While the advance of vaccination is to be celebrated in several countries in Europe and North America, those in Africa continue to fight for doses to immunize at least their most vulnerable population.
With around 17% of the world’s population, the continent only represents 1.6% of the 4.01 billion doses applied across the globe. And while Europeans are already around 38% fully immunized, Africans are only 1.6% – and with a record 166.5 thousand deaths and 6.6 million infections, figures considered far from reality due to underreporting.
According to specialists, three main reasons explain such a difference: the dependence on companies outside the continent to develop vaccines; logistical problems in ensuring the distribution of doses after their arrival; and reluctance to vaccines.
According to Benjamin Kagina, researcher at the Vaccines for Africa initiative, linked to the University of Cape Town, the demand for vaccines on the continent, not counting those against Covid, is around 1 billion doses per year, but only 1 % of it. amount comes from local manufacturers.
In addition, high-income countries were able to get doses even before vaccine development, which put Africa on the phone, says Mia Malan, editor-in-chief of the Bhekisisa Center for Health Journalism, a southern organization. African. independent media that have followed the Covid situation in the region. “The pandemic has been like a mirror that shows what the world really is like,” he says of the lopsided race.
The problem is further compounded on the continent, as internal inequalities are also significant, Malan stresses. South Africa, for example, is able to make deals with manufacturers for both the purchase and production of immunizers – starting next year, Biovac will start filling doses of Pfizer. / BioNTech.
Still, the country faces challenges in advancing its vaccination, with 9.4% receiving at least the first dose and 4.3% both. Pfizer’s vaccines did not begin to be applied until April, recalls the editor-in-chief of Bhekisisa, because when the government approached the pharmaceutical company in December, there were no more doses available. “This means that the vaccines we receive are arriving in smaller batches, because that’s all we have left,” says Malan.
Another significant impact was the delay in the delivery of one of the inputs for the production of the Johnson & Johnson immunizing agent, which led to the destruction of the doses that had been produced in the country. “Although this has happened in richer countries, the impact has not been as great as they have already purchased other vaccines,” says the publisher. “In South Africa we had nothing else, we had to buy more doses.”
However, many countries on the continent find themselves in an even worse situation, as they are unable to make production or even purchase agreements. This helps explain why there are cases like Seychelles, which have fully immunized 69.7% of its population (although there is a high number of cases under investigation by the WHO), and Tanzania, which vaccinated its first inhabitant two weeks ago, or that of Burundi and Eritrea, which have not even started to vaccinate their populations.
The difficulty in reaching agreements also makes countries totally dependent on vaccines provided by Covax, an initiative linked to the World Health Organization (WHO) for the distribution of vaccines to developing countries.
It was hoped that the consortium would be able to alleviate global inequality in immunization, but this kind of initiative would inevitably be insufficient, as richer countries would prioritize their populations over lower-income ones, Osman says. Dar, director of the Uma Saúde project. , which is part of Chatham House’s Global Health Program, a UK think tank. “Depending on the benevolence or solidarity of these countries should not be the basis of a global vaccine distribution system,” he says.
Kagina, from the University of Cape Town, adds that if the situation were reversed and Africa led the implementation of the vaccines, he would not want his son not to be vaccinated because his country’s government decided to send doses to lagging countries. “It’s human nature to work hard to tidy up your home,” he says. The researcher points out, however, that the biggest problem is having countries in excess – Canada, for example, has ten doses per person – while others lack them.
In Africa, 63.8 million doses have already been applied – added to the WHO consortium and other initiatives – and an additional 60 million are expected to arrive in the coming weeks via Covax, with donations from the United States, from Europe and the United Kingdom. In total, around 500 million vaccines are to be provided by the initiative, which is insufficient for a population of nearly 1.4 billion.
In addition to an already insufficient number, the distribution system was impacted by the suspension of vaccine exports decided by India, which needed the doses to cope with a devastating wave of the disease. As most of the Covax vaccines were supplied by an institution in the Asian country, there was a delay in delivery.
This has further hampered the distribution and application logistics of African countries, which are already deficient. Once the doses have arrived, there are difficulties in storage, transport and even application.
According to figures presented by the WHO Director for Africa, Matshidiso Moeti, at a press conference last week, a survey on the preparedness of the 55 countries of the African Union (including the Republic Sahrawi Arab Democratic Republic, which claims the territory of Western Sahara) has shown that 30% of them have more than half of their neighborhoods with cold storage difficulties.
Osman Dar stresses that there is still a lack of proper registration systems to identify and locate priority groups and of trained professionals to support mass delivery.
To thicken the broth, reluctance to get vaccinated is another concern. A study released in March this year by the African Centers for Disease Control and Prevention (CDC) found that 79% of the population of the 55 African Union countries were willing to be vaccinated. Internal variations, on the other hand, are excellent. While in Ethiopia this number rises to 94%, it drops to 59% in the Democratic Republic of Congo.
For Kagina, however, that shouldn’t be of great concern, given the still limited access to doses. “You don’t become hesitant about something you don’t have.”
Much of the reason for this inequality could have been avoided, however, and the governments of African countries are not without blame, says Evelyn Gitau, interim research director at the Center for Population and Health Research in Africa. “Many of them took a long time to get involved in the initiatives proposed for the purchase of vaccines, like Covax,” he explains. “As a result, they are fighting for limited doses, the rest having gone to countries that had signed up.”
She also points out that many of the distribution-related problems were easily avoidable, with funds allocated to purchase syringes and payment for protective equipment and human resources to apply the vaccines and guaranteed training for professionals to prepare for a vaccine. once the doses have arrived. Additionally, having up-to-date systems to monitor vaccinees and logistical issues such as storage and expiration dates would help avoid the situation.
This slowness of vaccination is becoming an even greater concern amid the emergence of more transmissible variants. “Make no mistake, the third wave in Africa is not over,” warned the WHO regional director. “This small step forward offers hope and inspiration, but it should not obscure the big picture. Many countries are still at the highest risk, and Africa’s third wave has grown faster and is stronger than ever. “
The delta variant, identified in India and which has generated strong peaks in Europe and the USA because it is more contagious, has already been found in 26 countries on the continent. Alpha (UK) and beta (South Africa) have been recorded in 35 countries.
Malan, from Bhekisisa, points out that, without access to vaccines, African countries are experiencing larger and more consistent waves of the disease – and with deaths that could have been prevented had the population been more immune.
This is why it is so important to speed up vaccination by familiarizing yourself with the challenges faced so far, said WHO’s Moeti. The hope was to vaccinate 20% of the population by the end of the year, which seems a distant goal at the moment. To reach 10% by the end of September, it will be necessary to multiply by five or six the pace, underlined the director.
At the current rate, 70% of countries will not meet this rate – between 3.5 million and 4 million doses are applied per week on the continent, a number that is expected to be 21 million to meet the target. “To accelerate the pace, it is necessary to improve operations, invest in running costs and focus confidence in the vaccine,” Moeti said, adding that the organization was helping countries with micro-planning. .
This acceleration is intrinsically linked to the arrival of additional doses, a scenario fraught with uncertainties. Some countries, for example, are already talking about stepping up vaccination with a third dose to cope with the increase in cases, further unbalancing vaccine availability.
Experts, for their part, stress that the need to protect Africans against Covid is not only a matter of regional importance. “If we leave the continent unvaccinated, we also increase the risk of generating more variants, and no one can predict what the next strain will do, even with those who have already been immunized,” says Kagina, of the University of the Cap. “We see the United States donating vaccines because they understand that the continent, without being immunized, poses a threat to the rest of the world community.”