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A volunteer receives an injection from a medical worker during the country's first human clinical trial for a potential vaccine against the novel coronavirus, at Baragwanath Hospital in Soweto, South Africa, on June 24, 2020.SIPHIWE SIBEKO/Reuters

When the United States preordered a huge batch of 300 million doses of a possible COVID-19 vaccine recently, without even waiting for proof of its effectiveness, alarm bells began ringing in Africa.

The fear was immediate: Would poorer countries be left behind in the rush for a vaccine, their people dying, while the citizens of wealthier countries took priority? It reinforced the determination of South African scientists, who have now launched the historic first African trial of a potential vaccine for the coronavirus that causes COVID-19.

The announcement of the U.S. vaccine order, worth up to US$1.2-billion, shows there is “already a threat hanging over our heads,” said Shabir Madhi, a vaccinology professor at Wits University in Johannesburg who leads the South African vaccine trial.

“It’s critical that we get information from the African context if we want Africans to benefit from COVID vaccines in the near future,” Prof. Madhi said as he launched the vaccine trial last week.

About 2,000 South African volunteers are being enrolled in the trial of the safety and effectiveness of the vaccine developed by Oxford University scientists, who are now working in partnership with AstraZeneca, a British-based company.

Thousands of volunteers in Britain and Brazil are participating in similar trials of the same vaccine, and another 30,000 people will be enrolled in the United States as the studies expand.

British cabinet ministers have promised that Britain will get first access to the Oxford vaccine, with 30 million doses already pledged to the country. AstraZeneca has also struck a deal to provide up to 400 million doses of the vaccine to European Union countries.

Chinese President Xi Jinping, meanwhile, has promised that African countries “will be among the first to benefit” from any Chinese vaccine for the virus – but only after its “development and deployment” is completed in China.

African countries lack the vaccine production capacity to produce a COVID-19 vaccine in mass quantities. So they are supporting the World Health Organization and other global bodies in efforts to ensure that any vaccine is distributed fairly.

“The debate is about vaccine nationalism, where a rich country with manufacturing capacity says, ‘I’m drawing a border, this is all for my people, they get it all first, and you in Africa will get the crumbs from the table when there are crumbs to be given,’” said Helen Rees, chairperson of the South African Health Products Regulatory Authority and executive director of the Reproductive Health and HIV Institute at Wits University.

“That debate about vaccine nationalism now is very critical,” Prof. Rees told an online briefing this week. “It’s going to be an ongoing fight. There has to be an equitable distribution of vaccines. It cannot be all for some and none for many others.”

The issue of fair distribution has deep resonance in South Africa, where millions of people with HIV were blocked from life-saving antiretroviral medicine for many years because of the high prices set by pharmaceutical companies, until generic versions were finally imported.

To ensure equal access to a potential COVID-19 vaccine, one of the first steps is to test the vaccine in Africa, to prove that it can be safe and effective in an African country, not just in Britain or the United States, scientists say.

“We’ve got our own unique circumstances in the African context, which are dissimilar from what might exist in the United Kingdom,” Prof. Madhi at Wits said.

“If we don’t generate evidence right now, we’ll never know just how well these vaccines will or will not work in our own local context.”

He estimates the vaccine could become available to the general public by September or October of 2021, if it is shown to be effective in the trials this year.

Of the 2,000 participants in the South African trial, half are receiving a placebo. The vaccine will be considered effective if it reduces infections by 60 per cent among those who receive the vaccine.

Based on a complex formula, the results will be evaluated as soon as 42 of the 2,000 participants have tested positive for the virus as a result of community transmission.

The study is scheduled to continue for a year. But because of the rapid spread of the virus in South Africa, the threshold of 42 infections among the trial’s participants could be reached as early as November, Prof. Madhi said.

“People are getting infected at a phenomenally high rate,” he said. “It’s unbelievable. Not in my wildest imagination did I think people would get infected as much as they’re getting infected right now.”

In recent weeks, South Africa has emerged as one of the world’s top 10 countries in new daily cases of the virus. On Monday, it reported more than 6,100 new cases of the virus, giving it a total of more than 144,000 cases. It was the fifth-largest number of new daily cases in the world.

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