The current trajectory of global vaccine distribution points toward a “Great Divide” between countries with access to vaccines and those without. This divide will manifest in divergent recoveries from the dual health and economic crises. High-income countries with surplus supplies of vaccines and bolstered by unprecedented fiscal expansionary policy are projected to recover relatively quickly. Meanwhile, unvaccinated Africa is facing a protracted pandemic and economic slowdown. The risk of Africa being left behind, as that Great Divide widens, has never been more concerning.
The health impact has been severe. Both Covid-19 and policy measures enforced to combat the virus have had long-lasting consequences on health services in Africa. The continent has so far recorded more than 8.3 million Covid-19 cases and more than 200,000 deaths. Without equitable access of vaccines in Africa, health progress is at risk of being undone in the coming years.
The biggest long-running risk posed by Covid-19 is on routine immunisation drives. According to the World Health Organisation (WHO), more than one-third of countries are still reporting disruptions to immunisation services. For children, these disruptions have serious consequences. In 2020, 23 million children missed out on basic childhood inoculations as part of routine health-care programmes; this has been the highest number in more than a decade. The compound effects of this missed preventative care could lead to severe health outcomes, with specific concerns both about measles, one of the most contagious viruses known and a major cause of child mortality in low-income countries, and polio, the only virus currently on course for eradication but which clings on in some parts of the world. These impacts are more dire for African countries whose health systems are already being weakened from responding to Covid-19.
The economic impact has been equally serious. Though useful in controlling transmission, lockdowns and travel restrictions have damaged local economies highly dependent on informal sectors which often don’t have the resilience and fiscal support to bounce back quickly.
Modelling by the Economist Intelligence Unit predicts that developing economies will bear the brunt of output shortfalls because of global vaccine inequity. Countries that are unable to achieve at least 60 per cent vaccination coverage by mid-2022 will suffer $2.3 trillion in GDP losses by 2025. Sub-Saharan Africa will experience the highest losses in terms of GDP share, totalling 3 per cent of the region’s 2022 to 2025 output forecast.
Combined, these threaten to put Africa on the wrong side of that Great Divide in the world, between those with access to Covid-19 vaccines and those without.
There are three areas where African governments must change course to prevent this.
In the short term, increasing vaccine supply and facilitating speedy rollout while increasing absorptive capacity is vital. COVAX is currently the primary source of vaccines to the continent. To meet its year-end target for Africa, it must provide the continent with an additional 400 million doses, delivering in just three months more than five times the supply it has provided in the past seven. Yet even if COVAX meets this ambitious goal, this supply will only be enough to vaccinate 17.5 per cent of the total African population. An additional 600 million doses are needed to achieve the WHO’s 40 per cent coverage target by the end of 2021. These vaccines are expected to come from the African Union’s African Vaccine Acquisition Task Team (AVATT), bilateral purchases, and donations from countries with surplus doses. This ambitious goal and previous failure to meet commitments should serve as an alarm bell for African governments to ramp up efforts to obtain vaccines and look for longer-term solution for self-sustainability.
African countries have a low coverage of vaccination (as seen in Figure 1) with only 15 countries having met the 10 per cent target set by the WHO. In addition to the challenges of vaccinating the population, there are also challenges of vaccine absorption; on average African countries have administered about 54 percent of vaccines that they have received as of early October.
Figure 1 – Africa vaccine coverage (% of population)
Source: Africa CDC
Second, African countries also need support to build institutional strength. Managing a crisis such as Covid-19 calls for agile government systems, structures and skills to make policies and promise a reality. This means building institutional structures to allow clear coordination among different parts of government, putting in place systems to track progress targets and equipping staff with sufficient capacity to take on the challenges which the pandemic presents.
Third, African governments must do more to build Africa’s own capacity for vaccine manufacturing. Over the past months, there has been significant continental and global mobilisation to support vaccine manufacturing in the African continent, driven by the African Union (AU) and Africa Centres for Disease Control and Prevention (ACDC), notably through the launch of the Africa CDC-lead Partnership for African Vaccine Manufacturing (PAVM). More African countries need to engage with these initiatives. Furthermore, in addition to building new manufacturing plants, governments need to explore how to support existing African facilities to participate in the production of Covid-19 vaccines by creating incentives for the sector and seeking to integrate the capabilities of different countries into the global production chain. This will be an important step towards self-sufficiency for Africa, reducing its dependence on foreign support during future crises.
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