Alert 152 – Delta variant amplifies Africa’s vaccine crisis

The more transmissible Delta variant of the coronavirus that fuelled India’s untold human suffering and misery in early 2020, and is still causing close to 1 000 deaths a day there, has now firmly entrenched itself in Africa. With almost universally weak health infrastructure across the continent, and concerns that previous infection from another strain of the virus might not protect against Delta, the undertow of looming tragedy is testing governance and public patience in various countries, with South Africa, Zambia and Uganda in the top five in terms of African countries reporting the most new infections daily.

South Africa is leading the pack with a 7-day average of 15 520 new cases a day. With unquestionably one of the best healthcare systems in the southern African region the country is going head-to-head with the Delta threat with scientists affirming that the variant is the dominant one in driving the country’s current third wave, which as of 29 June revealed a 28.3% positivity rate. With cases concentrated in the economic hub of Gauteng, South African President Cyril Ramaphosa has tightened lockdown restrictions yet again as health professionals warn that hospitals are already breaching capacity. Public anger, meanwhile, is mounting as the country’s Health Minister Zweli Mkhize has been put on special leave, pending investigations into his involvement in highly irregular spending relating to the Covid-19 management effort after a string of similar corruption scandals reported since the pandemic began. Compounding graft frustrations is government’s dismal performance on vaccine acquisition with opposition parties taking to the streets vowing to defy lockdown orders, and public disquiet likely to grow if slow vaccine rollout and creeping Covid-19 numbers converge in crisis in the next few weeks.  At the time of writing the outlook is poor, with only 2 682 710 people vaccinated ‒ about 4% of the population. Amid parallel uncertainty about whether this year’s local government elections will go ahead, it is also unclear how much collateral damage the ruling African National Congress (ANC) will incur at the polls, but its actual victory is not in doubt.

Third on the Africa list in terms of infection numbers, Zambia is recording a 7-day moving average of 2 719 new cases with mortuaries in Lusaka running out of space already and the real death toll in Zambia’s vast rural heartland little more than a guessing game. With Zambia headed for elections in August, President Edgar Lungu is clearly taking strain with a recent bout of “dizziness” in public prompting health speculation as well. Zambia’s top opposition figure Hakainde Hichilema will again be the main power contender and, after years of Lungu’s repressive crackdowns, Zambians may be emboldened to step away from the ruling Patriotic Front (PF) if the government’s manifest inability to take care of its citizens accelerates. As things stand this looks inevitable, with only 0.4% of Zambians ‒ 151 205 ‒ vaccinated as the Delta variant gains traction.

In the east of the continent and number 5 on the list (7-day moving average of 916 cases daily), even Uganda’s indefatigable President Yoweri Museveni seems under pressure, putting the country on lockdown amid a surge in infections and deaths exemplified by a 17.1% positivity rate among Uganda’s parliament. With broader testing severely limited, the government is even more edgy about the high prevalence among its own rank and file now that the Delta strain has been confirmed. The United Kingdom (UK) has affirmed worry about the shift by putting Uganda on its red list of banned travellers and RwandAir stopping flights to Entebbe.  It’s having a direct impact on governance with about 200 members of parliament (MPs) laid low by the virus and some ministries without leadership as they were unable to be sworn in on 21 June due to quarantine requirements. All this as Museveni still puts his new sixth administration together while opposition leader and presidential loser Bobi Wine remains under house arrest still questioning the outcome of this year’s election. With heretofore largely unaffected rural areas now also registering Covid-19 cases, the true extent of the crisis remains a massive unknown. And Uganda’s healthcare systems are nowhere near as evolved as South Africa’s, with oxygen shortages at already overfull public hospitals affecting poor Ugandans who cannot afford limited private care the most. The country, and the already tattered economy, is nakedly vulnerable with a mere 3% of Ugandans ‒ 843 039 ‒ vaccinated.

In all three cases, and across the continent, infection numbers and deaths are assumed to be underreported with testing capacity constrained and reporting channels often weak or non-existent. Vaccines are imperative but despite the expressed willingness of multilaterals such as the World Health Organisation (WHO), the often symbolic donations of Western Countries such as the United States (US), and initiatives such as the Covid-19 Vaccines Global Access (COVAX), the critical vaccination mass needed to yield even a semblance of national immunity is a pipe dream at present. Most African countries lack the resources to buy vaccines, the infrastructure to store and distribute them, and often the political will to drive and manage vaccine rollout.

How South Africa manages its battle with the Delta-driven third wave will be an important indicator of how Africa will cope in a best-case scenario. Current signs that the government is stepping up its efforts are encouraging, but it’s continued insistence that vaccine apartheid and rich nations that “hog” vaccines are to blame for a lacklustre rollout is disingenuous and simplistic, especially in South Africa’s case. Political enthusiasm and the engagement of South Africa’s private sector will be vital to avert further and even worse waves of Covid-19 and the concomitant economic damage. If it achieves measurable vaccine success, South Africa can then begin to more righteously confront the realities of the very vaccine apartheid that could be the undoing of Zambia, Uganda and many others.