This article is part of the series The COVID-19 Vaccine Challenge: Contextual and Country Analysis.
COVID-19 has devastated economies as countries put in place public health measures meant to safeguard weak fragmented health systems, which are often overwhelmed by surging demand when the case load is high.
These measures—curfews, closed borders, closure of schools and places of worship and cessation of movement—that were implemented repeatedly since March 2020, have left many jobless and hungry, with social ills like gender based violence, rising teenage pregnancy, and early child marriages rising in number. These measures have also pushed many economies into recession.
Beyond material security, people’s mental health has not been spared either. It is clear that economies and livelihoods will only truly be protected when lives are protected and the path to that is vaccinating as many people as possible to safeguard them from severe disease that may lead to hospitalisation or death. By doing so, health systems are protected to serve those who need it the most.
African countries have determined an initial goal of vaccinating 60 percent of its population, but the path to 60 percent is going to be tumultuous. The African continent manufactures only 1 percent of its total vaccine consumption traditionally and in the case of COVID19, zero! This has left the continent at the mercy of the rest of the world in accessing vaccines whose clinical trials were in some instances also carried out in Africa.
It is clear that economies and livelihoods will only truly be protected when lives are protected and the path to that is vaccinating as many people as possible to safeguard them from severe disease that may lead to hospitalisation or death.
Further, Africa suffers a serious fiscal challenge with extremely low per capita public expenditure on health—according to the World Bank, low-income countries spend about US $22 per capita from domestic general government resources with lower-middle income countries spending US $119; the average for Sub-Saharan Africa is US $70.
The result of this is that while rich countries, whose general public health expenditure per capita is about US $4000, are committing resources on booking vaccine doses in advance of manufacturing, most African countries can only watch.
The COVID-19 Vaccines Global Access initiative between Gavi–the Vaccine Alliance, the Coalition for Epidemic Preparedness, and the World Health Organisation came to fill this gap by raising adequate financial assistance to book vaccine doses on behalf of eligible countries including Kenya.
While this has been successful as a vaccine delivery mechanism, its forecasts were thrown into jeopardy by lower-than-expected production capacity, hoarding by rich nations, and nationalisation of the Serum Institute of India by the Indian government during the worst of India’s crisis leaving countries like Kenya holding empty syringes, partially vaccinated populations, and many others as spectators.
More recently in mid-2021, the African Union through the Africa Vaccines Acquisition Task Team has given African countries a relief by mobilising the force of the continent through the security of the Africa Export-Import Bank to commit doses on behalf of the continent for those countries that can afford it.
So far, several African countries out of the total 55 have used this route to acquire some doses to keep their vaccination drive going, but they are also using bilateral pathways where those who have too much are now in diplomatic trade of donating excess doses.
The African Union through the Africa Vaccines Acquisition Task Team has given African countries a relief by mobilising the force of the continent through the security of the Africa Export-Import Bank to commit doses on behalf of the continent for those countries that can afford it.
Some of these were expired while arriving to Africa because of the long route from store-to-store and countries needed speed to ensure they could move the doses from ports to arms in record time—this ended in a few vaccine casualties and some were unfortunately destroyed, estimated at about 450,000 doses across the continent (for context, this is 0.8 percent of 60 million doses administered in Africa by July). Whereas, this may have been related to speed of execution and logistical capacity, for some countries like Democratic Republic of Congo, South Sudan, Malawi and Uganda, we cannot discount the role of skepticism and hesitancy in the low vaccination numbers.
As Africa struggles on the race to 60 percent, a few things will need razor sharp focus.
First, a consistent supply of COVID-19 vaccines is critical if countries and communities are to succeed in vaccination. To have inconsistent supply is to impede the vaccination efforts as people wonder when and how they will access their scheduled doses. As Africa works closely with its international partners, Africa must also look inside and ask itself when it will stop relying on its neighbours and friends to take care of its people. Vaccine manufacturing conversations are in high gear and already technology transfer deals have been made.
But for sustainability, Africa must also at the same time invest in market shaping through faster ratification of the Africa Continental Free Trade Area to allow free flow of commodities within a common market, accelerate the ratification of the Africa Medicines Agency, and also engage global commodity aggregators like Gavi to purchase vaccines manufactured in Africa.
In Kenya, as in many other countries in Africa, major gaps exist in risk communication and community engagement, therefore, the government and policymakers can’t get through to their people.
Secondly, Africa needs to speak to its people. In Kenya, as in many other countries in Africa, major gaps exist in risk communication and community engagement, therefore, the government and policymakers can’t get through to their people. Community structures must be engaged if governments are to succeed in achieving their 60 percent target of their population being vaccinated.
Building community structures includes investing and meaningfully engaging with the people near where they live and work and with their own communication and engagement channels. TV announcements and press releases while necessary will not do on their own.
Finally, the vaccines will need to go to the people and not only people to the vaccines. As a start, we know that for many communities, health facilities are geographically far and financially inaccessible. For many vaccines for childhood diseases like polio and measles gaps in outreach were plugged when faced with the threat of an epidemic. Why not so for COVID-19 vaccines as well?
Governments must invest in commodity security through engaging with global partnerships, ensuring solutions for local manufacturing and market-shaping initiatives, engaging communities to overcome skepticism and ensuring access is equitable and cover the last mile.
This is the way to economic recovery and social cohesion for the African continent.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
Dr Githinji Gitahi is a medical doctor Global CEO Amref Health Africa and Commissioner in the Africa COVID19 Commission
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