Assessing the Implications of Inequity and Boosters on Africa’s Vaccination Efforts

Covid-19

Assessing the Implications of Inequity and Boosters on Africa’s Vaccination Efforts

Commentary
Posted on: 5th August 2021
Hayley Andersen
Associate

The emergence of the significantly more transmissible Delta variant, and the new wave of infections it is driving globally, underscores the urgency in vaccinating the world as quickly as possible.

Despite this, massive inequity in global vaccine supply persists. Of the nearly four billion doses administered globally to date, high- and upper-middle-income countries account for 83 per cent, whereas their low-income counterparts make up just 0.3 per cent.

Chart showing percentage of global doses administered per income group

Source: Climate Action Tracker/Our World in Data

Africa, which represents over 17 per cent of the global population, has administered just 1.6 per cent of global vaccinations.

% global population vs % global doses administered per region

Source: TBI Africa Covid-19 Vaccine Tracker, July 2021

The enormous disparity in vaccine distribution is largely the result of the financial and “home-court” manufacturing advantages that high-income countries had in early procurement. Of the 10.9 billion vaccine doses projected to be manufactured globally by the end of 2021, 9.9 billion have already been sold, leaving low- and middle-income countries (LMICs) dependent on the success of the COVAX Advance Market Commitment (COVAX AMC) facility – and the goodwill of bilateral relations – to obtain supply.

COVAX was due to deliver 75.5 million doses to participating African countries by the end of May but, as of late July, only 28.5 million vaccines had been received – less than half the original mid-year target. Due to these shortfalls, African countries have sought out alternative means of procurement through bilateral deals and donations and via the African Vaccine Acquisition Task Team multilateral partnership, which aims to supplement the efforts of COVAX to achieve 60 per cent population coverage. To date, however, these methods have not been enough to close the supply gap.

COVAX deliveries to Africa

Source: TBI Africa Covid-19 Vaccine Tracker, July 2021

COVAX has missed its target largely due to the export restrictions imposed by India during the country’s own devastating wave of infections in May. These restrictions remain in place. The Serum Institute of India had been expected to produce as much as 45 per cent of total COVAX supply by the end of this year. But targets have also been missed as a result of export limitations imposed by other countries, delays in clinical trials, manufacturing scale-up issues and donor countries that have not followed through on payment commitments, which has impeded the facility’s ability to make advance purchases. The newly announced mechanism between COVAX and the World Bank is meant to ease these financial constraints, though it currently lacks details.

Still, COVAX anticipates these challenges will begin to subside by the fourth quarter of 2021 as new vaccines (such as Novavax) receive WHO Emergency Use Listing approval, manufacturing expands and bottlenecks are smoothed out, and export restrictions lift. High-income countries with slowing vaccination rates and surplus vaccines are expected to begin ramping up donations. In June, the G7 committed to sharing at least 870 million vaccines with lower-income nations over the course of the year, with about 350 million possibly coming through by the fourth quarter.

With this anticipated influx of vaccines, COVAX estimates it will still be able to deliver enough vaccines to Africa to cover 23 per cent of the population by the end of the year, closing a 490-million-dose supply gap.

Yet some have cast doubt on this forecast, as it depends on numerous factors including regulatory approval of new vaccines, successful manufacturing scale-up at new production facilities and the lifting of export restrictions. For these reasons, analytics company Airfinity predicts a 24.3 per cent shortfall in COVAX 2021 deliveries. Furthermore, the projection assumes that countries with commitments to share their surplus vaccines will actually do so.

Will Boosters Widen the Supply Gap in LMICs?

Amid reports of breakthrough infections among the vaccinated and preliminary findings suggesting a slight waning in immunity six months after full vaccination, for example, in the case of Pfizer, a number of countries are already discussing the potential need for a third booster dose. Many, like the US, UK, UAE and Israel, have some of the highest-vaccination rates in the world and are equally among those that have promised to share doses.

The potential of a booster shot, especially when seen as providing improved protection against variants like Delta, should raise the alarm in countries that have yet to finish vaccinating even their most high-risk and vulnerable groups.

If boosters are approved, the supply that was expected to be donated to LMICs in the coming months is likely to be cut back, as these doses are instead used to provide a third jab to already-immunised populations. One health expert estimates that booster doses could redirect between 1 and 2 billion vaccines away from LMICs within the next year. 

Boosters could not only create enduring supply gaps in Africa but also mean an increase in the doses needed for each country to fully vaccinate their respective populations. In other words, our analysis suggests that if a third dose becomes standard, Africa will need an additional near-one billion vaccines to achieve 70 per cent population immunity.

While many are adopting a hopeful outlook on supply for the year-end – and countries should indeed be building their absorptive capacities now to ensure additional doses can be administered as soon as they’re received – ongoing production challenges and the possibility of booster shots threaten to derail existing targets in LMICs. African countries will therefore need to increase their advocacy for dose-sharing and ensure donor countries meet their current commitments.

Lead Image: Getty Images

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