COVID-19 Vaccination: Challenges to a Mass Rollout in Africa

Introduction 

The world has recorded over 2.9 million deaths since the outbreak of the pandemic one year ago and has left most parts of the world reeling from its effects. The world is relying on the effective COVID-19 vaccines to bring back life to normal or at the very least return a sense of normalcy. Amid the unforeseen effects of the pandemic on at-risk and lower-income communities, governments and organizations worldwide must convene to ensure the effective distribution of newly developed vaccines. At the time of writing, the total number of casesstands at 4 million, with 114,586 deaths, which underscores the need for Africa to access a vaccine for its citizens.  

More than 12 billion vaccine doses have been announced by all manufacturers for release in 2021, in case all vaccine candidates succeed in clinical trials. The first wave of vaccines for the 92 low- to middle-income COVAX (COVID-19 Vaccines Global Access) countries represents two to three times UNICEF’s yearly routine vaccination program. Deliveries of vaccine supplies under the COVAX program started in February, and most countries in Africa have signed up. The program backed by the World Health Organization and other multilateral bodies aims to supply 600 million doses to Africa, enough to vaccinate at least 20% of the population. So far, countries such as Nigeria are poised to receive 84 million doses from the COVAX facility. In contrast,Gahan received 600,000 doses back in February, and Ghana’s health service says that 162,541 people have already been inoculated. However, the vaccine rollout across Africa is heterogenous, with countries such as Zambia and Ethiopia Opting for China’s Sinopharm.  

Africa is currently facing the second wave of the pandemic, and it has spread more rapidly than the first wave affecting a greater number of the populations. The emergence of highly transmissible variants calls for mass immunization with COVID-19 vaccines. Current statistics show that 600 million doses of vaccine are required to vaccinate at least 20% of the population. The Africa CDC says the continent is facing significant challenges in securing continued access to these vaccines. Therefore, how will Africa cater to the remaining 80% of its citizens given its financial, logistical, and infrastructural challenges?  

Additionally, Africa is unique in having a largely young and mobile population, a large informal job sector, and hotspots of political instability and insecurity, all of which will pose substantial challenges to vaccine rollout strategies. The issue of vaccine hesitancy is a major issue in the rollout of the vaccines. Countries such as Tanzania and Madagascar have said they have no plans to acquire vaccines, and Burundi says that at the moment, they don’t need vaccines. Meanwhile, three African nations, the Democratic Republic of Congo, Mali, and Cameroon, have put the rollout of the AstraZeneca vaccine on hold as a precaution after concerns were raised in some European countries over its safety. However, the WHO guidance says that this vaccine is judged to be effective, while the economist calls such policies fallacy. We concur, of the 500 or so cases that have been linked to the Oxford-developed vaccine, some people had pre-existing conditions. As such, the link between correlation and causation remains unclear; even so, Britain’s regulator has suggested that the vaccine be suspended for people under 30.  

Is There a Choice for Africa? 

Vaccines are incredibly difficult to develop, and while one should hope that Africa has the technical expertise to research and manufacture vaccines, the extent of underinvestment is glaring. As such, the choice for vaccines is limited as African nations must depend on the COVAX facility to benefit from any vaccines.  

Recommendations for African Countries 

  1. Collective action is needed from governments, civil society organizations, and multilateral partners to ensure safe, equitable, and faster access to vaccines. This is ever more important in Africa, where logistical and infrastructural challenges continue to mount, thereby limiting the effect of health care strategies designed to curb the spread of the virus. It is imperative that to boost the capacity of health care workers and volunteers in rural parts of the continent to ensure last-mile reach. This will prevent a third wave of COVID-19 infections and ensure that a greater portion of the population can be vaccinated in sync with the global rollout of vaccines.   
  2. Vaccines will have to be imported from countries such as India, the UK, and the United States. Engaging with governments via public-private partnerships will ensure faster and safe movement of vaccines from one country to another. Cumbersome port procedures should be avoided to speed up access to vaccines by hospitals across the continent.  The ratification and effective implementation of the African Continental Free trade will act as a booster to the supply of chain of vaccines 
  3. Ensuring asset sharing to resolve administrative and logistical bottlenecks is necessary if Africa is to vaccinate its citizens effectively. It is imperative that any coordination from the African Union is done to prioritize need, transparency, and access for the most vulnerable citizens. Africa should learn several lessons from Ghana; by developing its digital and physical infrastructure, countries can ensure that vaccines are rolled out effectively and with little waste.  

Governments across Africa need non-competitive expertise across the health care sector to manage and coordinate their activities in a verifiable manner that leaves a digital trail. Machine learning and advanced data analytics will ensure that Africa is better prepared for future vaccine rollouts and vaccination campaigns. Furthermore, transparency, accountability, and governance are bulwarks of development and indispensable for African countries with underinvested health care systems.  

Overcoming Implementation Challenges  

The challenge with policy implementation has always been the need for Africa to balance external dictates with domestic realities. COVID-19 has reiterated the need for Africa to invest in its health care system, but more importantly, place a renewed focus on key aspects of health care such as zoonotic research, viruses, and vaccines. Africa is uniquely placed to leverage external support and regional coordination via the African CDC and the African Union. For example, it can ensure that countries and various regions develop and utilize key competencies across manufacturing, research, and biotechnology. As key competencies develop, it will be easier for the continent to develop and manufacture its vaccines based on credible science and hypothetical-deductive reasoning.  

Conclusion

COVID-19 has imposed grave harm on economies across the world. Still, Africa will need to develop and implement a proactive coordination and distribution system that accounts for its infrastructural challenges and logistical challenges. From aligning vaccine reception to delivery across rural areas to ensure last-mile reach, the scale of the challenge can only be met by a mix of interagency and donor-led initiatives across developing market economies.  

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Henri KOUAM is a Fellow in Economic Affairs at the Nkafu Policy Institute. He currently works as an economic consultant for a global expert network – Global Wonks.

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Dr. Odette Kibu is a Senior Health Policy Analyst at the Nkafu Policy Institute and PhD holder in Public Health at the University of Buea