As COVID-19 vaccination campaigns pick up pace across the globe, Africa continues to lag the rest of the world. The coming months are likely to see uneven progress in African vaccination drives amidst ongoing vaccine access issues, public vaccine hesitancy, and the possible emergence of new virus variants.
While the steady roll-out of mass COVID-19 vaccination campaigns in much of Europe and North America have created ample expectations of an impending return to “normalcy,” the situation remains tenuous in much of Africa. Most African states have received vaccines late, and in limited quantities, compared to their counterparts in the global North, resulting in a stark disparity in vaccination rates between Africa and the rest of the world. According to data published by Oxford University, as of 8 April, while 5.1 percent of the global population had received at least a single dose of the COVID-19 vaccine, only 0.62 percent of Africans could be placed in the same category.
As of 12 April, there were over 4.3 million reported cases of COVID-19 in Africa, and 115,710 deaths attributed to the virus. While daily new case numbers have been steadily dropping across the continent, the World Health Organisation (WHO) reports an upward trend in 15 countries, including Cameroon, Ethiopia, Kenya, Rwanda, Tunisia, and Guinea. Moreover, those countries that have seen a significant drop in cases still face the threat of further waves of infections as preventative strictures are eased.
In this context, it is crucial that vaccine access is improved as rapidly and in as many locales as possible. Apart from the public health necessity, whether a sufficient rate of vaccinations can be achieved across the continent will have considerable bearing on Africa’s economic recovery. In particular, the revival of the tourism sector depends upon the rapid resumption of international travel, which would be expedited by attaining herd immunity through vaccination.
Nonetheless, African vaccination programmes continue to face significant obstacles, including an ongoing shortage of vaccine supplies, and public vaccine hesitancy. Moreover, the greater the degree to which populations are exposed to COVID-19, the more likely that extensive circulation of the virus will give rise to new variants with potential to evade the current batch of vaccines. PANGEA-RISK examines the progress made to date and outlines the challenges which lie ahead.
Vaccination programme progress
According to the WHO, at the start of April, 43 African countries had embarked on public COVID-19 vaccination campaigns, with Morocco currently leading in terms of the vaccination rate. By the start of April, Morocco had reportedly vaccinated over 4.4 million people – almost 12 percent of the population – including 3.2 million people who had received a second dose. Behind Morocco are Senegal and Ghana, which have achieved vaccination rates of 1.84 percent and 1.93 percent, respectively.
Elsewhere on the continent, vaccination programmes have made considerably slower progress, with the WHO reporting that many African countries “have barely moved beyond the starting line.” By early April, South Africa, which has consistently reported the highest case numbers and fatalities on the continent, had distributed a single vaccine dose to less than 0.5 percent of the population.
Vaccine rollouts have been hampered by inadequate infrastructure, financial hurdles, as well as operational and logistical constraints. However, the most significant impediment to vaccination programmes across the continent is the broad lack of vaccine access to African states. According to the World Health Organisation (WHO), as at 7 April, Africa had administered 13 million COVID-19 vaccine doses, accounting for 2 percent of the total 690 million doses which have been administered globally. Indeed, some of the poorest African countries – including Niger, Chad, Cameroon, and South Sudan – have yet to receive any vaccine doses. Moreover, a few weeks after launching vaccination programmes, some African countries are reportedly already running short on their supply of vaccines and will likely face delays in the immediate term.
In mid-March, reports indicated that the continent had received some 23.6 million doses, well short of the 1.5 billion vaccine doses that the Africa Centres for Disease Control (Africa CDC) estimates will be required to protect 60 percent of Africa’s population. For instance, in Kenya projections according to the current pace of vaccinations indicate that only 30 percent of the population will be vaccinated by 2023. At this rate, the majority of African countries are unlikely to attain herd immunity by 2022, defined by the WHO as the point at which 65 to 70 percent of the population is vaccinated.
Kenya: Chaotic vaccine delivery in Africa’s fastest growing economy
Kenya is set to be Africa’s fastest growing economy this year, at 7.6 percent gross domestic product growth forecast by the IMF in 2021. To attain this level of economic recovery, a sustained vaccination drive will be crucial. Kenya has received just over a million shots of the AstraZeneca vaccine through the COVAX initiative. In the meantime, there has been confusion about the status of the Russian Sputnik vaccine, which is already being distributed at private hospitals. Ministry of Health officials have denied authorising the drug and claimed to be unaware that Sputnik was in Kenya. The chaotic vaccine rollout in Kenya has also been marked by reports of expatriates jumping queues for vaccine delivery, even though the priority is by age group.
Moreover, the UK has warned that promised surplus AstraZeneca vaccines may not be delivered any time soon. Instead, new travel restrictions and quarantine requirements have been imposed between the two countries in response to a new surge in COVID-19 infections in Kenya. On 26 March, the Kenyan government announced tighter restrictions on Nairobi, Kajiado, Machakos, Kiambu, and Nakuru counties. All travel into and out of the five counties has been banned. This will have an anticipated impact on economic activity, although the latest measures show reluctance by the government to again lock down the informal economy in the country.
Expanding opportunities to acquire vaccines
Impediments to African vaccine access are diverse. From the supply side, many vaccine producers have guaranteed lower prices and prioritised the supply for those countries – mostly wealthy states in Europe and North America – that had invested in their research and development processes. For example, South Africa reportedly purchased doses of AstraZeneca-Oxford vaccine at almost two and a half times the price paid by most European states. The Moderna vaccine – which benefited from some USD 2.5 billion in funding from the US – will reportedly not be offered to poorer countries at all.
Other manufacturers, while intending to distribute their vaccines more broadly, have prioritised their home country’s needs in the face of resurgent waves of the virus. For instance, in late March, the Serum Institute of India, which has been producing the AstraZeneca-Oxford vaccine, ceased exporting doses in order to prioritise India’s domestic demand.
In the face of these obstacles, African states have steadily worked to broaden their means of accessing higher amounts of vaccine doses. The primary mechanism for acquiring vaccines has been the COVID-19 Vaccine Global Access (COVAX) facility, a multilateral initiative co-launched last year by the WHO, the Coalition for Epidemic Preparedness Innovations, and Gavi, the Vaccine Alliance. COVAX facilitates access to pooled state and donor funding in order to procure vaccines for lower and middle-income countries.
Deliveries of vaccines under the COVAX initiative started in February, and by mid-March, COVAX had delivered 16.6 million doses to more than half the countries on the continent. These doses have accounted for 90 percent of the vaccines received by African states. The initiative eventually aims to supply 600 million doses to African states, with a target of achieving an initial goal of 20 percent vaccine coverage.
In addition to COVAX, several additional African multilateral initiatives have been established over the past six months. Notably. at the start of the year, the Africa Medical Supplies Platform (AMSP) – an online medical procurement portal created by the AU in September 2020 – opened vaccine pre-orders for all 55 AU member states. The AMSP pools suppliers and aggregates demand in order to drive prices down, and is intended to create a more efficient and safer mechanism for African states to obtain more equitable access to vaccines. States without the financial means to pay immediately can apply for a line of credit to be extended to them by the African Export-Import Bank. Through this initiative, the AU has so far signed deals with vaccine producers for over 600 million vaccine doses for distribution to member states over 2021 and 2022.
Moreover, on 9 April, the World Bank Group said will have committed USD 2 billion in financing by the end of April for COVID-19 vaccines in some 40 developing countries. The USD 2 billion is part of a pool of some USD 12 billion that the World Bank has made available overall for vaccine development, distribution and production in low-and middle-income countries. The bank expects this to expand to USD 4 billion worth of commitments in 50 countries by mid-year.
Building local vaccine production
There is also a drive to increase domestic vaccine manufacturing capacity in Africa to make up the shortfall. Up until now, all of Africa’s COVID-19 vaccines have been imported from outside the continent. However, in South Africa, pharmaceutical company Aspen recently signed a deal with Johnson & Johnson to package 300 million doses of the company’s vaccine for worldwide distribution. In April, Egypt also reported that it had reached an agreement to locally produce the COVID-19 vaccine produced by China’s Sinovac Biotech Ltd, with an expected output of between 20-60 million doses per year.
Improved local production capacity is likely to ease some access issues, especially for those states hosting production facilities. For instance, after South African regulators approved Johnson & Johnson’s vaccine in late March, the country signed an agreement with the company for 30 million doses of vaccine, all of which are expected to be packaged at South Africa’s local facility. Kenya is also expected to access the Johnson & Johnson vaccine via South Africa from July onward.
While initiatives to increase vaccine access and accelerate the acquisition of vaccine doses are likely to offer a substantial boost to COVID-19 vaccination campaigns across Africa, progress is likely to continue to be uneven in the coming months, as we forecast in previous reports (see COVID-19 & AFRICA: CHALLENGES TO EQUITABLE VACCINE DISTRIBUTION). On 9 April, the Mo Ibrahim Foundation argued that vaccine access should be seen as security issue in Africa. It reports that the latest data shows a 9 percent rise in novel coronavirus cases in Africa in a month, and that the average 2.7 percent case fatality in Africa is now higher than the global average of 2.2 percent. By mid-March, the Foundation said, Africa had received just 0.5 percent of available global vaccines although the continent has 17 percent of the world’s population.
Vaccination campaigns are likely to face continued disruption as a result of expanding concerns over vaccine safety. Democratic Republic of Congo, Mali, and Cameroon have all suspended rollouts of the AstraZeneca-Oxford vaccine after European health regulators linked the vaccine to the appearance of blood clots in a small number of recipients. This also contributes to public vaccine hesitancy. For instance, in December 2020, the Africa CDC released the results of a survey conducted in 18 countries which showed that only 25 percent of respondents believed the COVID-19 vaccines to be safe.
Vaccine hesitancy has also been exacerbated by the widespread proliferation of misinformation. For example, one popular conspiracy theory holds that the vaccines were designed by Western countries as a sterilisation tool to limit population growth in Africa. Several states have launched public awareness and information campaigns to counter such misinformation, including through televised vaccinations of high-ranking government officials and other public figures. However, in some cases vaccine scepticism has extended to the government level; Madagascar and Tanzania have both continued to refuse to acquire vaccines, reportedly placing their trust in natural herbal therapeutic agents. This is likely to prove an impediment to attaining herd immunity and will slow the re-opening of African economies. For instance, recent surveys in Nigeria indicate that 50 percent of the population does not intend to get vaccinated.
Another source of uncertainty is the presence of a growing number of COVID-19 mutations, which may also undermine vaccination campaigns. World Health Organization (WHO) director-general Tedros Adhanom Ghebreyesus recently said that existing vaccines could be rendered ineffective if the virus continues to spread and mutate. Tedros has called for more political will to boost production of COVID-19 vaccines and share supplies, including through stalled intellectual property waiver on vaccines through the World Trade Organization.
There are at least four “variants of concern” currently in global circulation: two which were first reported in South Africa and the United Kingdom in December 2020, another reported in travellers from Brazil in January, and a variant discovered in travellers from Tanzania in late March (see TANZANIA: REPRESSIVE GOVERNMENT POLICY RISKS CREATING A CORONAVIRUS INCUBATOR COUNTRY). Some of these variants have exhibited the ability to evade vaccines. For instance, South Africa – which had acquired over one million doses of the AstraZeneca vaccine – abruptly delayed its vaccination campaign in early February following the emergence of evidence that the vaccine was less effective against the South African variant (see SOUTH AFRICA: CONTEST FOR POLITICAL CONTROL REACHES A NEW CLIMAX). According to researchers, given the slow pace of vaccinations, additional new variants are highly likely to emerge in the coming year, which may complicate vaccination efforts.
There is also significant uncertainty over how long the vaccines will confer protection for. The latest data on the Pfizer vaccine shows that recipients remain protected for up to six months after receiving the vaccine. This means that the COVID-19 vaccine roll-out may become an annual exercise, as is currently the case with the seasonal flu vaccine. This is likely to create a significant additional financial and logistical burden on African states, many of which are unlikely to have completed a first round of vaccinations by the end of 2022.