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Brian Lehrer: Brian Lehrer on WNYC. I don't know if this part of the UN general assembly from last week broke through in many news stories but they had what was called a side summit. At it, president Biden hosted a virtual guy of leaders of other countries and international nonprofit organizations, philanthropists, scientists, and said to deal with what he called this global tragedy of COVID-19, we need to, "go big" Biden's words. He said the US would buy another 500 million doses of the Pfizer vaccine to donate to countries who need them.

That includes much of the African continent where only 14 countries have hit the milestone of vaccinating even 10% of their population and only four countries are above 20% vaccinated. That while the US is starting a third round of Pfizer shots. As you know for those, the CDC has deemed most vulnerable to serious disease. To talk about the global COVID picture and especially the picture in Africa and what vaccine equity might mean, I'm joined now by Dr. Richard Mihigo, the Immunization and Vaccines Development Program coordinator at the World Health Organization's regional office for Africa. He joins us now from Brazzaville, Congo. Dr. Mihigo, hello from New York. Thank you for coming on WNYC.

Dr. Richard Mihigo: Hello. Good morning. Good afternoon. We are already afternoon here, Brian. I'm glad to be with you this morning.

Brian Lehrer: Can you start by talking about the status of COVID-19 cases across Africa? How many waves have you seen? For example, we say second wave, third wave, we're in the fourth wave in the United States now. Where are things there?

Dr. Richard Mihigo: The number of cases unfortunately are still increasing. On the continent in total we have around 1.1 million cases that have been so far are recorded with more than 207,000 deaths. Which brings us to a case fatality rate of more than 2.5%. Which is by the way superior to the average at the global level. We do have a few countries that have entered what we call the resurgence, 16 countries and an additional number of countries that are now almost in their fourth wave, Nigeria, Benin, Egypt, Kenya, Mauritius. Although the last few weeks we have seen trending down of the number of cases, but we still have quite a substantial number of countries that are still in a very difficult situation.

Brian Lehrer: From what I've read, infection rates have been relatively low across Africa compared to other parts of the world. I'm curious if you have a sense of how well they're being tracked? Or I've also read that the lower numbers are more about demographics and the fact that the median age in most African countries is much lower than in the United States and elsewhere in the West. There are many fewer nursing homes where the most vulnerable are all in one place. What's your understanding?

Dr. Richard Mihigo: Thank you, Brian. I think some of the points you have raised have been very much discussed to try to explain the relatively low number of cases in Africa but the reality that they must been a number of reported cases. It's a combination of some of these factor that's potentially, is explaining the comparatively low burden of COVID illness on the continent. Indeed, issues like demographics, age demographics, the potential-- I think this has been very much now explored that the potential cross-protection from previous exposure to circulating other coronaviruses could have played a role in that.

Also, we need to face some reality as well. The limitation of public testing which could have resulted in undercounting a number of cases of death could have explained that. Let me say also that we saw Africa being hit almost the last continent compared to other places. There were quite some various stringent measure that was put in place and which unfortunately had very severe consequences on the economy, on the social life and very severe lockdowns that many countries put in place right at the beginning of the pandemic. I think that had allowed more time for nations to react and then maybe to sow to some extent a better public health response here.

Brian Lehrer: The system for funneling vaccines from the developed countries who have them to the less developed countries who need them is called COVAX. As you know that's where those 500 million doses president Biden just pledged will go through. There have been problems getting doses and distributing them, I understand. Where do things stand now?

Dr. Richard Mihigo: I think you're right. COVAX was really a global initiative made to really respond to a big concern around the equitable distribution of vaccines. Particularly, for the low-income countries majority of which are located in Africa. We know very well that when the vaccines came onto the market, wealthier countries like the US had already bought up all the doses. The facto COVAX, the COVAX initiative which was the major instrument finds itself in a situation where most of the vaccine had been bought up.

COVAX was locked out of the vaccine markets having to find new purchase agreement. Remember the situation in India which was the major supplier for the vaccine, for the COVAX where India stopped the export of the vaccine to try to deal with the devastating resurgence of the Delta variance there. The situation has improved a little bit. So far, I think we've seen close to 180 million doses that have been administered arrived to the region. This is comparatively very low when we compare to the close 6 billion doses that have been distributed globally. The latest announcement by the Biden administration, I think president Biden to provide 500 million additional doses is a much very welcomed initiative to solve this problem of shortage of vaccine in Africa.

Brian Lehrer: Well, I think one of the core questions is how big a difference will this pledge of 500 million shots make? That would bring the US total commitment to 1.1 billion doses but how many are needed to hit the target of vaccinating 70% of the world's population within a year from now?

Dr. Richard Mihigo: Yes, you're right. To vaccinate 70% of the population, remember Africa has got 1.3 billion people on the continent. If we need to administer a minimum of two doses, we are talking about between 1.8 to 2.2 billion doses that will be needed before the deadline that was fixed to be September at the world general assembly next year to hit the 70%. I think the US government announcement, it's quite huge but it's not going to solve all the problems. It's very important that the COVAX facility continue to receive vaccines from the manufacturers. The money has been raised. The problem now is to get the vaccines into the initiative so that they can be distributed to the country. Otherwise, we will continue to see the same process where this region is going to stay behind other continents.

Brian Lehrer: I just noticed we have time for a few phone calls if anybody has a question or an opinion about the global fight against COVID-19 and especially the impact of the global vaccine distribution program, COVAX. Whether there's any relationship to the boosters or third doses or a vaccine distribution generally in the United States and other wealthier countries. (646)-435-7286, (646)-435-7284 for Dr. Richard Mihigo, the Immunization and Vaccines Development Program coordinator at the World Health Organization's regional office for Africa. Dr. Mihigo, I saw coverage of the side summit that said despite the pledges that president Biden and others made for vaccines, it was disappointing because there was no promise to transfer the technology so these countries could produce their own vaccines. Is that something you think is needed?

Dr. Richard Mihigo: Absolutely. If there is one thing that we have learned from this pandemic, it's how vulnerable the continent is really with regards to vaccines imports actually on the continent. Just to give you an idea, 99% of the vaccines that are currently using Africa are coming from outside. We saw the country that are producing vaccines like India, that was the major supplier for the COVAX. When the situation went very bad in India, the country decided to stop all the export of the vaccines, making even more vulnerable the region for the response.

I think there is now a very strong push and the call for, at least starting some vaccine manufacturing processes in Africa. We have seen quite very good advances the last few months with a few countries that have started to produce vaccines locally, at least in terms of fill and finish. South Africa is, for instance, doing that with the Johnson and Johnson vaccine. Egypt is producing as well as, the Sinovac vaccine from China, Morocco, the same.

There are prospects from other countries with the transfer of technology to make sure that, not only the COVID-19 vaccine can be produced locally but at least even other vaccines for diseases that are very much predominant in Africa, like Malaria, Tuberculosis, and why not HIV that those vaccines can produced locally in this region. Remember that we are going probably to be in this pandemic for another if not one or two or even more years. We'll definitely need production of the vaccine close to where people leave.

Brian Lehrer: The zero-sum game question on the minds of a lot of people, the US just authorized third shots of the Pfizer vaccine for those over 65 or those who are at high risk of exposure or a serious illness, not for others in the population, but still the World Health Organization for which you work has spoken against boosters for the less vulnerable at least until the science is more settled or more people across the globe or vaccinated at all. What's your position on that?

Dr. Richard Mihigo: Well, I think we've been very clear at WHO around this issue of booster dose. I think we do very well understand the concerns of some of the governments in the US or other governments around the world have to protect their citizens, particularly against these new variants. We know very well that what the data is telling us today, though there is some evidence of waning of immunity, particularly for some of the elder people, I think, we still have enough evidence to show that the current vaccines that we have are still very much working very well to protect people against severe disease and hospitalization and ultimately death.

Even the data that has been published by the USCDC is showing that clearly, the people who end up in the hospital are those who are mainly not vaccinated. We believe that in a world where only 4%, 4% of the Africa population have received two doses compared to in some countries in the US close to 60%, in few countries in Europe up to 80% of the people have received their two doses. It's becoming a moral imperative really to make sure that those who are more vulnerable get at least the minimum of protection that will help them to avoid getting a severe disease and end up in the hospital.

Brian Lehrer: I understand the moral imperative that you're arguing but is it a zero-sum game? Could Pfizer and the other vaccine producers produce enough with enough money donated by the US and other wealthier countries, there could be enough for everyone in Africa and elsewhere around the world and enough for the third shots here?

Dr. Richard Mihigo: Yes, I think we've heard those arguments. Unfortunately, the reality on the ground is that there is no vaccine for the people. There is no jabs to put in the arms of vulnerable people in many low-income countries. We would like to see the increase of the production globally with Pfizer alike and other vaccine manufacturers to make sure that everybody can get the right prevention.

Brian Lehrer: What do you think is the impediment to production at that scale If there is one?

Dr. Richard Mihigo: Okay. There are probably not one impediment, there are probably seven. To be Frank, I think this is the first time in history that we are in a situation where billions of doses of vaccine have to be produced in a such short period of time. The capacity to scaling up the production is definitely limited and is what we have been advocating for to remove, for instance, the barrier around the intellectual properties so that the vaccine can be produced even in different other places where the ability and the technology exist to produce those vaccines, but this is not being done.

We cannot expect that the fewer major pharmaceutical companies will produce enough vaccines as soon as quickly as possible to serve everybody. I think we need absolutely to get to a situation where, at least for a pandemic like this one, some of the intellectual property rights could be waived temporarily so that we could have a massive production elsewhere which will help this time around not only to protect those who are more vulnerable. As data become available even provide booster doses for those where our immunity is waning.

Brian Lehrer: This is WNYC FMH D&N New York WNJ TFM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Net Kong, and WNJO 90.3 Toms River. We are New York and New Jersey public radio. A few minutes left with Dr. Richard Mihigo from the world health organization, joining us from Brazzaville Congo, as we talk about global vaccine distribution and vaccine equity, and whether things need to change in this country for people to have enough vaccine doses in other countries. We have some interesting-looking calls on the board. Let's take a few before we ran out of time. John, in Manhattan, you're on WNYC. Hi, John. You're on with Dr. Mihigo.

John: Yes. Hi. I would like to know about the Bureau of Investigative Journalism published a lot of studies and some of the other journalists and not studies, but inquiries into the high-level bullying that Pfizer has done in South America to certain countries like Argentina. They're seemingly doing it in Africa as well. There seems like there's a 500-pound needle in the room what is, is basically that Pfizer wants to get paid in order to deliver these vaccines. Also like in India, which happens to be one of the largest pharmaceutical countries in the world, this seems to be something very suspicious going on.

Yesterday, you had a great segment on eugenics and this is just a statement, not a question. It's very interesting. In India, the lower caste systems were not getting vaccinated, the same thing in Africa. There seems to be something going on that's very suspicious here. Otherwise, Pfizer and companies like that could produce enough vaccines and have them delivered to poor countries and Latin America and Africa. I think something here is very nefarious going on, but my question again is, how come there are reports of high-level bullying, and does the guest know about these reports? [unintelligible 00:18:46]

Brian Lehrer: John, thank you very much. Well, first of all, Dr. Mihigo, I'm going to guess that you don't support the implication, which is that Pfizer and the wealthier countries are trying to kill poor people around the world and darker people around the world on mass, right?

Dr. Richard Mihigo: Absolutely, yes.

Brian Lehrer: The bullying though as I understand it, that he's referring to the alleged bullying as bullying for price, do of anything like that going on?

Dr. Richard Mihigo: Well, yes. You're right. First of all, I think definitely we not thinking that there was this conspiracy theory around these, but what is true is that the amount of paper, the condition that countries had to fulfill before those vaccines have to be shipped, including issue related to liability and indemnification aspect that needs to be waived. It has been quite an interesting story particularly in a pandemic like this.

One could understand at the beginning when the vaccine was rolled out when people had not enough evidence and data around the safety of some of this product, a company could have been a bit more cautious around the issue related to liability and [unintelligible 00:20:17]. Today we have more than 6 billion doses that have been distributed globally. We have a very good track record around the safety of some of these products. We don't understand why we should continue to have such a high level of scrutiny around these documents before the vaccines are been shipped. I think that's the remaining concern. We hope that this is going to be solved quite soon.

Brian Lehrer: Elizabeth in Westchester, you're on WNYC with Dr. Mihigo. Hi Elizabeth.

Elizabeth: Hi. I had a quick question. I feel like in America, we're struggling a lot with vaccine hesitancy. It's almost an embarrassment. I was wondering if the same thing is happening in other countries. I'm just wondering how much influence the misinformation on social media affect countries. I know, like in America, everyone seems to be on social media. I'm just wondering how that compares to the other countries.

Brian Lehrer: Thank you. Dr. Mihigo.

Dr. Richard Mihigo: Definitely. I think the social media influence, particularly in major cities in Africa has become quite a strong vehicle to convey misinformation around the vaccination but also many other conspiracy theories. The reality is that the major issue in many countries is not really the demand it's mainly on the supply side. What we have realized really is that for those countries that have gone for a long period of time without vaccine, whenever the supply increase we just see long queues of people waiting for vaccination. We have even a quite very good absorption capacity. So far, if we looked at around the 180 million doses that have been distributed close to 80% of these doses, 76, close to 80% have already been administered. The real problem, really in many places without indeed downplaying the issue of misinformation, it's really the issue of supply, rather than the issue of demand in many countries in this region.

Brian Lehrer: The conspiracy theories, I wonder how you see them from the WHO. They're really incredible. Yesterday we had a caller who won't even, won't even give her daughter the polio vaccine because she thinks vaccination is a plot by the pharmaceutical companies to make money on things that don't work. Then we had a call or two calls ago, who thought the pharmaceutical companies are withholding vaccines from poor people around the world as a form of eugenics. It's just incredible what is very easy to find on our phones that are really wacky conspiracy theories.

Dr. Richard Mihigo: That's true. Unfortunately, I think there have been in the past, and I recall the situation in Nigeria with some of the clinical trials or medicines against meningitis, which led to some death there. There have been some suspicion which was there because of some of the unethical clinical trials that were conducted in the past that created some of this suspicion. What I can say moving forward, I think the situation has changed much in many countries. This is particularly what my program, what the work we are doing in trying really to strengthen the capacity of countries to conduct robust clinical trial evaluation, up to the standard of all international clinical trials that are happening elsewhere. Then to make sure that any product that arrived at least through the WHO pre-qualification system is safe and [unintelligible 00:24:38] vaccines that are being administered.

Indeed the social media amplifies any theory that is out there. With now the large penetration of social media, we have tried to put together what we call the Africa Infodemic Response Alliance which is really a coalition of journalists, a coalition of influencers who can debunk some of the force information that is circulating on the net, and then to try to work with countries to provide the right information to make sure that people at least get the verified and right information before they make any decision for vaccination.

Brian Lehrer: One more call. I think it's a really interesting one on why the Pfizer vaccine and is that the best one to distribute around the world? Ian, in Baltimore, you're on WNYC high.

Ian: Hi, Brian, can you hear me?

Brian Lehrer: I can hear just fine.

Ian: My question is the Pfizer and the mRNA vaccines. They have to be stored at incredibly low temperatures. They require two doses. I think people don't really think about the logistics of how to get a product like that and get it into the arms of people in low and middle-income countries. Then I guess tagging onto that, is if this isn't the best product for low middle-income countries for a variety of reasons, then why do booster shots in the US really matter? Thank you.

Brian Lehrer: Thank you very much. Let's deal with both of those very interesting questions, and then we'll be out of time, the 500 million doses that president Biden promised last week to donate Pfizer in particular, but we've had the conversation in this country about Pfizer needing to be stored at such super-low temperatures that it's harder to do than the other vaccines. I have read that some doses were arriving too close to their expiration dates, plus he raises the question of the ones that need two shots instead of one-shot if they're going to be in hard-to-reach areas for distribution. Do you have an opinion about that?

Dr. Richard Mihigo: Definitely. It's true that the Messenger RNA vaccine in general Pfizer and Moderna which a new technology came up with that additional problem with logistical storage need what we call the ultracold chain capacity up to -80. This is indeed something that has been a limitation in many places, but what I can say about that if you recall the devastating Ebola outbreak in DRC with the Merck vaccine, which was also being stored at -80%. We were able to deploy the Merck vaccine in Eastern a part of DRC in very secure places and to immunize close to 600,000 people, and then to stop the Ebola outbreak in Eastern DRC. Now, many countries indeed have run up up their capacity, of course at very different expenses to receive such a vaccine like Pfizer or Moderna, but in an ideal situation, we could have preferred to see vaccines that are logistically suited for some of these countries. [crosstalk]

Brian Lehrer: Would you rather Biden would've said we're going to donate 500 million doses of the Johnson & Johnson?

Dr. Richard Mihigo: I think that could have made 500 million people rather than 250 million. Again, we need a variety of products definitely to meet the demand and the needs from different countries. I think in the first distribution that many countries received from the US in this region, there was a variety of products, including Moderna, including a few doses of Johnson & Johnson, and indeed the Pfizer vaccine. It's true that what is needed for the moment it's vaccine first, whatever is available needs to be absolutely deployed to save lives. Then maybe we have the luxury of choosing product when we'll have enough.

Brian Lehrer: Finally the second question that the caller asked. I guess in effect it was, is there any data to show that partial immunity everywhere, beats super immunity for the few, like the people getting third doses in this country that in the long run, it's better even for the few, if the whole world is partially vaccinated, is that your scientific position or no?

Dr. Richard Mihigo: Absolutely. This is the position WHO has been arguing that the boost of those are not for fit and healthy people because the data is currently showing that the performance of the current product are still very well maintained in preventing severe disease and hospitalization. The data from the US CDC are showing clearly that. I think the world will be in a better place if we have everybody protected at least against this severe disease that will reduce the transmission, but more importantly will reduce the occurrence of new variants. If we continue this way, we will see another variant that will come and then will become even more severe and come even to hunt back. If I can put it, I can use that expression, even all the benefits that have been achieved with even a potential third dose.

Brian Lehrer: Because the new variants take hold mostly in unvaccinated populations. We thank Dr. Richard Mihigo, the immunization and vaccines development program coordinator at the World Health Organization, regional office for Africa. He has joined us from Brazzaville Congo. Dr. Mihigo, thank you so much.

Dr. Richard Mihigo: Thank you, Brian, for the invitation.

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