Africa and Its Struggle in the Quest for Vaccination

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Credit: Reuters

Since the introduction of COVID-19 in late December of 2019, COVID’s rampant spread has locked down families, communities and global economies. To date, the coronavirus has infected over 150 million individuals and killed three million, submitting its ticket to be considered the greatest health crisis faced in the 21st century.

Thankfully, with the introduction of vaccines by Pfizer, Moderna, Johnson & Johnson, and AstraZeneca, a light at the end of the COVID tunnel is finally in sight. In the United States, President Biden has promised vaccine eligibility for every adult by April 19th. In European countries, like France and the United Kingdom, leaders hope to have most adults vaccinated by the end of the summer. But in Africa, vaccination progress is anything but smooth. With a host of problems ranging from vaccine procurement to administration, Africa’s vaccination effort is in dire need of assistance.

The Problems in Africa

1) Vaccine Procurement

Difficulty with African vaccination lies first and foremost with the issue of vaccine procurement on both the domestic and international level. Domestically, only 10 African vaccine manufactures exist -- creating a situation where Africa holds 14% of the world’s population and yet produces less than 0.1% of the world’s vaccine production.[1] And despite all of this production being fed back into domestic African vaccine markets, production is simply too low to effectively vaccinate the vast African population.

As a result, the majority of Africa’s vaccine supply comes from international importation. Covax, an international scheme that aims to equitably deliver vaccines to countries around the world, has been the major provider of Africa’s vaccine supply. Yet, despite having delivered 18 million vaccine doses to 41 African countries, Covax-delivered vaccine supplies have already been exhausted in countries like Ghana and Botswana.[2] In others, such as Malawi, thousands of delivered vaccines have already expired and are slated to be destroyed despite World Health Organization (WHO) pleas to continue using expired vaccines.[3]

Shipment of Covax Vaccines Received in Cote d’Ivoire. Credit: UNICEF

Africa’s main supplier, Covax, is also struggling. India’s Serum Institute, one of the largest global vaccine producers and Covax’s main supplier, had exported 19.6 million vaccines to Covax to date. However, as India addresses an increasing domestic need for vaccines, new export limitations on the Serum Institute have cut an already suffering Covax -- and by extension, African -- vaccine supply.[4] Another emergent problem is a lack of funding -- unless recent global demands of an additional $3 billion are met, Reuters estimates that Covax will struggle to increase vaccine procurement capabilities.[5]  

2) Storage Complications

With vaccine procurement already incredibly difficult for African countries, a lack of proper storage only further damages the vaccination effort. Vaccines are notorious for their storage difficulties -- from manufacturing to delivery and administration, vaccines must be exposed to the appropriate light and temperature conditions to ensure their efficacy once administered. Known as the “cold chain”, this supply chain process is crucial to the vaccination effort.

Credit: PATH

Many African countries lack the resources and suitable circumstances needed to store these vaccines. In Ghana, the cash-strapped national government requires another $1.5 million to fund 11 walk-in cold rooms and over 650 fridges necessary to store their current vaccine capacity. In the Democratic Republic of Congo, Mali, and Somalia, dangerous insurgency groups threaten crucial vaccine transport links. And across Africa, unreliable electricity grids destabilize vaccine fridges.[6]

As a result of these factors, the WHO estimated in a 2010 study that over a third of vaccine doses are rendered inactive due to improper storage conditions in developing countries.[7] Furthermore, recent estimates for 2020 identify that vaccine waste accounts for 8% of the cost of immunization programs in low to middle income countries.[8] These findings signify the severity of vaccine waste across social and financial metrics and emphasize the dire nature of Africa’s vaccine storage inadequacies.      

3) Vaccine Administration

Compared to the strong outreach and vaccination rates boasted by the United States and Europe, Africa’s vaccine campaigns are much weaker. John Nkengasong, head of the Africa Centres for Disease Control and Prevention, acknowledges this shortcoming in his estimate that only up to 60 percent of Africa’s 1.3 billion people could be vaccinated by the end of 2022. This statement is a product of two fundamental issues that stand in the way of such vaccination goals.

Issue #1: Funding: The task of administering vaccines seems simple, yet requires millions of dollars of investment to successfully execute. An internal government vaccination plan for Mali reveals that the country would require $14.7 million to absorb costs related to vaccine transportation, vaccine storage, volunteer training, and community outreach. Countries like Ghana, who boast a larger population, face an even higher price tag; the Ghana national government estimates that the cost of inoculating half of its population would cost $51.7 million. For many African countries, these initiatives are simply too expensive.

Issue #2: Rural Communities: Another key problem is that of reaching rural communities -- rural communities receive significantly fewer vaccination opportunities compared to their urban counterparts. Key factors contributing to this urban-rural inequality are lower maternal education levels, lack of media access, high numbers of children under the age of five, and lower valuations of household wealth in rural communities. Socioeconomic status also is an important factor. Wealthier households tend to be taken to less crowded and more robust health facilities, thus receiving their vaccines and verification faster. On the other hand, poorer rural households must travel far and settle for crowded health facilities, slowing the vaccination process and contributing to the COVID-19 spread.[9]

Credit: UNHCR - USA

Potential Solutions

Most of the problems surrounding the African vaccine delivery have emerged from a lack of financial wherewithal. As a result, African governments should aim to secure funding by appealing to the World Bank and philanthropic organizations for funding. Currently, the World Bank is the premier resource for African countries. To date, the World Bank has approved vaccine projects in 17 countries amounting to $2 billion, and are slated to reach 50 countries with $4 billion in vaccine projects by the middle of the year. In addition, philanthropic sources should not be overlooked; historically, organizations like the Bill & Melinda Gates Foundation and UNICEF have allocated substantial funds to vaccine efforts against a range of harmful diseases in Africa.

Credit: The World Bank

Once secured, these funds should be allocated toward these three primary goals:  

  1. Increase domestic vaccine production and international importation
  2. Invest in more robust storage and transportation infrastructure
  3. Launch stronger COVID vaccination outreach campaigns

These three investment areas address the largest problems -- vaccine production, cold chain transportation, and rural communities -- currently facing the African vaccination effort. Hopefully, these efforts will yield the most successful results.

With COVID-19’s status as a dangerous and devastating virus, Africa’s vaccination struggles must be viewed with an urgent lens. With difficulties at all stages of vaccine procurement and delivery, the current state of the African vaccine effort is far from ideal. However, although Africa’s problems are substantial, they are not without solutions. Solving the African vaccine should be a global priority -- it will take collective initiative and investment from global leaders and organizations alike.

Sources:

[1] Ampofo, William. "Vaccine Manufacturing in Africa." World Health Organization. Accessed May 6, 2021. https://www.who.int/immunization/research/forums_and_initiatives/1_Wlliam_Ampofo_Vaccine_Manufacturing_Africa.pdf?ua=1.

[2] Mwai, Peter. "Covid-19 Africa: What Is Happening with Vaccines?" BBC News. April 23, 2021. Accessed May 07, 2021. https://www.bbc.com/news/56100076.

[3] Masina, Lameck. "Malawi Rejects WHO Call to Use Expired COVID Vaccine." Voice of America. April 24, 2021. Accessed May 07, 2021. https://www.voanews.com/covid-19-pandemic/malawi-rejects-who-call-use-expired-covid-vaccine.

[4] McGregor, Grady. "The World's Largest Vaccine Maker Can't Keep up with the World's Worst COVID Wave." Fortune. April 20, 2021. Accessed May 07, 2021. https://fortune.com/2021/04/20/india-covid-cases-vaccine-vaccinations-serum-institute/.

[5] Reuters. "Global COVID-19 Vaccine Supply 'Incredibly Tight', COVAX Needs Funds: Gavi." U.S. News & World Report. April 15, 2021. Accessed May 07, 2021. https://www.usnews.com/news/world/articles/2021-04-15/global-covid-19-vaccine-supply-incredibly-tight-covax-needs-funds-gavi.

[6] Edward Mcallister, Edward Mcallister. "Cash-strapped Africa Overwhelmed by COVID Vaccine Challenge." Reuters. April 21, 2021. Accessed May 07, 2021. https://www.reuters.com/world/africa/cash-strapped-africa-overwhelmed-by-covid-vaccine-challenge-2021-04-21/.

[7] Guichard, Stephane, Karen Hymbaugh, Brent Burkholder, Serguei Diorditsa, Christine Navarro, Selina Ahmed, and Mohd. Mahbubur Rahman. "Vaccine Wastage in Bangladesh." Vaccine 28, no. 3 (January 8, 2010): 858-63. doi:10.1016/j.vaccine.2009.08.035.

[8] Karp, Christopher L., Deborah Lans, José Esparza, Eleanore B. Edson, Katey E. Owen, Christopher B. Wilson, Penny M. Heaton, Orin S. Levine, and Raja Rao. "Evaluating the Value Proposition for Improving Vaccine Thermostability to Increase Vaccine Impact in Low and Middle-income Countries." Vaccine 33, no. 30 (July 9, 2015): 3471-479. doi:10.1016/j.vaccine.2015.05.071.

[9] Adamu, Abdu A., Olalekan A. Uthman, Evanson Z. Sambala, Duduzile Ndwandwe, Alison B. Wiyeh, Tawa Olukade, Ghose Bishwajit, Sanni Yaya, Jean-Marie Okwo-Bele, and Charles S. Wiysonge. "Rural-urban Disparities in Missed Opportunities for Vaccination in Sub-Saharan Africa: A Multi-country Decomposition Analyses." Human Vaccines & Immunotherapeutics 15, no. 5 (April 08, 2019): 1191-198. doi:10.1080/21645515.2019.1575163.

More posts by Ethan Soe.
Africa and Its Struggle in the Quest for Vaccination
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