Africa is now in the deadliest stage of its pandemic, and there is little prospect of relief in sight.
The delta variant is sweeping across the continent. Namibia and Tunisia are reporting more deaths per capita than any other country. Hospitals across the continent are filling up, oxygen supplies and medical workers are stretched thin, and recorded deaths jumped 40% last week alone.
But only about 1% of Africans have been fully vaccinated. And even the African Union’s modest goal of getting 20% of the population vaccinated by the end of 2021 seems out of reach.
Rich nations have bought up most doses long into the future, often far more than they could conceivably need. Hundreds of millions of shots from a global vaccine-sharing effort have failed to materialize.
Supplies to African countries are unlikely to increase much in the next few months, rendering the most effective tool against COVID, vaccines, of little use in the current wave. Instead, many countries are resorting to lockdowns and curfews.
Even a year from now, supplies may not be enough to meet demand from Africa’s 1.3 billion people unless richer countries share their stockpiles and rethink how the distribution system should work.
“The blame squarely lies with the rich countries,” said Dr. Githinji Gitahi, a commissioner with Africa COVID-19 Response, a continental task force. “A vaccine delayed is a vaccine denied.”
Unable to strike early deals for vaccines, African countries relied on COVAX, a global partnership, to deliver free doses to countries that needed them.
But COVAX deliveries ground to a halt after India imposed export restrictions on the AstraZeneca vaccine as it dealt with its own resurgence this year.
Even if everything goes according to plan, COVAX officials project they won’t be able to deliver more than 200 million doses to Africa, enough to fully vaccinate around 7% of the population, until October.
There is little room for African countries to buy doses on their own: Almost all of the vaccines forecast to be made in 2021 have already been sold, according to data from Airfinity, an analytics firm. Most of the surplus supply includes Chinese vaccines and an Indian vaccine, Covaxin.
Some of the world’s richest countries will have 1.9 billion doses more than they need to vaccinate their populations by the end of August, according to the One campaign. The size of their excess supply has drawn the ire of African leaders, scientists and rights groups, who have called for accountability and warned that protectionism and stockpiling would only contribute to prolonging the pandemic.
“COVAX is a really lovely idea,” said Andrea Taylor, an assistant director at the Duke Global Health Innovation Center. But, she added: “It didn’t take into account how human behavior actually works in real life. It didn’t assume that wealthy countries would act in their own self-interest, and it should have done so.”
Africa’s Grim Vaccine Prognosis
The pace of vaccination remains far slower in Africa than in the rest of the world. Europe and South America are dispensing vaccines nearly 20 times faster than Africa, adjusted for population. About three-quarters of the 70 million doses, African countries have received have already been administered, according to the World Health Organization.
At the current pace of inoculation, only eight small African countries are set to meet a global target to vaccinate at least 10% of each country’s population by September, the WHO says. Vaccine deliveries to Africa are not expected to ramp up until then, according to COVAX.
Even Africa’s modest vaccination goals this year appear out of reach.
The African Union, aware of the challenge of obtaining enough vaccines, hoped to immunize 20% of its population by year’s end. The International Monetary Fund proposed a more ambitious goal: 40% immunization this year, and 60% by mid-2022. But reaching either of those goals would require a huge change in current vaccination rates.
Logistical Roadblocks to Delivery
India’s decision in March to significantly cut back on its vaccine exports — particularly the supplies from the Serum Institute of India that COVAX relied on — disrupted Africa’s vaccine rollouts. As stocks were depleted, immunization campaigns in Africa slowed down or were suspended altogether in May, even as a brutal third wave was getting underway.
Restrictions on vaccine exports and raw materials in the United States and the European Union have also undermined efforts to produce and deliver vaccines.
One lesson from this crisis was that Africa could not “be dependent on another sovereign state” for supplies, Gitahi said. The postponement in deliveries, he said, left many front-line workers and families vulnerable to infection and death. A recent study found that those who experience severe COVID in Africa are more likely to die than patients in other parts of the world because of scarcity in intensive care unit equipment and the prevalence of chronic conditions like HIV and diabetes.
Yet even when vaccines arrived, some African nations struggled to distribute them. From the start, many nations lacked the requisite planning, funding, workforce, refrigeration, and transportation network needed to get their citizens inoculated.
After the first vaccines began to roll out in December, scientists, and activists in South Africa — then one of the continent’s hardest-hit countries — criticized the government for not having a vaccine deployment strategy and leaving behind high-risk populations. In Kenya, as authorities prepared to receive the first doses in early March, front-line workers lamented they didn’t know where to register or get inoculated. And after pausing initial rollouts because of concerns over blood clots, Congo gave away 1.3 million out of the 1.7 million AstraZeneca doses it had received from COVAX because it couldn’t administer them before they expired.
Dr. Matshidiso Moeti, the WHO regional director for Africa, said that when it comes to ensuring citizens receive doses of the vaccine, there was still “a lot of work to do to get countries up to speed.”
The ultra-cold storage requirements of some vaccines have posed a challenge on the continent, too. Only a few African countries, like Rwanda, initially had the capacity to receive the Pfizer-BioNTech vaccine, which at the time had to be stored at temperatures well below freezing, after it became the first to receive WHO emergency authorization in December.
Gavi, the public-private partnership that helps lead COVAX, is working to procure thousands of cold boxes, vaccine carriers, refrigerators, and freezers for 71 low-income nations, 39 of them in Africa, according to a Gavi spokesperson. The equipment will include solar and ice-lined refrigerators that can keep vaccines cold for days without power, he said. Even the electricity needed to refrigerate vaccines can be hard to come by: Only 28% of health care facilities in sub-Saharan Africa has reliable electricity, according to the World Bank.
Ensuring this equipment will arrive in time to transport doses into rural areas and hard-to-reach zones remains a concern, said Hitesh Hurkchand, a senior adviser to the World Food Program who is advising the African Union on cold-storage logistics and vaccine supply chains.
Hesitancy and Misinformation
Even in areas where vaccine doses may be available soon, some Africans are hesitant about taking them.
About 68% of people surveyed expressed concerns around vaccine safety in a 15-country study released in March by the Africa Centers for Disease Control and Prevention. And while the willingness to accept vaccines varied from country to country, over half of those surveyed said they were “not very well or not at all informed about vaccine development.”
In Malawi, health experts said skepticism about vaccines has played a role in the slow distribution and eventual expiration of doses. In Congo, inoculation campaigns have been hampered by a number of factors, including concerns about the rare blood clots related to the AstraZeneca vaccine, low trust in government systems, and a belief that diseases like Ebola and measles pose more of a threat than COVID. In Senegal, vaccine hesitancy was fueled by misinformation spread on social media platforms. In Uganda, the health minister had to rebut accusations that she faked receiving a shot.
Health officials say vaccinations have increased as more doses have arrived on the continent. Still, Dr. Marina Joubert, a senior science communication researcher at the Stellenbosch University in South Africa, warned that conspiracy theories continue to persist, stoking unfounded fears, for example, that COVID-19 vaccines cause infertility or that Africans are being used as “guinea pigs” to test vaccine safety and efficacy.
To counter misinformation, social scientists and health experts will need to work closely with governments to roll out public awareness initiatives, Joubert said. “It’s a kind of a balancing act of timing, accuracy, consistency, credibility, the skill to speak in a way that takes complex science and delivers it in a way that people can understand,” she said.
What Could Speed Up Vaccinations
The WHO and the Africa CDC have said they are hopeful vaccine deliveries — both bilateral donations and those from COVAX — would gather momentum in the coming weeks. Aurélia Nguyen, the managing director of COVAX, said last week that it expected to deliver 520 million vaccines to Africa by the end of the year, and 850 million by the end of the first quarter of 2022.
Until then, wealthy nations with excess doses have started sharing vaccines. In coordination with the African Union, COVAX will soon deliver more than 20 million Johnson & Johnson and Pfizer-BioNTech vaccines donated by the United States to 49 African countries. The Group of 7 nations also announced in June their intention to share at least 870 million doses with low-income nations, including those in Africa.
Some nations are also looking to manufacturing to boost vaccine availability. Only seven African countries have companies operating in the vaccine-manufacturing chain, a recent study shows. Kenya has announced plans to build a plant that would package COVID-19 vaccines and distribute them regionally. Moroccan and Egyptian companies aim to start producing China’s Sinopharm and Sinovac vaccines, while Rwanda signed a deal with the European Union to bolster its vaccine manufacturing capabilities. A joint American-European plan would invest more than $700 million for a South African plant to produce more than 500 million doses of the Johnson & Johnson vaccine by the end of 2022.
The availability of more vaccine varieties globally could help curb the virus in Africa, said Taylor of the Duke Global Health Innovation Center.
But even as more people get inoculated, the efficacy of the particular vaccines being delivered to African countries remains a concern. That is the case in Seychelles, which raced to vaccinate its population of just over 100,000 with China’s Sinopharm, only to face a surge in coronavirus infections. While the WHO and the Africa CDC have said they are studying the situation in Seychelles, both institutions have for now encouraging countries to continue using any of the COVID-19 vaccines listed for emergency use.
This article originally appeared in The New York Times.