Is Africa Ready for the COVID-19 Vaccination Drive?
By Kaushal Shah
Meticulous planning is key to ensuring the COVID-19 vaccines reach all priority groups, wherever they are, in every single African country.
Ms. Kaushal Shah
This article looks at:
Challenges in vaccine access, procurement, financing, delivery and uptake
Public-private partnerships and how they can take us forward in achieving vaccine coverage
The speed at which the COVID-19 vaccine was developed is the medical breakthrough of our lifetimes with the scientific community creating multiple candidate vaccines within a year of the discovery of the novel virus. Now the focus has shifted to how successfully and quickly the vaccines can be administered to the global population. The scale of the challenge is immense and for Africa this is the largest immunisation drive in the continent’s history.
Coordination and Collaboration
Although existing structures used for routine immunisations should be leveraged, the scale and speed of the COVID-19 immunisation campaign calls for leadership beyond the Ministry of Health. Government bodies, policy makers, healthcare professionals, the private sector, community groups, development organisations and other stakeholders will need to work collaboratively to roll out effective immunisation programs across a continent of more than 1.3 billion people. The successful rollout of vaccines will require the timely execution of an interconnected chain of processes, including:
Securing access to sufficient volumes of the vaccine
Mobilisation of funds for vaccine procurement distribution of the vaccines across a continent that spans 30.3 million km2
Setting up cold storage facilities
Healthcare workforce capacity building
Distribution of ancillary vaccine supplies to vaccine centres
Public education regarding the vaccine
The management and monitoring of vaccine programs including prioritising target populations and maintaining immunisation registries
All this will need to be carried out while large numbers of the population continue to contract the virus and economies continue to struggle. Globally, the total number of confirmed COVID-19 cases since the start of the pandemic reached almost 129 million and the number of global deaths reached close to three million as of 31 March 2021. The African continent, home to nearly 20% of the worldu2019s population, recorded about four million COVID-19 cases and a total of approximately 113,000 deaths as of 31 March 2021. Africa accounted for 3.2% of the total global cases and 4.0% of global deaths as of 31 March 2021.
Access to Vaccines
Africa is dependent on the success of the COVID-19 Vaccine Global Access (COVAX) Facility to secure the majority of its vaccine supply. COVAX is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi and the World Health Organization (WHO), alongside key delivery partner UNICEF. COVAX aims to accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for every country in the world.
COVAX has agreements in place to access just over two billion doses of vaccine candidates. Based on this, COVAX aims to protect at least 20% of each participating population by the end of the year. A minimum of 1.3 billion doses are to be made available to the 92 economies eligible by the end of 2021.
In this regard, African nations started receiving free doses of the vaccine developed by AstraZeneca and the University of Oxford from COVAX in late February 2021, with the expectation that they would receive follow-up shipments in the following months. Ghana received 600,000 doses on 24 February 2021 u2013 the first African country to receive vaccines from the COVAX facility. By the end of March 2021, it was reported that COVAX had supplied nearly 16 million doses to 28 African countries since launching deliveries to the continent. In total, 44 African countries had received vaccines through the COVAX Facility and through other donations and bilateral agreements by the end of March 2021, and 32 of them had begun vaccinations.
Just the Start
While the vaccine deliveries in the first quarter of 2021 have enabled many African countries to roll out vaccinations, the continent is yet to secure adequate volumes of vaccines to support mass immunisation programs. As of 30 March 2021, a total of 547,727,346 vaccine doses had been administered globally, with the United States accounting for 25% of the vaccines administered. As of 30 March 2021, a total of 10,156,566 vaccinations had been administered in Africa, which represents just 1.8% of total global vaccinations. To achieve the goal of vaccinating 60% of the population on the continent required to attain herd immunity, in addition to securing sufficient volumes of vaccines, African countries need to establish robust systems for rolling out rapid and efficient vaccination campaigns.
Additional Funding for Ongoing Vaccine Procurement
While interventions such as COVAX and the African Vaccine Acquisition Task Team (AVATT) are allowing for access to vaccines at no cost or a low cost, it is vital that in the coming years African governments are able to allocate additional financial resources to purchase sufficient vaccine volumes.
India’s recent announcement that it is restricting the export of COVID-19 vaccines means the African continent might not reach the goal of vaccinating 30% of its population by the end of 2021. The move by India is creating uncertainty around when African nations might receive shipments of doses from the COVAX Facility produced by the Serum Institute of India.
As the result of a procurement agreement signed on 28 March 2021, all African Union Member States, through the AVAT, will have access to 220 million doses of the Johnson & Johnson single-shot COVID-19 vaccine, with the potential to order an additional 180 million doses. The countries will be able to purchase the vaccines either using cash or a facility from Afreximbank. However, the 220 million initial doses from Johnson & Johnson will not become available until the third quarter of this year, with the rest expected next year. This leaves a several-month gap, putting countries in a state of limbo regarding existing doses supplied by COVAX.
Additionally, if funding gaps to operationalise rollout activities are not closed, there are significant risks, including vaccines expiring while sitting unmoved from central warehouse shelves and insufficient administration sites, resulting in low coverage.
Supply Chain Strengthening
The success of the mass immunisation drive in Africa relies heavily on the supply of vaccines to each country and the supply chain infrastructure within countries u2013 a particular issue for a continent with large, geographically remote and rural populations. Once cleared through ports of entry, the vaccines need to be inventoried, batch tested, allocated for regional distribution based on population demographics and then transported around the country.
Investments in the establishment of cold chain facilities spanning the entire supply chain, from shipment to delivery, will be critical. Additionally, the distribution of ancillary vaccine supplies, such as syringes, will also require effective coordination and collaboration. Particularly challenging will be the last-mile delivery of vaccines to rural areas.
Healthcare Workforce Capacity Building
Governments will need to train and build the capacity of healthcare workers at all levels of the healthcare human resource spectrum. All health workers involved in the implementation of COVID-19 vaccination will need to have adequate knowledge and skills to ensure safe and efficient COVID-19 vaccine administration, in addition to an understanding of cold-chain requirements, vaccine storage techniques and the correct procedures for waste disposal. Furthermore, healthcare workers should be trained and equipped to manage the enormous pressure and workload that will come with mass immunisation and information dissemination. Insufficient or poorly trained staff and planning will result in vaccine and resource waste and, ultimately, missed target goals.
Governments will need to instil public confidence in order to allow for the successful adoption of vaccines. Public communication, messaging and education will be required to ensure that populations are aware of vaccination drives and that populations choose to receive the vaccine. It will not be a straightforward task due to differing and changing opinions and views, variable trust in public health communications, fragmented news and misinformation.
Populations will want answers to many questions, including: Is the vaccine safe? Who are the priority groups that will receive the vaccine first? Which vaccine will we receive? Where can I get vaccinated? Is the vaccine free? Are there side effects? When can I get a second dose?
Additionally, the magnitude of immunising the African content in the coming months and years will require collective action from both the public and private sector. With regards to the private sector, organisations can engage with governments, customs authorities, and nongovernmental organisations to enter public-private partnerships that ensure the fast and safe movement of vaccines into and within Africa.
Additionally, the private sector can assist in healthcare workforce training, asset sharing (private facilities can be used for vaccine storage and private hospitals and healthcare workers can be utilised for immunisation drives), public education regarding the vaccine and managing and monitoring vaccine programs, including prioritising target populations and maintaining immunisation registries using digital technologies that may not be readily available to the public health authorities. Digitised, up-to-date demographic data will significantly improve pre-delivery planning, including accuracy of demand and supply forecasting. In the delivery and post-delivery phases, digitisation of data will enable real-time situation monitoring and swift issue mitigation.
Although African countries are lagging behind developed economies in terms of their access to COVID-19 vaccinations, it is vital that governments learn from the experiences of other nations and adopt more efficient immunisation programs. An inadequate cold chain will lead to vaccine spoilage. An inadequately trained workforce and uninformed public will lead to vaccine wastage. The COVID-19 pandemic ends with successful global vaccine deployment.