This week we are concerned about the growing spread of the B.1.617 Covid-19 strain (first recorded in India in March and suspected of driving case numbers there) in African countries. The World Health Organisation (WHO) has classified it as the fourth “variant of concern”, along with the UK variant (B.1.1.7), the South African (B.1.351) and the Brazilian (P.1).
This classification is based on the unique risks posed by a variant of increased transmissibility, more severe clinical effects and potentially reduced effects of antibodies or vaccines. This strain’s “double mutations” mean it is the first time a variant has been identified with both higher transmissibility and a potential ability to resist antibodies and/or some vaccines. This latter risk is yet to be properly evaluated with enough data, but populations are likely better off with the vaccine than without, hence the relevance of vaccinating; a person's infection is likely to be less severe even if they go on to contract Covid-19 post-vaccination, and there are other mutants we are contending with beyond just the Indian one.
The WHO has reported the presence of the strain in 44 countries globally, including seven in Africa: South Africa, Morocco, Uganda, the Democratic Republic of the Congo, Nigeria, Algeria and Kenya.
Our concern is driven by the potential risks B.1.617’s double mutation poses to pandemic containment efforts, given the current low rate of vaccination in Africa. Africa has currently vaccinated less than 2 per cent of its population, compared to global average of 9 per cent and much higher rates elsewhere.
Figure 1 – Share of people receiving at least one dose of Covid-19 vaccine, 16 May 2021
With cases rising in a number of African countries, some of those affected by this new strain – like Nigeria – have introduced some movement restrictions and targeted travel bans. We are concerned the recent Eid celebrations may drive a surge in new cases over the next few weeks across the continent more widely.
Countries relying on vaccine supplies from India face difficult choices following the recent ban on vaccine exports from the Serum Institute of India, the largest single supplier to the COVAX scheme. COVAX is 140 million doses short because of India's continuing Covid-19 crisis and the Serum Institute has made none of its planned shipments since exports were suspended in March.
As a result, there is a significant risk this new strain and others will drive infections on the continent just as vaccination slows. Several African countries are close to exhausting their COVAX supplies over the next month or so.
Figure 2 – Vaccine doses received/expected through May via COVAX
At least seven African countries have used up 90 per cent or more of their COVAX supplies. Kenya, for example, has so far managed a higher vaccination rate than the average on the continent (over 1.74 per cent of its population was vaccinated as of last week, compared to the continental average of around 1.3 per cent). It has also succeeded in steadily bringing down transmission rates over the last month. But it has used over 90 per cent of its stocks in its drive and relies heavily on COVAX. In early May, the country recorded five cases of B.1.617, with a further 15 identified last week – illustrating the challenges its leaders, like many others contending with this new strain, face.
A combination of low testing and uneven genome sequencing means the extent of new variant spread could already be underestimated across the continent and countries like Kenya need support to boost their vaccine supply as a matter of urgency.
Policymakers should redouble their efforts to expand vaccine sources. In the immediate term consider targeted containment measures (as in Nigeria), especially following the recent Muslim Eid festival which saw large gatherings in many countries.
The importance of increasing vaccine supply overall to reduce reliance on one or two sources is greater than ever. This includes accelerating efforts to transfer spare vaccines from other countries and expanding production.
Lead Image: Getty Images