The quest for more COVID-19 vaccinations in Africa

Abstract

At the end of March, 2022, many African countries had partially reduced COVID-19 surveillance and quarantine measures. The number of COVID-19 cases across the continent have declined since the peak of the fourth wave, driven by the omicron variant in early January, 2022.The WHO Regional Office for Africa (WHO-Africa) analysed open-source data, from Aug 1, 2020, to March 15, 2022, on screening, contact tracing, mask wearing, monitoring indoor and outdoor gatherings, and comparing the decrease in testing rates. They found that 13 countries were conducting comprehensive surveillance, 19 were carrying out prioritised contact tracing, and 22 were no longer doing any kind of contact tracing. Seven of 21 countries that originally put in place quarantine measures no longer required quarantine for people exposed to the virus, while 22 countries still banned mass gatherings, down from 41 in 2021. 43 countries had maintained mask-wearing by March 15, 2022, but some had eased the level of restrictions for this measure, with masks mandatory only on public transport or in enclosed spaces. Despite these reductions in non-pharmacological interventions, the pandemic continues and the possibility of future waves still exists. To date, more than 14·5 million COVID-19 cases have recorded in Africa, 10·8 million have been recovered, and 784 million vaccine doses have been received across 54 countries.Africa has struggled to access COVID-19 vaccines. The vaccine supply picked up by Dec, 2021, after wealthy nations had rolled out booster programmes and had surpluses of vaccines—at which point, more than 80% of people in Africa had not yet received a single dose. Rufaro Samanga, an epidemiologist based in Johannesburg, South Africa, believes this issue of vaccine supply and access is at the heart of the difficulties in trying to increase vaccination rates in Africa. “For the most part, vaccines have been donated to African countries by European and North American countries, which has meant constantly incurring vaccine shortages, having to get rid of vaccines after a short period because of their expiration date, and sometimes simply not receiving the vaccines at all”, she says. “If these donor countries and big pharma companies can disband current proprietary restrictions, more African countries could manufacture their own vaccines. This is more sustainable over the long term”, Samanga adds.“In terms of vaccinations, we are still very far behind. As of May 5, 2022, only 17% of the African population have been vaccinated against SARS-CoV-2, and we want to reach 70%”, Ahmed Ogwell Ouma, deputy director of the Africa Centres for Disease Control and Prevention (Africa CDC), told The Lancet Respiratory Medicine. Ten African Union member states have, to date, vaccinated more than 35% of their populations, including Botswana, Cape Verde, Lesotho, Mauritius, Morocco, Mozambique, Rwanda, São Tomé and Príncipe, Seychelles, and Tunisia. Eritrea is yet to start a vaccine rollout.At the end of March, 2022, John Nkengasong, director of the Africa CDC, described four barriers that many African countries face when administering vaccinations: lack of adequate storage facilities for incoming vaccines that require refrigerators; difficulties in transporting vaccines and keeping the correct conditions to avoid spoilage; insufficient numbers of health-care workers to administer vaccines; and people's willingness to get vaccinated.As the number of cases drop, people think it is no longer necessary to get vaccinated. “There is a reduced risk perception”, says Benido Impouma, director of Communicable and Non-Communicable Diseases at WHO-Africa. Vaccine hesitancy has also contributed to delays in vaccination coverage. Alongside misinformation about vaccine safety, there are also questions regarding immunity from previous infection and how this fits in with vaccination. “If there is high seropositivity in the population, can we adopt a different approach to vaccination? There is no answer to that question yet, but this is a rolling situation that we should get on top of in our region”, says Helen Rees, executive director of the Wits Reproductive Health and HIV Institute in Johannesburg, South Africa.Only three of 272 vaccine effectiveness studies have been conducted in the African region. Jason Mwenda, head of the African Region Monitoring COVID-19 Vaccine Effectiveness Network at WHO Africa says more trials are needed, and believes it is important to document the interval period between the first and second doses and whether vaccines have been stored correctly, and also to monitor vaccine delivery to remote areas.Ogwell Ouma confirms that the Africa CDC is documenting the approach used in different countries for vaccine rollout, and is monitoring the positive and negative outcomes so that Africa might learn from these approaches for future vaccine rollout plans. There has been a combination of strategies used to scale up vaccination. For example, some countries have used mass vaccination campaigns that have led to an increased uptake of vaccines, whereas other countries have targeted more vulnerable populations, such as health-care workers and those with comorbidities, says Impouma.Mauritius, with a population of 1·5 million, was one of the first African countries to launch a COVID-19 vaccination campaign. The country sourced various vaccine types and gave regulatory clearances to accelerate the rollout. It prioritised people working on the frontline, including health-care workers, police officers, hotel staff, airport personnel, and senior citizens. Schools and other public facilities were repurposed for the vaccination drive and a further extension of the programme eventually targeted young people aged 12–17 years. Kailash Jagutpal, health and wellness minister in Mauritius, says the past 2 years have been very challenging for his country, and the government had to compromise between delivery of COVID-19 vaccination and that of other vaccination programmes. As of May 2, 2022, 212 doses were administered per 100 individuals. Messages should be tailored to the target audience to ensure education on the safety of vaccination is communicated clearly, says Jagutpal. For example, in Mauritius, public health messages addressed how the omicron variant might negatively affect the economy, the country's borders, and schools, and how vaccination might help mitigate some of these effects.In Ghana, when a yellow fever outbreak occurred in November, 2021, the country integrated COVID-19 and yellow fever vaccination campaigns. Around 2 million doses were administered in its initial mass COVID-19 campaign reaching over 80% of the target population set for the campaign. Ghana also used the National Immunization Days against Polio initiative as a template for its first National COVID-19 Vaccination Day, which ran Feb 2–6, 2022. A second campaign was started to coincide with African Vaccination Week and ran during the first week of May, 2022. The number of doses administered increased from 9·7 million at the end of January to 13 million at the end of March, 2022, representing a 34% increase in the cumulative number of doses.In February, 2022, Nigeria's health minister, Osagie Ehanire, was upbeat about a new vaccine scale-up strategy introduced in the country, which guides the integration of routine immunisation with COVID-19 vaccination for mothers and their babies. The Nigerian plan expanded access to COVID-19 vaccines outside of health facilities and saw mass vaccination sites established in public places, such as markets, parks, shopping malls, schools, mosques, and churches.COVAX, the vaccine arm of the Access to COVID-19 Tools (ACT) Accelerator is encouraging countries to combine campaigns against measles and polio with COVID-19. Ted Chaiban, global lead coordinator for COVID Vaccine Country Readiness and Delivery, said in a media briefing, May 5, 2022, that COVID-19 vaccination drives provide an opportunity to strengthen pre-existing health challenges and that incorporating COVID-19 vaccination into primary health-care initiatives for measles, polio, and malaria, has become crucial to vaccinate more people.Over 20 700 people have been infected with COVID-19 in Burkina Faso, with more than 375 deaths, but the country has one of the lowest rates of vaccine uptake in Africa. COVAX's vaccine delivery partners, Gavi and UNICEF, assisted Burkina Faso with funds to run a rapid vaccination campaign to save 100 000 of its Pfizer doses from expiring. In the Democratic Republic of the Congo, Chaiban said a similar campaign was underway to ensure the use of several hundreds of thousands of vaccines that would otherwise expire between May and July.A modelling study (preprint) found that vaccine scale-up in Kenya could be more cost-effective if COVID vaccination campaigns targeted specific populations (ie, older people and those at risk). Edwine Barasa, director at the Kenya Medical Research Institute-Wellcome Trust Research Programme, says ensuring older adults and other at-risk groups receive vaccines quickly is the best way to achieve greater health outcomes. “We hope these data help policymakers across the continent determine how to structure impactful, cost-effective, long-term COVID-19 responses”, he adds.South Africa had a slow start to its vaccine rollout compared with its neighbouring countries, such as Zimbabwe. This was due to procurement issues, the eventual phasing out of the AstraZeneca vaccine, as well as the tiered approach in first vaccinating certain groups of individuals in the country over others, Samanga says. “What the country has done particularly well in is overseeing and maintaining the regulations around vaccines by the South African Health Products Regulatory Authority”, she adds. “However, with about 40% of adults currently vaccinated, this is still far from the goal of 70%, which the government had hoped would be achieved by the end of last year.”Ogwell Ouma says that to accelerate the uptake of COVID-19 vaccination among the younger African population, the African CDC established a network of youth champions across the continent in April, 2022. The African CDC is also hoping that top policymakers and celebrities will be available to encourage vaccine uptake. Mobile vaccination units are also being deployed to enable easier access for people. “Asking someone to stop their economic activities and travel 10–20 km to get vaccinated is not feasible”, says Ogwell Ouma.“We hope that by the end of this year, the proportion of people vaccinated will have increased substantially”, says Impouma. To do so, strategies across the continent will have to be further refined to ensure success. At the end of March, 2022, many African countries had partially reduced COVID-19 surveillance and quarantine measures. The number of COVID-19 cases across the continent have declined since the peak of the fourth wave, driven by the omicron variant in early January, 2022. The WHO Regional Office for Africa (WHO-Africa) analysed open-source data, from Aug 1, 2020, to March 15, 2022, on screening, contact tracing, mask wearing, monitoring indoor and outdoor gatherings, and comparing the decrease in testing rates. They found that 13 countries were conducting comprehensive surveillance, 19 were carrying out prioritised contact tracing, and 22 were no longer doing any kind of contact tracing. Seven of 21 countries that originally put in place quarantine measures no longer required quarantine for people exposed to the virus, while 22 countries still banned mass gatherings, down from 41 in 2021. 43 countries had maintained mask-wearing by March 15, 2022, but some had eased the level of restrictions for this measure, with masks mandatory only on public transport or in enclosed spaces. Despite these reductions in non-pharmacological interventions, the pandemic continues and the possibility of future waves still exists. To date, more than 14·5 million COVID-19 cases have recorded in Africa, 10·8 million have been recovered, and 784 million vaccine doses have been received across 54 countries. Africa has struggled to access COVID-19 vaccines. The vaccine supply picked up by Dec, 2021, after wealthy nations had rolled out booster programmes and had surpluses of vaccines—at which point, more than 80% of people in Africa had not yet received a single dose. Rufaro Samanga, an epidemiologist based in Johannesburg, South Africa, believes this issue of vaccine supply and access is at the heart of the difficulties in trying to increase vaccination rates in Africa. “For the most part, vaccines have been donated to African countries by European and North American countries, which has meant constantly incurring vaccine shortages, having to get rid of vaccines after a short period because of their expiration date, and sometimes simply not receiving the vaccines at all”, she says. “If these donor countries and big pharma companies can disband current proprietary restrictions, more African countries could manufacture their own vaccines. This is more sustainable over the long term”, Samanga adds. “In terms of vaccinations, we are still very far behind. As of May 5, 2022, only 17% of the African population have been vaccinated against SARS-CoV-2, and we want to reach 70%”, Ahmed Ogwell Ouma, deputy director of the Africa Centres for Disease Control and Prevention (Africa CDC), told The Lancet Respiratory Medicine. Ten African Union member states have, to date, vaccinated more than 35% of their populations, including Botswana, Cape Verde, Lesotho, Mauritius, Morocco, Mozambique, Rwanda, São Tomé and Príncipe, Seychelles, and Tunisia. Eritrea is yet to start a vaccine rollout. At the end of March, 2022, John Nkengasong, director of the Africa CDC, described four barriers that many African countries face when administering vaccinations: lack of adequate storage facilities for incoming vaccines that require refrigerators; difficulties in transporting vaccines and keeping the correct conditions to avoid spoilage; insufficient numbers of health-care workers to administer vaccines; and people's willingness to get vaccinated. As the number of cases drop, people think it is no longer necessary to get vaccinated. “There is a reduced risk perception”, says Benido Impouma, director of Communicable and Non-Communicable Diseases at WHO-Africa. Vaccine hesitancy has also contributed to delays in vaccination coverage. Alongside misinformation about vaccine safety, there are also questions regarding immunity from previous infection and how this fits in with vaccination. “If there is high seropositivity in the population, can we adopt a different approach to vaccination? There is no answer to that question yet, but this is a rolling situation that we should get on top of in our region”, says Helen Rees, executive director of the Wits Reproductive Health and HIV Institute in Johannesburg, South Africa. Only three of 272 vaccine effectiveness studies have been conducted in the African region. Jason Mwenda, head of the African Region Monitoring COVID-19 Vaccine Effectiveness Network at WHO Africa says more trials are needed, and believes it is important to document the interval period between the first and second doses and whether vaccines have been stored correctly, and also to monitor vaccine delivery to remote areas. Ogwell Ouma confirms that the Africa CDC is documenting the approach used in different countries for vaccine rollout, and is monitoring the positive and negative outcomes so that Africa might learn from these approaches for future vaccine rollout plans. There has been a combination of strategies used to scale up vaccination. For example, some countries have used mass vaccination campaigns that have led to an increased uptake of vaccines, whereas other countries have targeted more vulnerable populations, such as health-care workers and those with comorbidities, says Impouma. Mauritius, with a population of 1·5 million, was one of the first African countries to launch a COVID-19 vaccination campaign. The country sourced various vaccine types and gave regulatory clearances to accelerate the rollout. It prioritised people working on the frontline, including health-care workers, police officers, hotel staff, airport personnel, and senior citizens. Schools and other public facilities were repurposed for the vaccination drive and a further extension of the programme eventually targeted young people aged 12–17 years. Kailash Jagutpal, health and wellness minister in Mauritius, says the past 2 years have been very challenging for his country, and the government had to compromise between delivery of COVID-19 vaccination and that of other vaccination programmes. As of May 2, 2022, 212 doses were administered per 100 individuals. Messages should be tailored to the target audience to ensure education on the safety of vaccination is communicated clearly, says Jagutpal. For example, in Mauritius, public health messages addressed how the omicron variant might negatively affect the economy, the country's borders, and schools, and how vaccination might help mitigate some of these effects. In Ghana, when a yellow fever outbreak occurred in November, 2021, the country integrated COVID-19 and yellow fever vaccination campaigns. Around 2 million doses were administered in its initial mass COVID-19 campaign reaching over 80% of the target population set for the campaign. Ghana also used the National Immunization Days against Polio initiative as a template for its first National COVID-19 Vaccination Day, which ran Feb 2–6, 2022. A second campaign was started to coincide with African Vaccination Week and ran during the first week of May, 2022. The number of doses administered increased from 9·7 million at the end of January to 13 million at the end of March, 2022, representing a 34% increase in the cumulative number of doses. In February, 2022, Nigeria's health minister, Osagie Ehanire, was upbeat about a new vaccine scale-up strategy introduced in the country, which guides the integration of routine immunisation with COVID-19 vaccination for mothers and their babies. The Nigerian plan expanded access to COVID-19 vaccines outside of health facilities and saw mass vaccination sites established in public places, such as markets, parks, shopping malls, schools, mosques, and churches. COVAX, the vaccine arm of the Access to COVID-19 Tools (ACT) Accelerator is encouraging countries to combine campaigns against measles and polio with COVID-19. Ted Chaiban, global lead coordinator for COVID Vaccine Country Readiness and Delivery, said in a media briefing, May 5, 2022, that COVID-19 vaccination drives provide an opportunity to strengthen pre-existing health challenges and that incorporating COVID-19 vaccination into primary health-care initiatives for measles, polio, and malaria, has become crucial to vaccinate more people. Over 20 700 people have been infected with COVID-19 in Burkina Faso, with more than 375 deaths, but the country has one of the lowest rates of vaccine uptake in Africa. COVAX's vaccine delivery partners, Gavi and UNICEF, assisted Burkina Faso with funds to run a rapid vaccination campaign to save 100 000 of its Pfizer doses from expiring. In the Democratic Republic of the Congo, Chaiban said a similar campaign was underway to ensure the use of several hundreds of thousands of vaccines that would otherwise expire between May and July. A modelling study (preprint) found that vaccine scale-up in Kenya could be more cost-effective if COVID vaccination campaigns targeted specific populations (ie, older people and those at risk). Edwine Barasa, director at the Kenya Medical Research Institute-Wellcome Trust Research Programme, says ensuring older adults and other at-risk groups receive vaccines quickly is the best way to achieve greater health outcomes. “We hope these data help policymakers across the continent determine how to structure impactful, cost-effective, long-term COVID-19 responses”, he adds. South Africa had a slow start to its vaccine rollout compared with its neighbouring countries, such as Zimbabwe. This was due to procurement issues, the eventual phasing out of the AstraZeneca vaccine, as well as the tiered approach in first vaccinating certain groups of individuals in the country over others, Samanga says. “What the country has done particularly well in is overseeing and maintaining the regulations around vaccines by the South African Health Products Regulatory Authority”, she adds. “However, with about 40% of adults currently vaccinated, this is still far from the goal of 70%, which the government had hoped would be achieved by the end of last year.” Ogwell Ouma says that to accelerate the uptake of COVID-19 vaccination among the younger African population, the African CDC established a network of youth champions across the continent in April, 2022. The African CDC is also hoping that top policymakers and celebrities will be available to encourage vaccine uptake. Mobile vaccination units are also being deployed to enable easier access for people. “Asking someone to stop their economic activities and travel 10–20 km to get vaccinated is not feasible”, says Ogwell Ouma. “We hope that by the end of this year, the proportion of people vaccinated will have increased substantially”, says Impouma. To do so, strategies across the continent will have to be further refined to ensure success.