lusine Kallon
Deputy Minister of Youth Affairs, Hon. Lusine Kallon has led a delegation to Kenya and Ghana ahead of the review of the National Youth Service (NYS) Act, which was legislated in 2016.
The team comprises Hon. Abdul Kargbo-Chairman of the
Parliamentary Committee on Youth Affairs, NYS Board Chairman Sahr Nyaama and
the NYS Deputy Executive Director Onanah Jalloh.
The NYS study tour to Kenya and Ghana is to inform
the review of the 2016 NYS Act, as proclaimed by President Julius Maada Bio in
his maiden address to Parliament on 10th May 2018.
The choice of Kenya and Ghana is meant to obtain
best practices from the youth services of both countries and to further obtain
all technical information and literature that would enhance the implementation
of the scheme in Sierra Leone.
Minister Kallon said the government believes in effective institutional reforms that will resonate with youth empowerment and national development. According to him, this will help the government to implement programmes and projects in line with its national agenda.
“The study tour is important and timely,” said
Minister Kallon, “it will help us to obtain best practices and lessons from
other countries ahead of the review process.”
Onanah Jalloh, Deputy Executive Director of the NYS
said they are on track and working assiduously to ensure that the NYS become an
envy in the subregion. He said since inception, the NYS was dormant but they
have injected a “new blood” into the scheme to achieve President Bio’s
ambitious vision for the youth.
“We were able to recruit the first batch of graduate
corps and today they have been deployed across the country,” said Director
Jalloh. He went on to state that “after the tour we would certainly review the
Act which is why we travelled with the Chairman of the Parliamentary Committee
on Youth Affairs to demonstrate seriousness.”
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