Arrival of 1bn vaccine doses won’t solve Africa’s Covid crisis, experts say | Global development
With 1bn doses of Covid vaccines expected to arrive in Africa in the coming months, concern has shifted to a global shortage of equipment required to deliver them, such as syringes, as well as insufficient planning in some countries that could create bottlenecks in the rollout.
After a troubled start to vaccination programmes on the continent, health officials are examining ways to encourage take-up as some countries have had to throw away doses.
Critics have blamed hoarding of vaccine doses by a handful of western countries for a situation in which only 7.5% of people in African countries have been vaccinated – which some argue led to the emergence of the Omicron variant in southern Africa – but health experts point to a wider series of issues.
The World Health Organization says a shortage of syringes – in particular a 0.3ml syringe version required to deliver the Pfizer dose – may slow delivery, and it has stepped up technical assistance missions in 15 countries that have lagged behind.
Figures show a wide disparity in what has been achieved, with 15 countries reaching a target of 10% of the population vaccinated by the end of September, and more than half struggling to reach a third of that number.
Among the success stories have been some smaller island states, including Seychelles and Mauritius, which have vaccinated more than 60% of their populations, and Morocco has reached 48%.
The case of South Africa – which had vaccinated 40% of its population as of 3 December – highlights some of the complexities involved.
With sufficient doses for an estimated 150 days of vaccination, it has cancelled some vaccine shipments as it has tried to reinvigorate a campaign that had met resistance from some sections of the population, not least in the 18-34 age group.
Some of South Africa’s vaccine supply problems were self-inflicted, including being slow to initially secure stock. There have also been technological issues, with requirements to register using a phone or computer creating a digital barrier in a country where only 60% of people are internet users.
Dr Richard Mihigo, a WHO programme coordinator, said there had been a “start and stop” approach to vaccine drives in Africa in recent months.
“The first doses arrived in Ghana in March and there were a lot of promises from Covax [the global vaccine consortium] that countries would receive their allocations. But that delivery was stopped when India halted delivery from the Serum Institute [in the midst of its own outbreak] earlier this year,” he said.
“That start was not ideal. Since then, however, the situation has stabilised. Now the prospects through March 2022 looks very good with almost 1bn doses forecast to arrive, which in theory could cover 70% of the African population.”
Set against that, however, has been the struggle of some countries to deliver what doses they have – because of instability, for example in the Democratic Republic of the Congo and Nigeria; health systems with poor reach, especially outside big cities; and vaccine hesitancy around the Covid jab.
Nigeria’s underfunded health system lacks everyday supplies such as cotton swabs. Spotty power supply means fridges holding vaccines need to be kept on expensive fuel generators, and millions of citizens live in areas racked by banditry or Islamist insurgencies that medics cannot reach.
Nigeria’s health minister, Osagie Ehanire, said last week: “The foundation is not strong. And if you don’t have a strong foundation, there’s not much you can build on top.”
Hesitancy has been driven by a combination of factors on a continent that in general, studies suggest, has far higher rates of vaccine acceptance than the US. The huge amount of misinformation that has circulated globally is partly to blame, but there are also economic reasons.
David Harrison, the head of the nonprofit DG Murray Trust in South Africa, said some were reluctant to give up a day’s work or pay to travel to a vaccination site. “Twelve million people applied for an R350 (£16) emergency Covid-19 relief grant,” he said. “If you’re asking those people to pay R20 for a taxi fare to and from a vaccine site, it’s a significant trade-off.”
Mihigo, of the WHO, echoed this point. “To make sure more and more of the available vaccine can be put in arms of the people, we need to focus attention on providing additional incentives to people to get vaccinated without compromising their livelihoods.
“I was in DRC recently and I heard someone say precisely this. They can’t afford to travel and then wait in a vaccination centre for two hours.”
Writing in South Africa’s Mail and Guardian this week, Anand Madhvani, a co-founder of Covid Kenya – a group of volunteers that uses social media to create awareness about Covid-19 issues – raised local inequalities in vaccine access.
“In many African countries we have some existing systems for vaccinations, but these require massive expansion and support for mass adult campaigns – even once a steady supply of vaccines is available,” he wrote. “In Kenya, where I work, we needed high-profile local language vaccination campaigns. There is deep inequality within our countries. Relative elites in capitals quickly got themselves vaccinated but stopped pushing for everyone.”
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