Operation Bottleneck: Three Steps to Increase Africa’s Capacity to Deliver Covid-19 Vaccines

Covid-19

Operation Bottleneck: Three Steps to Increase Africa’s Capacity to Deliver Covid-19 Vaccines

Commentary
Posted on: 4th March 2022
Adam Bradshaw
Senior Covid-19 Policy Adviser

Covid-19 vaccines are piling up in landfills in the European Union and this is only the beginning of what will likely result in the destruction of billions of doses by the end of 2022. 

Analysis from The People’s Vaccine shows that the EU is set to destroy 55 million vaccine doses by the end of February 2022. This is 25 million more doses than have been donated to Africa so far this year. By September 2021, the US had reportedly already destroyed 34 million doses while Indonesia recently tossed out a million shots due to their short shelf life. Airfinity analysis shows that, by December 2021, G7 countries would have let a grand total of 107 million doses expire.  

Before the pandemic, global vaccine-production capacity stood at 5 billion doses per year. This has now increased to 12 billion doses per year for Covid-19 alone and is estimated to reach 24 billion by mid-2022. These volumes are unprecedented. Yet while the ability to produce vaccines has increased, absorptive capacity to administer them has not been able to keep up.   

African countries have been the subject of numerous reports of vaccine wastage – mostly due to vaccines that were about to expire being dumped on them. Yet in reality, only around 2.8 million vaccines have expired so far across the continent. This is just 0.5 per cent of the total vaccines received.  

High-income countries – which have escaped the brunt of this negative coverage – have destroyed a far greater proportion of vaccines, with some countries disposing of as much as 25 per cent of certain vaccines

Why, if we are still in the middle of the pandemic, are vaccines expiring en masse rather than being diverted to where they are most needed? And, most importantly, how can this be avoided in the future? 

Why Are Vaccines Being Left to Expire? 

When Covid vaccines first came on the market, the African Union was able to order only 0.2 doses per person. By comparison, high-income countries were able to order significantly more: Canada ordered 9.6 doses per person, the UK 5.5 doses per person, and the EU 3.5 doses per person. This mass purchasing effectively shut African and other lower-income countries out of the marketplace. Once the vaccination campaigns in high-income countries hit full saturation – everyone having had a second or third dose – demand plummeted, and vaccines began accumulating in warehouses. 

High-income countries recognised this and began to offload vaccines – often with shelf lives of just weeks or a few months – to African and other lower-income countries. This shifted the problem of expiring vaccines. Yet despite the often ad-hoc deliveries with differing brands, timings and quantities, it was reported by the Africa Centres for Disease Control and Prevention (Africa CDC) that 99.5 per cent of these donated vaccines did not expire.   

Today, supply is no longer an issue. In December 2021, COVAX delivered about 300 million vaccine doses to mostly low- and middle-income countries (LMICs), roughly one third of the total number of vaccine doses COVAX delivered in all of 2021. This ramped up COVAX’s numbers but also contributed to the growing stockpile in LMICs. While at the same time, demand across the globe for vaccines continues to drop – COVAX has 436 million doses to allocate when low-income countries asked for only 100 million, the first time supply has outstripped demand. Vaccines are now available in abundance for African countries. 

Countries in Africa are now dealing with bottlenecks in vaccine administration that are a result of this increased supply. The immediate bottleneck was short vaccine shelf lives, making it difficult to align vaccines with the national vaccination programme and plan out the use of those doses. This was partly resolved when the Africa CDC stated that African countries would no longer accept vaccines with shelf lives of less than three months. Directly following this announcement, more than 100 million doses were rejected for delivery in low-income countries in December 2021 alone, pointing to the enormous volume of vaccines that had already been donated with a short shelf-life. 

Nonetheless, the baseline capacity to absorb vaccines across Africa falls well behind the global manufacturing capacity of 12 billion vaccines a year, and there is a growing stockpile. In Africa, this stockpile is currently in the hundreds of millions, and they will eventually expire without international efforts to support African countries to administer them.  

The Tony Blair Institute for Global Change is supporting several countries in Africa to improve delivery of Covid vaccines. Through this work, TBI has gathered on-the-ground information that indicates the most critical bottlenecks for vaccine rollout are: 

  1. Financial cost of vaccine delivery: Mobilisation of financial resources to cover immunisation expenses, deployment of vaccines, operational costs, storage costs, and one-time costs versus ongoing costs. 
  2. Workforce: There are not enough people available for Covid vaccination campaigns without eviscerating the wider health system – often one person is doing the job of six people. 
  3. Insufficient investment in community mobilisation campaigns: There are large pockets of low demand across African countries that can be resolved by intense community mobilisation campaigns, but these are expensive. 
  4. Vaccine-data management: Untimely collection and dissemination of data hinders the vaccination effort. 

Taken together, these bottlenecks slow the absorption rate across the continent. Across Africa, the continental absorption rate – the percentage of received doses administered – is 63 per cent. That means that for every 100 doses provided, 63 will be administered.  

The financial cost of resolving these bottlenecks and getting vaccines into arms will be significantly less than the health, economic and social costs of letting people go unvaccinated.  

These bottlenecks will not be resolved overnight. Countries, multilateral institutions, and other donors will have to work within these constraints, but there are practical steps that can be taken now to resolve vaccination bottlenecks and minimise vaccine expiry in 2022.

First, there is an urgent need to create a dashboard or mechanism through which donating countries and COVAX can match the available vaccine supply to countries with high rates of vaccine absorption. This will reduce the number of wasted doses and allow more accurate matching of supply to demand. 

Second, all vaccines must be donated with at least three months’ shelf life to give countries enough time to plan and feed the vaccines into their vaccination rollout.  

Third, countries need to prioritise assistance for what will be the main challenge of 2022: vaccine delivery. This challenge is solvable – but only if African countries are empowered to meet it with financial and delivery support. Supply is no longer an issue and efforts should focus on resolving the critical delivery challenges such as ensuring that vaccinators who use donated vehicles are also given the financial ability to pay for fuel for these vehicles to travel to more remote areas.  

Over the coming months, the world will watch as vaccines are destroyed by the millions. The goal now should be to try and use as many of these as possible before they expire.  

Lead Image: Getty Images

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