Alert 138 – Securing Africa’s Covid-19 Vaccines: the access challenge

14/08/2023 by ERA

In 2021, initiating an effective Covid-19 vaccination programme is an essential part of any country’s economic recovery. Most of Africa’s 52 nations are planning to implement programmes – Madagascar and Tanzania are notable exceptions. However, the World Health Organisation (WHO) and others are worried that Africa will lag behind the rest of the world, causing increased economic damage to the region. In November 2020, reports indicated that African nations were only at 33% readiness for vaccine delivery, well below the 80% global average. Since then, only Egypt and Morocco have begun vaccination programmes. Experts believe that most African nations will only start vaccination programmes towards the end of Q1 in 2021, if not in Q2.

The main challenges for African countries are: securing doses of vaccines, buying personal protective equipment (PPE) for health professionals, and storing and moving vaccines. And all are rooted in a lack of funding. The African Export-Import Bank (Afreximbank) claimed the continent would need at least US$9 billion to buy and distribute vaccines. On 29 December 2020, the Nigerian Ministry of Health estimated that it will cost the country NGN400 billion (US$1 billion) to vaccinate 70% of its 300 million people. Researchers at the University of the Witwatersrand (Wits) project it will cost the South African government ZAR8.6 billion (US$556 million) to do the same for 60 million people. This may seem like a large discrepancy, but the Wits study assumes that all vaccinations will be purchased and distributed in three phases through 2021; whereas Nigeria plans to spread its programmes over two years. The Nigerian estimate also precedes AstraZeneca stating that its vaccine would also require two doses to have maximum efficiency. Hence, while the AstraZeneca vaccine remains the cheapest of the WHO-approved vaccines at about US$10 per dose – the Nigerian government was working with smaller numbers.

Another differentiating factor in the two countries’ cost estimates is experience. South Africa has never had to implement large-scale, cold chain vaccination programmes under this kind of stress. In November 2020, the Nigerian government vaccinated 2.5 million people against yellow fever in its north-eastern states and has been on the cutting edge of implementing cheap and effective vaccination programmes throughout the 21^st century. Similarly, many troubled African nations, such as Liberia, Sierra Leone, and the Democratic Republic of Congo (DRC) have been able to implement effective vaccination programmes against Ebola using Moderna/Pfizer style mRNA vaccines. The issue in Africa is not solely logistics or distribution capability, but access.

Developed nations have bought large supplies of vaccines and driven the price of certain vaccines incredibly high. Due to high demand, the Pfizer vaccine presently costs ZAR364.50 (US$24) per dose and the Moderna vaccine over ZAR575 (US$37) per dose. Indeed, Moderna pulled out of the South African vaccination programme after the South African government could not make a deposit when the company raised its prices. Due to high sovereign debt levels, many pharmaceutical companies are placing harsher restrictions on African nations, making it more difficult for them to secure vaccines.

To compensate for market pressures on low-income economies, the WHO and the Global Vaccine Alliance (GAVI) have created the COVAX programme to ensure that all countries can vaccinate at least 10% of their populations. COVAX allows low-income economies to pay off vaccination costs in small, partially subsidised instalments. However, COVAX has not negotiated the best prices available. Currently, it will cost countries ZAR366.70 (US$25) per dose. Nevertheless, some nations will only be able to secure vaccines through COVAX – in December 2020, eSwatini was the first African nation to announce that it would be able to secure COVAX vaccines in 2021.

China, India, and Russia have all offered their African allies access to their vaccines, but most nations have chosen not to take up their offers – preferring to wait for WHO authorisation. There is a good reason for this. The population of Africa is far more genetically diverse than the rest of the world, putting it at greater risk of developing side-effects from vaccines and vaccine-resistant strains of Covid-19. As a result, the Nigerian government insists that it will conduct its own quick trials before distributing a vaccine. These trials will further delay the distribution of vaccines but may prove vital to mitigating negative side-effects associated with a rushed rollout.

Concerns have already been raised over a new strain discovered in South Africa (variant 501.V2) in December 2020. Studies by British authorities have found that variant 501.V2 will be partially resistant to vaccines, although initial WHO studies have found that vaccines are still sufficiently effective against variant 501.V2. While this is not unusual when it comes to vaccines, the emergence of new strains is increasing anxiety around the world.

Associated concerns that new Covid-19 strains may render vaccination programmes ineffective or fuel travel bans from certain countries have created the perfect conditions for black market vaccine dealers. The International Police (INTERPOL) began the Enhancing Africa’s Response to Traditional Organised Crime (ENACT) programme to monitor the black market distribution of vaccines in December 2020. ENACT has already uncovered several illicit medication circuits in Kenya, distributing unauthorised medications across the country. The WHO is also concerned that rollouts in some countries will be hindered by religious groups, pseudo-scientific organisations, and traditional healers. Zambia has already implemented a lauded programme that encourages traditional healers to work with conventional medical establishments, which other countries are looking to mimic. Conversely, Madagascar’s President Andry Rajoelina has pushed an unproven herbal remedy called Covid-Organics. However, it appears that most people on the continent support getting vaccinated. A recent study found that over 80% of African people were willing to be vaccinated by an approved vaccine.

Therefore, amid a range of pre-existing inhibitions, the primary problem facing African countries remains access to vaccines. That said, there are benefits to waiting, such as reduced side-effects and better-tuned formulas. Moreover, it is important to remember that vaccines are not a silver bullet for a country’s economy. Pushing a nation into higher levels of debt to secure vaccines now may be ill-advised. Nevertheless, African nations will have to overcome a number of challenges before they can effectively secure and distribute enough Covid-19 vaccines to guarantee herd immunity.