How will Africa deploy Covid-19 vaccines by mid-2021 to cover 60% of population?

Africa faces some major challenges acquiring and deploying Covid-19 vaccinations across the continent, notably acquiring vaccines, as countries race to immunise their populations. Some fear that an insufficient vaccination programme could leave the continent isolated and cut off from the world.

“Fighting a pandemic is like fighting any kind of war, like in the military, you don't build up your army in the middle of the war, you prepare your army to be ready,” Abdoulaye Diop, chief of staff for the African Union Commission, told a briefing this week.

Diop raised concerns about how Africa will be put at a disadvantage compared to other regions of the world, highlighting available funding for vaccine procurement, and a shortfall of some $5 billion.

Obtaining funding to buy vaccines from big pharmaceutical companies is a major stumbling block, as the majority of cash-strapped African governments simply do not have money available to buy new coronavirus vaccines, especially as richer countries compete to secure supplies for their own populations.

Three main avenues of funding are available to African countries, according to John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), describing these different funding streams as “very complementary”.

The World Bank announced in October that it had approved $12 billion in financing to support vaccination in developing countries. African Export-Import Bank, known as Afreximbank, is preparing to raise $5 billion for vaccination programmes, said Nkengasong.

And Covax, an initiative launched by the World Health Organisation, European Commission and France, said $2.1 billion has been secured from donors to fund vaccines in lower income countries.

'True solidarity'
The Covax facility is seen by Africa CDC's Nkengasong as “truly an expression of solidarity” since it acts as part of procurement mechanism that both provides vaccines paid for by donors and assists other countries who are self-financing their vaccine purchases, a sort of vaccine cartel for everybody who wanted to join.

More well-off African countries including Botswana, Equatorial Guinea, Gabon, Libya, Namibia and South Africa have signalled their intention to take part in the Covax facility. While 92 low- and middle-income countries, including the rest of the African continent, are eligible to be supported by Covax.

However, this will provide just 1 billion doses of Covid-19 vaccines for the 92 eligible countries, and with a population of 1.3 billion people, immunisation relying just on the Covax facility would be insufficient.

“I think it's reassuring that there's been very good buy-in for Covax, but inevitably there's going to be a big rush to get hold of these vaccines,” Kevin Marsh, a senior advisor to the African Academy of Sciences, told RFI's Africa Calling podcast.

Timeframe
Africa CDC chief Nkengasong told an online press conference that the roll-out of vaccination programmes could take place on the African continent in mid-2021. Until then African countries would have to continue coping with the pandemic using measures such as mask-wearing and social distancing to slow the spread of infections.

Furthermore, the lag time between vaccine deployment for Africa and other regions of the world has caused anxiety that travel from the continent could be curtailed, with the prospect of countries requiring Covid-19 vaccination certificates, similar to requirements for Covid-19 testing.

“My concern is that we see vaccination in Europe complete, and then restrictions come in, where they say, 'if you don't have a vaccination, like a Yellow Fever vaccination, to show that you've been vaccinated, you cannot travel',” said Nkengasong last week.

Such restrictions would leave Africa “stranded” as other countries begin to ease Covid-19 measures following mass immunisation, according to the Cameroonian virologist. He insisted that such circumstances are not just hypothetical, citing the neglect of public health in Africa during his career.

It is “very hard” to predict when vaccination programmes in African countries could start, referring to current status of registered vaccines, said Kevin Marsh, an expert in tropical medicine in Africa.

“I think it is reasonable to think we would have had significant progress by then,” said Marsh, talking about predictions for the vaccination timescale. “I think vaccine roll-out will start in some parts of Africa early in the new year, it's not clear what proportion of the population will have been vaccinated by mid-year,” he added.

Africa CDC is targeting a vaccination programme covering 60% of the population across the continent. Nkengasong cited a research paper published in The Lancet which discusses the level of coverage need to create herd immunity and block transmission of SARS-CoV-2, the virus that causes Covid-19.

The coverage required relies on the effectiveness of the vaccines deployed, and ranges from 60-72% to 75-90%, depending on how good the vaccine is, according to the paper entitled, Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination.

Question of logistics
The infrastructure and resources available for a mass vaccination campaign could also be a challenge for many African countries, especially given the cold storage requirements of some vaccines, such as the Pfizer/BioNTech product which needs to be kept at minus 70 Celsius.

Some vaccines need to be administered in two separate doses and reaching the population of countries where transport and infrastructure could be an issue may be a considerable feat.

At the same time, there is reason for hope, especially since countries in Africa do have experience with mass vaccination campaigns, such as that combatting the wild poliovirus, which was declared eradicated from the continent earlier this year.

Tropical medicine expert Marsh points to vaccines that do not require extreme refrigeration, such as those produced by AstraZeneca which does not have the same cold storage requirements. Nevertheless, he thinks cold storage knowledge in other fields could prove invaluable.

“There is experience across Africa with relation to veterinary vaccines, and also even in terms of rural farms across much of Africa, where cows are artificially inseminated, and vets and veterinary teams regularly take materials at that temperature,” he said.

Africa CDC chief Nkengasong is keen on emphasising the need to strengthen systems to create conditions so that mass vaccinations can take place.

“If it requires that, we say for example, in every capital city we have five immunisation sites, we put in deep freezers of minus 70 and make the population move to those places for vaccinations, we'll do that,” he said.

“As a continent, let me be very clear, our goal is to achieve 60% vaccination of our population,” said Nkengasong, discussing the targets the continent's health authorities have set themselves. “We have to be seen to have failed trying to get to 60%, than we didn't even try to get to 60%,” he added, striking a note of caution about some of the challenges ahead.