Vaccine Production in Africa: A Feasible Business Model for Capacity Building and Sustainable New Vaccine Introduction

Addressing the re-emergence and resurgence of vaccine-preventable diseases in Africa: A health equity perspective

Vaccination is one of the greatest public health achievements of the 20th century, with a tremendous impact in the prevention and control of diseases. However, the recent reemergence of vaccine-preventable diseases calls for a need to evaluate current vaccination practices and disparities in vaccination between high-income countries and low-and-middle-income countries. There are massive deficits in vaccine availability and coverage in resource-constrained settings. Therefore, this perspective seeks to highlight the reemergence of vaccine-preventable diseases in Africa within the lens of health equity and offer recommendations on how the continent should be prepared to deal with the myriad of its health systems challenges. Among the notable factors contributing to the reemergence, stand health inequities affecting vaccine availability and the dynamic vaccine hesitancy. Strengthening health systems and addressing health inequities could prove useful in halting the reemergence of vaccine-preventable diseases.

Advancing Vaccinology Capacity: Education and Efforts in Vaccine Development and Manufacturing across Africa

Africa, home to the world's second-largest population of approximately 1.3 billion, grapples with significant challenges in meeting its medical needs, particularly in accessing quality healthcare services and products. The continent faces a continuous onslaught of emerging infectious diseases, exacerbating the strain on its already fragile public health infrastructure. The COVID-19 crisis highlighted the urgency to build local vaccine production capacity and strengthen the health infrastructure in general. The risks associated with a heavy reliance on imported vaccines were exposed during the COVID-19 pandemic, necessitating the need to nurture and strengthen the local manufacturing of vaccines and therapeutic biologics. Various initiatives addressing training, manufacturing, and regulatory affairs are underway, and these require increasing dedicated and purposeful financial investment. Building vaccine manufacturing capacity requires substantial investment in training and infrastructure. This manuscript examines the current state of education in vaccinology and related sciences in Africa. It also provides an overview of the continent's efforts to address educational needs in vaccine development and manufacturing. Additionally, it evaluates the initiatives aimed at strengthening vaccine education and literacy, highlighting successful approaches and ongoing challenges. By assessing the progress made and identifying the remaining obstacles, this review offers insights into how Africa can enhance its vaccine manufacturing capacity to respond to vaccine-preventable disease challenges.

Malaria vaccination in Africa: A mini-review of challenges and opportunities

Malaria remains an endemic public health concern in Africa, significantly contributing to morbidity and mortality rates. The inadequacies of traditional prevention measures, like integrated vector management and antimalarial drugs, have spurred efforts to strengthen the development and deployment of malaria vaccines. In addition to existing interventions like insecticide-treated bed nets and artemisinin-based combination therapies, malaria vaccine introduction and implementation in Africa could drastically reduce the disease burden and hasten steps toward malaria elimination. The malaria vaccine rollout is imminent as optimistic results from final clinical trials are anticipated. Thus, determining potential hurdles to malaria vaccine delivery and uptake in malaria-endemic regions of sub-Saharan Africa will enhance decisions and policymakers' preparedness to facilitate efficient and equitable vaccine delivery. A multisectoral approach is recommended to increase funding and resources, active community engagement and participation, and the involvement of healthcare providers.

Africa (COVID-19) Vaccine Technology Transfer: Where Are We?

The rampant spread of the COVID-19 infection poses a grave and formidable challenge to global healthcare, with particular concern to the inhabitants of the African continent. In response to these pressing concerns, different strategies have been employed to combat the emergence of this insidious disease, encompassing crucial measures such as physical distancing, the utilization of face masks, meticulous hand hygiene, and widespread vaccination campaigns. Nevertheless, the economic realities faced by numerous African nations, characterized by their classification as "low-income countries (LICs)", present a formidable barrier to accessing and distributing approved vaccines to their populations. Moreover, it is essential to discuss the hesitancy of the European Union (EU) in releasing intellectual property rights associated with the transfer of vaccine technology to Africa. While the EU has been a key player in global efforts to combat the pandemic, there has been reluctance in sharing valuable knowledge and resources with African countries. This hesitancy raises concerns about equitable vaccine access and the potential for a prolonged health crisis in Africa. This review underscores the urgent imperative and need of establishing localized vaccine development and production facilities within Africa, necessitating the active involvement of governments and collaborative partnerships to achieve this crucial objective. Furthermore, this review advocates for the exploration of viable avenues for the transfer of vaccine technology as a means to facilitate equitable vaccine access across the African continent and also the cruciality and the need for the EU to reconsider its stance and actively engage in transferring vaccine technology to Africa through sharing intellectual property. The EU can contribute to the establishment of localized vaccine production facilities on the continent, which will not only increase vaccine availability but also promote self-sufficiency and resilience in the face of future health emergencies.

Epidemiology and Transmission Dynamics of Viral Encephalitides in West Africa

Encephalitis is an inflammation of the brain, often caused by an autoimmune reaction, or in most cases because of a direct viral, bacterial, or parasitic infection. Viral encephalitides (VE) presents a significant public health concern globally, especially in West Africa. There are more than five hundred known arthropod-borne viruses (arboviruses), with over a hundred of them identified to cause encephalitic diseases in humans and animals, giving rise to a tremendous burden of the diseases and socioeconomic strains in tropical and subtropical regions worldwide. Despite their importance, few effective preventive and control measures in the form of vaccines and therapies are available, and when they are, their use is limited. These limitations are largely hinged on the paucity of information about the molecular epidemiology and transmission patterns of VE in West Africa. Here, we reviewed the transmission dynamics, molecular epidemiology, and the ecological drivers of VE in West Africa. Collectively, timely and accurate interventions are essential for encephalitic viral disease control. Moreover, the integrated health system approach, combining surveillance, vaccination, vector control, and community engagement, could be effective in preventing viral encephalitis globally.

Inequitable access to Ebola vaccines and the resurgence of Ebola in Africa: A state of arts review

The Ebola virus, a member of the filoviridae family of viruses, is responsible for causing Ebola Virus Disease (EVD) with a case fatality rate as high as 50%. The largest EVD outbreak was recorded in West Africa from March 2013 to June 2016, leading to over 28 000 cases and 11 000 deaths. It affected several countries, including Nigeria, Senegal, Guinea, Liberia, and Sierra Leone. Until then, EVD was predominantly reported in remote villages in central and west Africa close to tropical rainforests. Human mobility, behavioral and cultural norms, the use of bushmeat, burial customs, preference for traditional remedies and treatments, and resistance to health interventions are just a few of the social factors that considerably aid and amplify the risk of transmission. The scale and persistence of recent ebola outbreaks, as well as the risk of widespread global transmission and its ability for bioterrorism, have led to a rethinking of public health strategies to curb the disease, such as the expedition of Ebola vaccine production. However, as vaccine production lags in the subcontinent, among other challenges, the risk of another ebola outbreak is likely and feared by public health authorities in the region. This review describes the inequality of vaccine production in Africa and the resurgence of EVD, emphasizing the significance of health equality.

The need for Africa to develop capacity for vaccinology as a means of curbing antimicrobial resistance

The high prevalence of infectious diseases in Africa, combined with weak healthcare systems, poor antimicrobial stewardship, and an unchecked drug supply chain, is steadily reversing the trend in the fight against infectious diseases in this part of the world, posing severe threats to antimicrobial resistance (AMR). AMR continuously evolves and threatens to undermine antimicrobial efficacy and undo advances against infectious diseases. This brewing pandemic is now recognized as a significant worldwide health danger, implicated in several cases of morbidity, mortality, and increasing healthcare costs. Vaccine technology has been proven to be the principal remedy to this imminent danger since it prevents microbial infections. However, since Africa cannot produce its vaccines, it relies on external sources and, as a result, it is significantly affected by vaccine nationalism, hoarding, and instabilities in global supply chains. This has further adversely impacted the ability of African governments to regulate rollouts, protect their citizens, and ultimately rejoin the global economy. This dependency is a severe challenge to Africa's health resilience, as it is unsustainable. Given the inevitability of potential global pandemics and the alarming incidences of multi-drug resistance infections reported daily, Africa must develop the capability to produce its vaccines. The review utilized a systematic search of academic databases and grey literature, as well as a manual search of relevant reports and articles. In this review, we outline the public health threats and concerns that AMR poses to Africans, and the hurdles and advances achieved in vaccine development over the years. We also highlight possible strategies, particularly collaborative efforts, that will accelerate vaccine production and ease the strain of infectious diseases and antimicrobial resistance in Africa. Key findings indicate that Africa has significant gaps in its vaccine manufacturing and distribution capacity, with only a few countries having the ability to produce vaccines. Additionally, existing vaccine production facilities are often outdated and require significant investment to meet international standards. The review also highlights successful initiatives in Africa, such as the mRNA vaccine hub and the African Vaccine Manufacturing Initiative, which have demonstrated the potential for building local vaccine manufacturing capacity. The study concludes that Africa needs to prioritize investment in vaccine research and development, regulatory capacity, and infrastructure to build a sustainable vaccine manufacturing ecosystem. Overall, this review emphasizes the urgent need for Africa to develop its vaccine manufacturing capacity to improve vaccine access and strengthen its ability to respond to future pandemics. The findings underscore the importance of collaboration between African governments, international organizations, and the private sector to build a resilient vaccine ecosystem in Africa.

Monkeypox vaccination in the global south: Fighting a war without a weapon

Background

The Mpox outbreak awakened countries worldwide to renew efforts in epidemiological surveillance and vaccination of susceptible populations. In terms of Mpox vaccination, various challenges exist in the global south, which impede adequate vaccine coverage, especially in Africa. This paper reviewed the situation of Mpox vaccination in the global south and potential ameliorative approaches.

Methods

A review of online literature from PubMed and Google Scholar concerning Mpox vaccination in countries belonging to the 'global south' category was done between August and September, 2022. The major focus areas included inequity in global vaccine distribution, challenges impeding vaccine coverage in the global south, and potential strategies for bridging the gap in vaccine equity. The papers that met the inclusion criteria were collated and narratively discussed.

Results

Our analysis revealed that, while the high-income countries secured large supplies of the Mpox vaccines, the low- and middle-income countries were unable to independently access substantial quantities of the vaccine and had to rely on vaccine donations from high-income countries, as was the case during the COVID-19 pandemic. The challenges in the global south particularly revolved around inadequate vaccine production capacity due to lack of qualified personnel and specialized infrastructure for full vaccine development and manufacturing, limited cold chain equipment for vaccine distribution, and consistent vaccine hesitancy.

Conclusion

To tackle the trend of vaccine inequity in the global south, African governments and international stakeholders must invest properly in adequate production and dissemination of Mpox vaccines in low- and middle-income countries.

Uptake and determinants of childhood vaccination status among children aged 0-12 months in three West African countries

BACKGROUND

Vaccination has long been recognized as one of the most effective ways to reduce child mortality. It has played a significant role, particularly for children, and is considered a major achievement and relevant in preventing childhood diseases worldwide. This study looks at the uptake and determinants of childhood vaccination status among children under the age of one year, for Gambia, Sierra Leon, and Liberia.

METHOD

Data from 2019 to 20 Demographic and Health Survey (DHS) data from Gambia, Sierra Leone, and Liberia were pooled for the analysis used in this study. Data were obtained from a total weighted sample of 5,368 children aged 0-12 months through a stratified two-stage cluster sampling approach. A multivariable logistic regression model was used to assess the predictors of childhood vaccination uptake at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs).

RESULTS

The weighted sample pooled prevalence of full vaccination among children under 12 months of age was 15.1% for males and 15.0% for females. After controlling for confounders in the regression model, factors that were found to be associated with vaccination status include children whose mothers attended postnatal care (PNC) visits had higher odds of being fully vaccinated (aOR = 1.23, 95% CI = 1.03-1.46), while children whose fathers had primary education (aOR = 0.67, 95% CI = 0.48-0.96), children whose households never watched TV (aOR = 0.68, 95% CI = 0.56-0.82) and children whose mothers attended 1-3 antenatal care (ANC) visits (aOR = 0.59, 95% CI = 0.45-0.79) had lower odds of being fully vaccinated.

CONCLUSION

Childhood vaccination uptake was low among children under 12 months of age in these countries. Hence, there is a need to promote the uptake of vaccination across these three West African countries especially among rural dwellers.

Impact of high human genetic diversity in Africa on immunogenicity and efficacy of RTS,S/AS01 vaccine

In modern medicine, vaccination is one of the most effective public health strategies to prevent infectious diseases. Indisputably, vaccines have saved millions of lives by reducing the burden of many serious infections such as polio, tuberculosis, measles, pneumonia, and tetanus. Despite the recent recommendation by the World Health Organization (WHO) to roll out RTS,S/AS01, this malaria vaccine still faces major challenges of variability in its efficacy partly due to high genetic variation in humans and malaria parasites. Immune responses to malaria vary between individuals and populations. Human genetic variation in immune system genes is the probable cause for this heterogeneity. In this review, we will focus on human genetic factors that determine variable responses to vaccination and how variation in immune system genes affect the immunogenicity and efficacy of the RTS,S/AS01 vaccine.

DECOLONISING VACCINE PRODUCTION: UNPACKING GHANAIANS’ SUPPORT FOR MADE-IN-AFRICA VACCINES

Localisation of vaccine production is essential worldwide, but it is particularly crucial for Africa. This continent is more vulnerable to disease burdens and also lags behind other continents regarding access to vaccines. Moreover, many people in Africa have a long-standing apathy towards locally made products and services. This mindset raises the question of whether Africans will support African-made vaccines and what the associated reasons are. Guided by the theories of nationalism and import substitution industrialisation, we formulated and tested eight hypotheses. To answer these, we analysed survey data from 6,731 residents backed by key informant interviews in Ghana. Our findings identified three types of local vaccine consumers: Afrocentric-ethnocentrics, Apathetic-Afrocentrics and Afrocentric-Fence Sitters. Four out of the eight hypothesised factors explain why some individuals have a positive attitude towards locally made vaccines, compared to those who are unsure of their stance. The proposed typology of local vaccine consumers and their defining characteristics can help design public health campaigns to mobilize support for locally produced vaccines.

Strengthening Africa's capacity for vaccine research: Needs and challenges

Vaccine development and production harbinger the control and eradication of infectious diseases. Vaccination played a huge role in the curtailment of disease outbreaks like smallpox and polio, especially in Africa. Despite the high demand for several vaccines in Africa due to the highly infectious disease burden, the continent still lacks adequate capacity for vaccine research and development. This paper aims to discuss the need and challenges of Africa to strengthen its capacity for vaccine research and development and also highlight practical recommendations. Some of the needs for Africa to prioritize vaccine research and development include; improving quality of life and well-being, cost-effectiveness, independent preparedness and response to local outbreaks, and increased access to funding. Challenges associated with vaccine research and development include the cost of the investment, risk of failure; poor ethical framework and legislation; lack of adequate funding; lack of political will & support; and poor surveillance system. Strategies to create sufficient research funds, an efficient surveillance system, and a legislative framework are clearly described. In conclusion, strengthening vaccine research capacity in Africa requires the political goodwill of African governments and strategic partnerships with international organizations and institutes. The challenges facing this development and possible solutions have been highlighted in this article.

COVID-19 vaccinology landscape in Africa

More than two years after the start of COVID-19 pandemic, Africa still lags behind in terms vaccine distribution. This highlights the predicament of Africa in terms of vaccine development, deployment, and sustainability, not only for COVID-19, but for other major infectious diseases that plague the continent. This opinion discusses the challenges Africa faces in its race to vaccinate its people, and offers recommendations on the way forward. Specifically, to get out of the ongoing vaccine shortage trap, Africa needs to diversify investment not only to COVID-19 but also other diseases that burden the population. The continent needs to increase its capacity to acquire vaccines more equitably, improve access to technologies to enable local manufacture of vaccines, increase awareness on vaccines both in rural and urban areas to significantly reduce disease incidence of COVID-19 and as well as other prevalent diseases on the African continent such as HIV and TB. Such efforts will go a long way to reduce the disease burden in Africa.

Recent advances and challenges in the early diagnosis and management of invasive fungal infections in Africa

Invasive fungal infections are a serious concern globally, especially in African settings which are typified by poorly funded and fragile healthcare systems. Low performance diagnostics, limited therapeutics and poor societal awareness of invasive fungal infections are some of the perennial challenges which have contributed to the unacceptably high death rates from these serious infections. However, recent advances have been recorded in fungal diagnostics and therapeutics development. Research into the development of vaccines to prevent fungal disease is beginning to yield promising results. Here we highlight key successes recorded and gaps in this journey and argue that national governments and relevant stakeholders need to do more to prioritise invasive fungal infections. Pragmatic and context-specific measures are proposed to mitigate the peculiar challenges Africa faces in tackling invasive fungal infections.

Increasing challenges of malaria control in sub-Saharan Africa: Priorities for public health research and policymakers

The ever-increasing cases and mortality due to malaria remains one of the most important public health threats, especially in sub-Saharan Africa-where this burden is considerably high. In 2020, sub-Saharan Africa accounted for about 95% of all cases and 96% of all malaria deaths with about 80% of these deaths reported in children under the age of 5. This review, adopting a public health focus, aimed to understand the challenges of malaria control in sub-Saharan Africa despite ongoing public health interventions. Our review highlights two important findings. First, the increasing resistance of malaria parasites to artemisinin-based combination therapy (ACT) and its partner drugs coupled with increased vector resistance to pyrethroids and insecticides is reversing the progress of public health interventions in keeping malaria under control. Second, the wanning for the efficacy of the WHO-approved vaccine i.e. RTS,S from 60 to 70% following 18 months of observation, and its short-term availability remains an impediment to achieving the WHO target of producing malaria vaccines with more than 75% efficacy by 2030. Our findings underline the need to reassess research priorities with a focus on vaccine production in sub-Saharan Africa. Furthermore, African governments and policymakers must be committed to invest both the political and financial capital in vaccine production and distribution.

COVID-19 management landscape: A need for an affordable platform to manufacture safe and efficacious biotherapeutics and prophylactics for the developing countries

To gain world-wide control over COVID-19 pandemic, it is necessary to have affordable and accessible vaccine and monoclonal antibody technologies across the globe. In comparison to the western countries, Asian and African countries have less percentage of vaccination done which warrants urgent attention. Global manufacturer production capacities, dependency on advanced nations for the supply of vaccines or the raw material, national economy, limited research facilities, and logistics could be the factors. This review article elaborates the existing therapeutic and prophylactic strategies available for COVID-19, currently adopted vaccine and monoclonal antibody platforms for SARS-CoV-2 along with the approaches to bridge the gap prevailing in the challenges faced by low- and middle-income countries. We believe adoption of yeast-derived P. pastoris technology can help in developing safe, proven, easy to scale-up, and affordable recombinant vaccine or monoclonal antibodies against SARS-CoV-2. This platform has the advantage of not requiring a dedicated or specialized facility making it an affordable option using existing manufacturing facilities, without significant additional capital investments. Besides, the technology platform of multiantigen vaccine approach and monoclonal antibody cocktail will serve as effective weapons to combat the threat posed by the SARS-CoV-2 variants. Successful development of vaccines and monoclonal antibodies using such a technology will lead to self-sufficiency of these nations in terms of availability of vaccines and monoclonal antibodies.

Domestic funding opportunities for Tanzania as five new Middle-Income countries brace for reduced Gavi support for immunization

Vaccines have produced remarkable impact in reducing the global burden of disease. Thanks to Gavi-the Vaccine Alliance, which supports eligible countries to increase access to the new and underused vaccines. Gavi support depends on economic growth, whereby low-income countries contribute 0.2 USD per dose of supported vaccines, while middle-income countries contribute by price fraction that increases gradually by 15% annually. A country must become fully self-financing within five years when its economy reaches 1,630 USD GNI per capita. Recently, Tanzania, Benin, Haiti, Nepal, and Tajikistan became middle-income countries triggering gradual reduction in Gavi support. This paper first compares the socio-demographic characteristics, immunization program performance, and health financing strategies of these countries and second, explores domestic financing strategies that Tanzania can use to close the funding gap. Although the five countries are similar economically, they vary in demography, health financing strategies, extent of donor dependency, and strength of immunization programs. Some health indicators are not any better than those in low-income countries. Tanzania receives the largest financial support from Gavi and is projected to be fully self-financing by 2043. The potential domestic funding opportunities include to increase Government budget, use of innovative financing strategies, and health insurance, complemented with enhanced program efficiency.

Capacity Building for Vaccine Manufacturing Across Developing Countries: The Way Forward

Approved vaccines prevent 2 to 3 million deaths per year. There is a lack of equitable access to vaccines in the low- and middle-income developing nations. Challenges in the life cycle of vaccine production include process development, lead time, intellectual property, and local vaccine production. A robust and stable manufacturing process and constant raw material supplies over decades is critical. In a continuously evolving vaccine landscape, the need of the hour for developing nations is to manufacture their own vaccines besides having supply security, control over production scheduling and sustainability, control of costs, socio-economic development, and rapid response to local epidemics. There is a need for capacity building of workforce development, technology transfer, and financial support. Technology transfer has improved vaccine access and reduced prices of vaccines. Capacity building for the manufacturing of vaccines in developing countries has always been an area of paramount importance and more so in a pandemic situation.

COVID-19 vaccines development in Africa: a review of current situation and existing challenges of vaccine production

Following the development of the coronavirus disease 2019 (COVID-19) vaccines and the launching of vaccination, the World Health Organization has reported that the African Continent is lagging in the race to vaccinate its population against the deadly virus. The Continent has received a limited number of vaccines, implying that vaccine production needs to be scaled up in Africa. In this review, we summarize the current situation concerning COVID-19 vaccine development in Africa, progress made, challenges faced in vaccine development over the years and potential strategies that will harness vaccine production success.

COVID-19 and vaccines in Africa: a descriptive and thematic analysis of Twitter content

Introduction: As coronavirus disease 2019 (COVID-19) vaccines become available, it becomes important to understand public perceptions of the vaccines and implementation plans. The social media platform TwitterTM, which publicly shares information, serves as an important source of content related to COVID-19 vaccines. This study employed a qualitative descriptive design to examine content related to COVID-19 vaccines posted by Twitter users located in Africa. Methods: Data were collected from Twitter between the 11th and the 16th of December 2020 using the NCapture tool. We searched Twitter using the terms 'coronavirus', 'COVID-19 vaccine' and 'Africa' to identify the nature and content of tweets related to COVID-19 and vaccines shared by Twitter users from the African region. Descriptive statistics were used to describe the characteristics of Twitter accounts and thematic analysis helped determine, analyse, and clarify patterns of meaning (themes) emerging from the tweets. Results: The study found n=208 Twitter accounts, the majority (n=69; 33%) from South Africa and most (42%; n=87) from news agencies. The final dataset included n=212 tweets. The most used hashtag was #Covid19vaccine(s). Four themes were identified: i) capacity for vaccine production, ii) vaccine procurement, iii) vaccine logistics, and iv) perceived safety and efficacy of vaccines. The capacity of countries in Africa to manufacture a COVID-19 vaccine was deemed minimal and most tweets questioned Africa’s ability to procure vaccines based on the costs. Tweets also centred around the distribution of vaccines, storage and roll-out and the need to leverage existing solar-powered technologies to enhance the cold supply chain in Africa's remote locations. Questions about the safety and efficacy of vaccines developed in under one year were also raised. Conclusions: Concerns about vaccine procurement and readiness for distribution were dominant topics. These public concerns can be important in informing policymakers in preparation for the roll-out of vaccines in these contexts.

COVID-19 pandemic: the implications of the natural history, challenges of diagnosis and management for care in sub-Saharan Africa

BACKGROUND

Coronavirus disease (COVID-19) is a severe acute respiratory infection which has afflicted virtually almost all nations of the earth. It is highly transmissible and represents one of the most serious pandemics in recent times, with the capacity to overwhelm any healthcare system and cause morbidity and fatality.

MAIN CONTENT

The diagnosis of this disease is daunting and challenging as it is dependent on emerging clinical symptomatology that continues to increase and change very rapidly. The definitive test is the very expensive and scarce polymerase chain reaction (PCR) viral identification technique. The management has remained largely supportive and empirical, as there are no officially approved therapeutic agents, vaccines or antiviral medications for the management of the disease. Severe cases often require intensive care facilities and personnel. Yet there is paucity of facilities including the personnel required for diagnosis and treatment of COVID-19 in sub-Saharan Africa (SSA). It is against this backdrop that a review of key published reports on the pandemic in SSA and globally is made, as understanding the natural history of a disease and the documented responses to diagnosis and management is usually a key public health strategy for designing and improving as appropriate, relevant interventions. Lead findings were that responses by most nations of SSA were adhoc, paucity of public health awareness strategies and absence of legislations that would help enforce preventive measures, as well as limited facilities (including personal protective equipment) and institutional capacities to deliver needed interventions.

CONCLUSION

COVID-19 is real and has overwhelmed global health care system especially low-income countries of the sub-Sahara such as Nigeria. Suggestions for improvement of healthcare policies and programs to contain the current pandemic and to respond more optimally in case of future pandemics are made herein.