News of the successful development of a vaccine against the virus that causes Covid-19 was met with a global sigh of relief. Vaccine distribution is slated to start in early 2021. Where does Africa stand in this scenario?
Already, Oxfam has cautioned that rich countries, representing 13 per cent of the global population, have claimed half of all the Covid-19 vaccine doses that will be made available. This means that many African countries may have to wait until 2022 to get sufficient vaccines for their populations.
However, there is hope on the horizon, with a robust vaccine pipeline. There are many candidates on a variety of platforms and technologies with results expected in the first half of 2021, with the initial millions of doses delivered by mid-2021.
Proposed strategies for improvement have focused on ensuring vaccine availability, minimising stock-outs, and enhancing vaccination coverage. The transport, energy, and health sectors together form the core of the logistical infrastructure from the time the vaccines are manufactured, delivered to central storage points, distributed, and administered to a recipient at a specified location.
Globally, immunisation is recognised as one of the most successful and cost-effective public health interventions, reducing infectious disease-related morbidly and mortality of children at a low cost, and saving millions of lives. However, achieving universal immunisation coverage continues to be a challenge.
The Covid-19 death rate in Africa has been lower than Europe and the Americas, with the bulk of reported cases and deaths (75 per cent) concentrated in five countries, namely South Africa, Morocco, Egypt, Ethiopia, and Tunisia. On the flip side, due to the higher levels of poverty and weak health systems, millions of people have been pushed deeper into poverty, and the disease burden has gone up, with routine immunisation and essential maternal and child health services declining, as well as HIV, TB and malaria care. The rapid increase in Covid-19 cases is causing a significant loss of life and overwhelming many health systems.
The majority of the Low and Middle Income Countries (LMICs) are working through the COVAX facility - a partnership of the World Health Organisation (WHO), Gavi, and the Coalition for Epidemic Preparedness Innovations (CEPI) – to secure subsidised vaccines for their populations.
WHO Africa estimates that the cost of rolling out a two-dose regimen of the Covid-19 vaccine to priority populations in Africa will be around $5.7 billion. An additional 15-20 per cent will be required for associated materials (syringes and needles) and the delivery of vaccines (trained health workers, supply chain, logistics, risk communication, community mobilisation, and monitoring of any adverse events). However, the final prices have still to be determined and discussions with COVAX are in progress to determine if further subsidies can be provided, including free vaccines for priority targets in LMICs.
Lack of access and inadequate health systems have shaped the narrative in Africa regarding epidemics, from HIV to H5NI influenza and now Covid-19. Africans have perished while awaiting donor/development support to purchase needed supplies for diagnosis and treatment. The newly established Africa Centres for Disease Control (CDC) created a partnership to accelerate Covid-19 testing to fill this gap. The situation is somewhat better as countries have started to manufacture test kits locally in Ethiopia, Kenya, Nigeria, Morocco, Senegal, and South Africa.
Due to the limited quantities of vaccines that will be available in the early stages, COVAX will initially focus on 3 per cent of the population (health workers and people with underlying conditions), progressively increasing to 16-20 per cent as more vaccines become available.
Estimates suggest that vaccination levels of 60-70 per cent are needed to achieve herd immunity, the level at which most people are protected against a virus. Africa will need 1.5 billion doses to vaccinate 60 per cent of its population of 1.2 billion, assuming there are two doses per vaccine. Given that up to 80 per cent of the projected production for 2021 has already been secured by developed countries, a more realistic option is for the continent to collectively negotiate directly with vaccine manufacturers to secure additional supplies under bilateral arrangements.
Obtaining and delivering the Covid-19 vaccines while continuing with routine immunisation will present a range of formidable challenges. Now is the time to create an enabling environment, and a preparedness assessment is key to this process. With the first vaccines projected to become more available in the early part of 2021, the window for planning and preparation is now.
The immediate goal for each country is to efficiently execute complex immunisation campaigns simultaneously, to multiple “non-traditional” immunisation target groups in each country. Establishing a strategic framework for collaboration with Unicef, WHO, Gavi, local and regional regulatory agencies, development partners, the private sector, and civil society is the starting point. At the implementation level, institutions or groups with structures to manage logistics in disasters or emergencies such as the military, or those with a comparative advantage in logistics, information systems, and communication, such as private sector suppliers of fast-moving goods, should be co-opted into this framework. The preparedness assessment should inform vaccine delivery and distribution; public communication and education; mobilisation, recruitment, training, and monitoring of healthcare workers and volunteers; as well as safe and efficient administration of Covid-19 vaccines.
The first doses
The key question of who should receive the first doses of the vaccine is complex and should be determined in the earliest stages of planning. For example, frontline workers are often at the top of the proposed priority lists.
Risk communication should underpin the entire vaccination effort to improve uptake by providing beneficial information, addressing misinformation and rumours, and targeting specific factors driving vaccine hesitancy in the different contexts. An active social media campaign can mitigate issues as they arise and improve overall outcomes.
Last but not least, all these efforts are worth little without a robust surveillance system in place for early detection and rapid, targeted responses. In order to ensure appropriate vaccine reporting, monitoring, and evaluation, countries should begin to prepare and improve their vaccine management, reporting, monitoring, and evaluation systems to reduce stock-outs and wastage, and to ensure proper re-allocation and accountability.
Countries worldwide are still figuring out the best information system to manage this entire Covid-19 vaccine process, including distribution and quality assurance, especially where multiple doses are required. At operational level, individuals need to know what vaccine they are getting and remember or be reminded to get the second dose; health providers need to keep track of who has received what vaccines so they can provide the correct second dose; and above all, the government needs to distribute the right type of vaccines to the right geographic regions to avoid stock-outs, especially when people are ready for the second dose.
Africa is in a unique situation. The African Union has established Africa CDC, a specialised health agency dedicated to Africa that is leading the fight against Covid-19 in the region. It is currently engaged with various development partners, researchers, and pharmaceutical companies to explore how Africa can obtain and distribute the Covid-19 vaccine.
Grace Mercy Osewe is Senior Public Health Specialist and Managing Director, MDA Health Consulting Limited