Battling a pandemic: an African perspective

Researchers from the University of Cape Town’s (UCT) faculties of Health Sciences and Science have recently published a paper describing an African perspective on global approaches to the fight against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2), which causes COVID-19. “Prospects for SARS-CoV-2 diagnostics, therapeutics and vaccines in Africa” was published in Nature Reviews Microbiology.

Emmanuel Margolin, a postdoctoral scientist who works in both the Institute of Infectious Disease and Molecular Medicine (IDM) in the Faculty of Health Sciences and the Biopharming Research Unit in the Department of Molecular and Cell Biology in the Faculty of Science, was the lead author on the paper. His main research interest is the development of inexpensive vaccines and vaccine technology for emerging pathogens that impact Africa.

His work, which has included the investigation of the sparse infrastructure for the manufacturing of pharmaceuticals on the continent, shone a spotlight on the fact that approaches to dealing with SARS-CoV-2 currently being implemented in developed countries are not always suitable to Africa.

The continent experiences a high burden of both communicable and non-communicable disease, impacting scores of its diverse populations.

The emergence of SARS-CoV‑2 has prompted a worldwide wave of work geared towards combating and containing the virus, including the implementation of broad testing efforts and the expeditious mobilisation of research programmes aimed at developing vaccines and therapeutics.

The strategies that are applied in developed countries, however, may not always be suitable for developing countries, which have limited infrastructure.

According to Margolin, the review “highlights the challenges facing African countries in their response to the SARS-CoV-2 pandemic, while proposing the implementation of strategies that consider the context of the region and so are accordingly suited to it”.

His work is in affiliation with the Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), which fosters investigator-led approaches via the overarching scientific objective of combating infection, especially HIV-1 and tuberculosis, through clinical and laboratory research.

Multiple hindrances

Although medical innovations and pioneering research are in progress on the continent, there are still multiple and complex hindrances that slow down these processes. These can include often poorly developed infrastructure for testing and limited manufacturing as a result of minimal capacity to produce pharmaceuticals.

The region faces a dearth of healthcare infrastructure, and the potential impact of co-infections such as HIV-1 and tuberculosis (TB). Avert, a charity providing up-to-date HIV information, puts new infections in adults in 2018 at roughly 1.7 million with this ranging between 41 and 51% in Africa.

According to the World Health Organization (WHO), a global estimate of 10 million people were diagnosed with TB in 2018. Of these newly recorded TB cases, 24% were in Africa. In addition, in 2018 there were an estimated 862 000 new cases of TB among people who were HIV-positive, 72% of whom were living in Africa.

“Given the slow time for vaccine development, drug repurposing is discussed as a short-term strategy to manage the pandemic.”

The advent of the new SARS-CoV-2 pandemic has had a notable impact on work combating these infections, and has concerningly resulted in the redirecting of resources and funding away from this work. This impacts the health status in Africa and may similarly impact people’s susceptibility to severe COVID-19.

The paper focuses on three aspects of the response to the SARS-CoV-2: diagnostics, vaccines and therapeutics.

Margolin explained: “Diagnostics discusses how the current infrastructure is not suited to widespread testing to identify and isolate asymptomatic infections. Several potential approaches are discussed to augment the testing capacity and increase the turnaround time.

“Given the slow time for vaccine development, drug repurposing is discussed as a short-term strategy to manage the pandemic. Existing drugs with an already established safety profile will have a lower regulatory barrier for approval.”

Vaccine development

According to the paper, establishing appropriate manufacturing partnerships to produce vaccines that can be tested and licensed on the continent, to limit reliance on global initiatives which may be overwhelmed by the global demand for a vaccine, is an important next step. Similarly, the development of therapeutics should focus on repurposing existing drugs or using convalescent plasma that can be rapidly implemented to treat infection.

The review also delves into what has been recognised as an urgent need to invest in vaccine manufacturing capacity in Africa – to limit reliance on developed countries. The lack of manufacturing capacity available lends itself to the consideration of various approaches, discussed in the paper, of how African scientists can contribute to the global development of a vaccine.

“[Particular] emphasis [should be] placed on repurposing existing vaccine development platforms and partnering with clinical manufacturing organisations to produce vaccines.”

“[Particular] emphasis [should be] placed on repurposing existing vaccine development platforms and partnering with clinical manufacturing organisations to produce vaccines for human testing,” said Margolin.

One of the ways in which limited infrastructure has been evidenced with SARS-CoV‑2 diagnosis has been through asymptomatic infections, pre-symptomatic infections with high viral loads in the upper airways (probably at peak infectivity) and the range of non-specific symptoms that manifest in symptomatic cases.

The paper acknowledges the important role of widespread testing in identifying these individuals and so enabling contact tracing and isolation. But the authors note: “Whilst this has been highly successful in countries like Germany and South Korea, it is not generally possible in most African countries where the infrastructure is weak.

“Indeed, in countries like South Africa, where widespread community testing was attempted, this has resulted in a very large backlog of tests and delays of weeks for returning test results, which are then rendered meaningless for quarantining of cases and containment.”

Support and investment

These challenges faced on the continent are not insurmountable. A lot of work is being done in vaccine and therapeutics development as well as testing capacity – even under the strain of limited resources.

The need for support and significant capital investment in the region, for capacity and resource development, is integral to progress on the continent.

But this support should be context-specific and work in collaboration with local researchers and communities to co-create nuanced and relevant approaches that can amplify the African footprint in this important work at this crucial time.