The history of vaccine trials in Africa poses a serious challenge in the fight against COVID-19

15 Apr 2020

 

Controversy over where Coronavirus vaccine testing should take place has lit up French media outlets.  

 

During an interview, Jean-Paul Mira, head of intensive care at a Parisian hospital, suggested plans to trial vaccines in Australia and Europe should be accompanied by similar trials in Africa where there are ‘no masks, no treatment, no resuscitation’. 

 

Mira went on to compare Africans to prostitutes who do not protect themselves. Astoundingly, Mira’s comments were left unchecked by his fellow interviewee Camille Locht, who will be overseeing the vaccine trials in France.

 

Naturally, social media exploded in the aftermath of the interview. The footballer Didier Drogba objected to the ‘deeply racist words’. Many other Africans claimed they were being portrayed as guinea pigs in a lab. 

 

Shortly after the controversy broke, a COVID-19 testing facility was destroyed by an angry crowd in Ivory Coast. At the same time, a lawyers association in Morocco stated it was prepared to take legal action over the comments. 

 

Meanwhile, WHO’s director-general felt compelled to make a public broadcast condemning Mira’s ‘racism’. With a series of stupid and repulsive comments, magnified through social media, Mira has managed to do untold damage to the prospect of Coronavirus vaccination trials in Africa. 

 

As his reluctant apology made clear, the reaction to his interview left Mira confused. For a man struggling to cope with the Coronavirus outbreak in his own country, perhaps the perceived greater suffering of others was something of a comfort. 

 

The absurd pictures painted by his comments simply don’t match up with any kind of reality. Taking just one example, cities in Morocco and Senegal have now made wearing a mask in public compulsory. Yet, inadvertently, Mira found himself picking at a very sensitive wound: the prospect of vaccine trials in Africa. 

 

The history of the disease in Africa is deeply bound up with the colonial experience. Colonial incursions in the nineteenth and twentieth centuries changed settlement patterns facilitating the spread of infectious diseases. 

 

New pathogens such as rinderpest were introduced from Europe and decimated cattle and wildlife populations. Violent colonial ‘expeditions’ helped transport new strains of sexual diseases inland. 

 

The Emin Pasha Relief Expedition has even been suggested as a primary cause of the massive sleeping sickness epidemic that spread through central Africa in the early twentieth century.

 

Confronted by these ‘African problems’, colonial governments sought to limit the spread of infectious diseases. Yet, many of these colonial initiatives created unintended consequences. 

 

 

For many West Africans, their first encounter with modern medicine came through forced injections administered by French colonial authorities from the 1920s onwards. These injections were touted as a vaccine against sleeping sickness. Today their efficacy is seen to be questionable at best. The injections also carried severe side effects including blindness and gangrene. 

 

If cases of colonial medical abuse are easy to find, the same sadly remains true for the actions of several modern pharmaceutical companies in Africa. 

 

One of the most notorious examples remains the illegal clinical trials carried out by Pfizer in 1990s Nigeria. During a meningitis epidemic, a Pfizer research team administered 100 children with an unregistered drug known as Trovan (later banned in America as it was found to damage the liver). 

 

Not only was this trial conducted without approval from the Nigerian government, but the families involved were never informed their children were being given experimental drugs. 11 children died from the trial in total. 

 

Examples such as these go some way to explaining widespread suspicion of vaccines in parts of Africa. Most Africans are acutely aware of the power imbalance in such situations. Rural farmers with limited education find themselves reliant on the word of a doctor or healthcare worker that a particular treatment is for the best. 

 

If trust in these professionals has been damaged by colonial and contemporary abuse, African’s find themselves facing a false choice between questionable treatment and no treatment at all. 

 

In short, economic inequality and unequal access to medical knowledge mean vaccine trials will always need to be rigorously vetted in Africa because of the power dynamics at play.

 

This does not mean that vaccine trials should never take place on the continent. Africa is, genetically speaking, an optimal region for trails because of its enormous diversity. Yet, long before Mira’s comments, Africa was trailing far behind in trials for COVID-19 vaccines.

 

According to the United States National Institute of Health, which lists global clinical trials, there are only 4 taking place in Africa as of April 9th. Meanwhile, Europe has 61 and North America 67. One problem is the lack of centres of excellence where clinical trials are usually conducted. Most of these are confined to South Africa and Egypt.

 

In recent times, another model of vaccine testing has been used in Africa. In the past year WHO has been quietly carrying out its late-stage vaccine trials for a different disease: malaria. At locations in Ghana, Malawi and Kenya, carefully chosen local communities have been offered the opportunity to use an already clinically tested malaria vaccine. 

 

Larger, late-stage trials such as these evaluate the practicalities of administering the vaccine and only take place after extensive smaller scale trials. Engaging the whole village community and building trust is a fundamental part of this late-stage trial process.

 

Could a late-stage COVID-19 trail ever take place in Africa? After the negative press of the past week, it’s hard to imagine so, at least not without real controversy.

 

But to remove an entire continent from the fight for a vaccine would be a serious loss, for both Africa and the world. How WHO addresses this situation long-term will be interesting to observe.

 

Trust becomes invaluable in a crisis. The fight against Coronavirus is a global fight and the West cannot cooperate effectively in a global struggle if it remains blind in its historical legacies. Now is the time to speak with great care and humility.

 

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