Insufficient doses, poor uptake of the coronavirus vaccine by priority groups, inadequate trained staff for distribution, and scepticism about their safety and efficacy continue to define Africa’s efforts at inoculating people against Covid-19.
The continent continues to lag behind in acquiring Covid-19 vaccines and is losing the race to get herd immunity. Africa has the slowest vaccination rate, with many countries yet to start mass campaigns.
Amid hesitancy among priority groups, some countries are facing the challenge of using their doses before they expire, compelling health ministries to open up the inoculation to other categories of people than were previously planned for.
In Uganda, the Health ministry recently changed its programme. Initially, vaccination was supposed to start with health workers, teachers, security personnel, persons living with underlying conditions and those aged 50 and above. However, since many in these categories were shunning the vaccine, the schedule has changed.
Now companies, individuals and whoever comes in is vaccinated. Vaccination has been opened up to persons aged 18 and above with underlying conditions, and persons aged 50 and above in the country. By Wednesday. 245,939 people had received the vaccine.
Expansion of categories
With the expansion of categories of eligibility, Diana Atwine, the Permanent Secretary in the Health Ministry, said the numbers of those vaccinated is expected to rise rapidly in the coming weeks.
Dr Atwine said that since the change in the programme, the number of people going for vaccination daily is steadily going up with some districts already indicating that doses allocated to them could soon be depleted.
When the first doses arrived in Ghana, the Ivory Coast, Kenya, and Rwanda in late February and early March, it seemed that the continent’s rollout was finally off the ground. However, efforts are stumbling in the face of systemic obstacles to distribution.
In Kenya, the vaccination efforts hit the ground running, made possible by the delivery of just over one million AstraZeneca vaccines that arrived in two batches: 1.02 million doses through the global the Covid-19 Vaccines Global Access (Covax) initiative, and a donation of 100,000 from the Indian government.
However, as soon as the government began the vaccination drive, there was widespread hesitancy, even among doctors, compelling the government to administer the doses to non-essential workers to avoid wasting them.
One month into the exercise, just over 750,000 people had been vaccinated. This is slow relative to the target the government had set to vaccinate 3.3 million by June 2021. The plan has been hindered by lack of efforts to educate the public, slow distribution systems from regional depots to vaccination centres, and hesitancy among health workers who are among the priority groups.
The World Health Organization (WHO) estimates that less than two percent of the 910 million vaccine doses administered to date globally have been in Africa.
About 1,373,895 doses have been administered in three East African countries (778,254 in Kenya; 245,939 in Uganda; and 349,702 in Rwanda).
“My appeal to member states is, if we are doing our part to mobilise these vaccines, you do your part and use the vaccines,” John Nkengasong, director of the Africa CDC, said in a news conference on Thursday. The problems are not just in countries with few vaccines, as those with buying power also lag behind. In South Africa, where a roll-out error that sparked widespread outrage saw the government terminate the use of the Oxford/AstraZeneca vaccine following reports that it was ineffective against the B.1.351 variant that first emerged in the country in December.
As a result, South Africa turned to the Pfizer/BioNTech and Johnson & Johnson (J&J) vaccines. Last week, the country temporarily stopped the use of J&J following reports of rare cases of blood clots and low platelets in some recipients in the US. The country lifted the suspension a few days later.
These hitches have seen South Africa unable to meet its target to begin vaccinating the rest of the population by June, after reports emerged that the second phase of the rollout programme is yet to start. The country is currently completing the first phase, which targets frontline workers.
The second phase, targeting essential workers, persons with comorbidities as well as those aged 60 and above, is set to begin mid-May until the end of October. The government’s narrative is that they hope to inoculate 46.2 million of the population by March 2022.
Despite lagging behind in the rollout programme, Health Minister Zweli Mkhize insists that they are still on the right track.
“After October of course everybody else who has not been vaccinated will have to come in, starting with those who will be in congregate settings and risk and so on,” said Dr Mkhize.
Public confusion over whether to get the vaccine, and where to do so and at what stage, has contributed to the expiration of doses. Malawi announced it is set to destroy more than 16,000 doses of the AstraZeneca vaccine, and 59,000 unused doses expired in South Sudan this month.
However, the WHO has urged countries not to destroy the shots that may have passed their expiry date, but instead hold them and wait for further guidance.
WHO’s Africa regional director Matshidiso Moeti urged countries to “store the vaccines safely as we continue to study and try to get definitive advice on whether the vaccines can be used for longer”.
Other than Malawi and South Sudan, the WHO said Ghana and Sierra Leone had also not used all of their vaccines because they expired in mid-April.
Tens of thousands of vaccines have also been thrown away in countries like France and the US.
Many vaccines can be used up to 36 months after the date of manufacture. But because Covid-19 vaccines are newly developed, there is not enough data to prove their effectiveness over longer periods.
Besides the acceptance challenges, African countries are also facing uncertainty about the exact date when the next shipment of vaccines from Covax will come in, especially after India’s domestic demand will delay shipments of the second doses of the Oxford/AstraZeneca vaccine from the Serum Institute of India, its main manufacturer.
Kenya’s aim to vaccinate at least 25 million people before the end of the year is likely to fall short as the country does not even have reassurance that people who got the first shot of Oxford/AstraZeneca will get their second dose. Although the government says it is in “advanced” stages of negotiations to acquire seven million doses of Pfizer/BioNTech and 10 million of Johnson & Johnson vaccines, there are no solid agreements signed yet.
Uganda is unsure of when it will receive the first batch of the 18 million doses it directly purchased from the Serum Institute of India outside the Covax facility. Of these, 400,000 doses were expected into the country last month but they have not yet arrived.
Ghana, which was the first African nation to receive doses from Covax, is about to run out of its initial supplies and doesn’t know when the next batch arrives.