Governments in Africa Must Act on Vaccine Absorption – Before New Stock Arrives

Africa still lags behind the global vaccination average, with just over 2 per cent of people having had a vaccine so far. On the advice of the World Health Organisation, many countries raced to get first shots into arms rather than stockpile them for second doses. With the suspension of exports from India, however – a key source of vaccines for nations heavily reliant on COVAX – many must now contend with not having second doses in time, even as the Delta variant seems to be driving a third wave in several countries, creating unprecedented infection rates.

Naturally, policymakers are currently focused on finding more vaccines as quickly as possible. But even with the growing global willingness to cooperate on sharing excess supplies, and with new manufacturing coming online, it is very likely that over the next few months, as more vaccines and therapies become available, some countries will struggle to administer the new stock quickly enough. Indeed, there is already evidence of countries (Malawi and the Democratic Republic of the Congo, for example) destroying the last batches of some of their vaccines because they expired before they could be used.

There are three main drivers of the low vaccination rates in many African countries:

Lack of Vaccine Supplies. The ban on exports from India has significantly impacted many countries that relied on the COVAX initiative for the bulk of their Covid-19 vaccines.

Challenges Accessing Finance. Many low- and middle-income countries face challenges accessing existing financing (World Bank, Afreximbank, and so on) and other mechanisms to support their vaccine procurement and rollout.

Low Vaccine Absorption Rates. Even with existing supplies, absorption rates remain low in many countries. This is driven by a combination of low political will, limited planning, delivery resources and systems, and vaccine hesitancy.

Each of these challenges has different levers – international and domestic – and we think policymakers should be targeting all three now.

We recommend that countries start to work early on their financial planning and robust supply arrangements to access stock coming online. This is even more crucial in terms of new therapies and vaccine boosters that are in development – otherwise the challenges in accessing the first wave of vaccines will be repeated in a few months. Multilateral African medical and financial organisations (Afreximbank, African Development Bank, Africa Centres for Diseases Control and Prevention) offer windows and support mechanisms that many countries are yet to fully access.

Map Your Demographics Today

Many countries are likely to find that the logistical challenges of vaccine deployment grow exponentially as they move beyond immunising health-care workers to identifying and delivering vaccines to vulnerable groups in the wider population. Some of these groups may not be able to come to hospital. Unless countries move now to map these demographics, working with local communities and organisations, precious time will be lost once vaccines arrive. The same applies to mapping an even bigger and accelerating second-phase rollout because transport, cold chain, verification and so on all require investment and planning. It is important to redouble efforts to access funds available for strengthening cold chains, logistics and human resources. This also means determining deployment strategies, doing dry runs to spot and fix wrinkles in operational planning, and making sure the Covid-19 vaccine rollout doesn’t significantly impact other annual vaccination programmes for measles, meningitis and other viruses and infections more deadly than Covid-19.

It is also important to understand that restricted supply, finance, logistics and distribution are only parts of the reason why vaccination rates are low in Africa. Hesitancy has been taking root in parts of the continent as conspiracy theories related to vaccines have increased. Before the vaccines were deployed, data seemed to suggest that Africans were more willing to take the shots in the second half of 2020 than compared to March 2021, for example, when a more recent 15-country survey indicated some worrying trends in the other direction. For example, in Tunisia and Ethiopia the survey found that 9 in 10 surveyed residents are willing but this number drops to 8 in 10 and 6 in 10 in Nigeria and the DRC respectively. The latter are two of the largest countries on the continent.

The data we link to above is from the end of last year. During the past six months, we have seen confusion over regulatory advice on vaccine safety and effectiveness by different governments across the world as well as conspiracy theories gaining more traction. This has been exacerbated by confusing recent messaging around whether vaccines stop both infections and transmission.

All these factors are likely to mean that each policymaker needs up-to-date and country-, region- and district-specific analyses of knowledge and perceptions around vaccines as they stand now.   Policymakers should consider preparing a revamp of their public engagement to influence attitudes around vaccine uptake. These should both be targeted to address observed drivers of hesitancy but also more broadly re-engage people on the facts around the emergence of new variants, the need for taking personal responsibility in stemming transmission and the role that vaccines play.

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