Africa has the slowest vaccination rate in the world. Why this should worry us

Africa has the slowest vaccination rate of any continent, with just 24 per cent of its population receiving at least one dose of a Covid-19 vaccine, according to the Covid World Vaccination Tracker.      

The tracker illustrates that Latin America leads, with 82 per cent of its population receiving at least one dose of the vaccines, followed by the United States and Canada, and Asia Pacific at 81 per cent each.  

Europe is at 70 per cent, with the Middle East at 58 per cent and Africa lagging behind at 31 per cent.

More than 70 per cent of Africa's population has yet to receive a single dose of the coronavirus disease vaccine, with a huge striking divide between regions in the world, said World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus.   

The gap in vaccination coverage between high-income and low-income countries widened because less wealthy countries and Africa as a continent fully relied on donations from richer countries.

A vaccinated person refers to someone who has received at least one dose of a vaccine, and a fully vaccinated person has received either a single-dose vaccine or both doses of a two-dose vaccine with a booster of an extra dose.

Hoarding vaccines

Many wealthy countries hoarded vaccines to provide booster shots for their populations as they fight the emergence of new Covid-19 variants. The less fortunate countries had to make their own arrangements through a vaccine-sharing arrangement, Covax, to get vaccines for their populations.
Initially, Covax had a target of acquiring two billion doses by the end of 2021, but with export bans, manufacturing problems and vaccine hoarding, it cut its forecast.

The continent has so far received 936 million vaccine doses, 62 per cent of which came from the Covax facility. This affected the vaccination numbers as countries had to wait for donations and whether the vaccines were available for them to continue with vaccination, with many countries including France, Germany and Chile administering many boosting shots to their population.

The hoarding confirmed the historical phenomenon that repeats itself whenever a global pandemic is announced by the WHO. Rich countries rush to purchase billions of vaccine doses, leaving poor countries at the mercy of willing givers.

Even as African countries relied on supplies produced outside the region, the countries needed financial support to procure the supplies that at some point were available, but they did not have the money.

Before the pandemic, Africa produced less than one per cent of the vaccines that it consumed while importing over 99 per cent despite consuming over 25 per cent of vaccines globally.

Africa also accounts for 23 per cent of the world’s overall disease burden.

The potential for dangerous mutations of the virus could affect vaccine effectiveness and global travel could increase the spread of the virus.

“None of us is safe until all of us are vaccinated,” said Dr Matshidiso Moeti, WHO regional director for Africa.

Build factories

But with the pandemic, many pharmaceutical firms have announced plans to create factories in the region, though many have raised a number of challenges, including infrastructure and regulations.
Already, some work is ongoing and in two years’ time, a Covid-19 vaccine developed in Africa for Africans will be approved, with human trials expected to start early next year.

The vaccine candidate produced from mRNA technology will be the first to be designed, developed and assembled at a laboratory scale in Africa, thanks to the hub at Afrigen Biologics and Vaccines, a biotechnology company that may help the continent end its overreliance on developed countries.

The lack of soup-to-nuts manufacturers is one major reason low- and middle-income countries, and specifically in Africa, were boxed out of buying Covid-19 vaccines when the pandemic first hit.

Globally, the concentration of vaccine production in a few high-income countries has led to vast inequities in access to Covid-19 vaccines.

Without a manufacturing hub that produces at least 50 per cent of the vaccines that Africa needs, there will never be research and development capability. There will also be no pandemic preparedness, and no vaccine and health equity.

“We have to build this sector at all costs. This is our breakthrough as a continent and it’s now,” said Prof Petro Terblanche, Afrigen's managing director, when journalists toured the facility in Cape Town, South Africa, earlier this month.

Several disease outbreaks have been reported on the continent in recent years, most recently Ebola in Uganda and the Covid-19 virus, yellow fever, swine flu, polio, measles and monkeypox.

“If African countries come together and make Afrigen the mRNA vaccine hub, then the continent will have their first vaccine manufacturing hub, making it the first mRNA vaccine ever in Africa to receive approval by the World Health Organisation,” Prof Terblanche said.

The majority of mRNA vaccine trials have been going on in high-income countries, with minimal interest in Africa.

The mRNA vaccine teaches its cells how to make a protein that will trigger an immune response in one’s body, rather than putting a weakened or inactivated germ into the body.

The gap was also seen in other areas including logistics, Covid-19 treatments, drugs, and protective supplies which were less accessible to less wealthy nations. This made it difficult to get shots.

At the onset of the pandemic, some countries including Kenya had to wait for months after making an order for testing reagents and personal protective equipment to be delivered. This led to the deaths of about 20 healthcare workers who were at the forefront of fighting Covid-19 and were working without the equipment.

Africa is the world's second-largest and second-most-populous continent after Asia. With 1.4 billion people, it accounts for about 18 per cent of the world's human population.

Early last month, Covid-19 vaccination coverage had stagnated in half of African countries, while the number of doses administered monthly declined by over 50 per cent between July and September, according to a WHO analysis.

Although Africa is far from reaching the year-end global target of protecting 70 per cent of the population, it is reported that it has vaccinated a majority of its high-risk population groups, particularly the elderly.

The WHO analysis shows that the percentage of people with complete primary vaccination series (one dose for Johnson & Johnson and two doses for other vaccines) has barely moved in 27 of 54 African countries in the past two months (August 17-October 16, 2022).

In addition, in September this year, 23 million doses were given, 18 per cent less than the number registered in August, and 51 per cent less than the 47 million doses administered in July.

From the analysis, just 24 per cent of the continent’s population had completed their primary vaccination series compared with the coverage of 64 per cent at the global level.

'End is in sight'

Africa is expected to meet the global target of 70 per cent of people with complete primary vaccination series by April 2025. Is this achievable with the current pace of vaccination?

“The end of the Covid-19 pandemic is within sight, but as long as Africa lags far behind the rest of the world in reaching widespread protection, there is a dangerous gap which the virus can exploit to come roaring back,” said Dr Moeti.

“The biggest priority is to shield our most vulnerable populations from the worst effects of Covid-19. On this front, we are seeing some progress as countries step up efforts to boost coverage among health workers, the elderly and those with compromised immune systems.”

Based on data from 31 countries, by last month, 40 per cent of African health workers had completed their primary series. In 15 of these countries, more than 70 per cent of health workers have been fully vaccinated compared with 27 per cent at the beginning of the year.

Thirty-one per cent of older adults (above 50) have been fully vaccinated according to data from 27 countries, an increase from 21 per cent in January 2022.

While difficult access to doses undermined vaccination efforts in 2021, these issues have been largely resolved, with countries on average receiving 67 doses per 100 people compared with 34 doses per 100 people at the end of 2021, and 13 doses per 100 at the end of September 2021. The continent has received 936 million vaccine doses, 62 per cent of which came from the Covax facility.

“After a bumpy start, the Covax partnership has assured a steady pipeline of Covid-19 vaccines to Africa,” said Dr Moeti. “Now, we are a victim of our own success. As vaccines have helped bring the number of infections down, people no longer fear Covid-19 and so few are willing to get vaccinated.”

Mass vaccination campaigns have been instrumental in boosting Covid-19 vaccine coverage, contributing to 85 per cent of total doses administered in the African region. However, in the past few months, the number of people vaccinated has dropped significantly while the operational costs per person keep increasing. This decline in effectiveness is due to sub-optimal planning and preparations, especially at the sub-national levels.

“Covid-19 vaccination campaigns are quick operations and are only effective with good planning,” said Dr Moeti. “I urge countries to make our goal of reaching every district a reality by improving preparations for vaccination campaigns.”

Over the past 12 weeks, Africa has recorded the lowest case numbers since the start of the pandemic. In the week ending October, about 4,500 new cases were reported, representing 1.3 per cent of the peak of the Omicron-fuelled surge last year.

No country is currently in resurgence or on high alert and deaths remain low across the region, with 256,242 deaths representing a case fatality rate of 2.1 per cent with 10,363,429 recoveries
By the end of August 2022, over 12 million cases of Covid-19 in 55 African countries had been confirmed, with 373,195,217 vaccinations administered across the continent.

In Africa, according to the WHO and Covid World Vaccination Tracker, Liberia, Mauritius and Seychelles have surpassed 70 per cent of people with full vaccination coverage. Rwanda is on the verge of achieving this milestone as well.

Seychelles is the African country with the highest coronavirus vaccination rate, with around 201 doses administered per 100 individuals. Mauritius and Rwanda followed with 198 and 194 doses per 100 people, respectively. Ranking fourth, Morocco had a vaccination rate of about 149 doses per 100 people, the second-highest vaccinated after Egypt.

In South Africa, the most affected country on the continent, the vaccination rate instead reached around 63 per 100 people.

Around 20 per cent of Africa's population was fully vaccinated against Covid-19 as of August 2022. Among countries, the proportion presents wide variations. Seychelles had over 80 per cent of its population with the vaccinal cycle completed. On the other hand, only 0.1 per cent of Burundi's population was fully vaccinated against Covid-19.

South Africa has the most reported cases, over four million, with 102,066 deaths. Other most affected countries are Morocco (1,263,943), Tunisia (1,141,773), Egypt (515,645), Libya (506,515), Ethiopia (492,960), and Kenya (339,252) cases as of August.

East African countries have registered over 26,000 deaths due to the coronavirus. The number of cases in the region surpassed 1.34 million. Ethiopia was the most affected in East Africa, accounting for some 7,500 deaths. Kenya followed, with over 5,600 deaths caused by the disease.
Mr Tian Johnson, founder and strategist for the Africa Alliance and member of the Ministerial Advisory Committee on the Covid-19 vaccine, said Africa needs to think about research and development.

“From the pandemic, the concept of global solidarity is a lie. Waiting for the high-income countries to give us the leftover vaccines should be a lesson. We were waiting as they vaccinated their population,” he said.

“This was the first indication that the systems were not working. There was also the spectacular greed of the pharmaceutical companies [which made billions] because of the pandemic. 

“These are companies that continued to supply wealthy countries to hoard vaccines that they did not need while continuing to ignore the African countries that had paid for the vaccines and could not get them.

“Many African governments struggled for months [and] even a year to secure vaccines in a system where wealthy countries took the lion’s share, hence the global inequalities. 

For most countries in the region, that challenge continues. With the Ebola outbreak in Uganda without a vaccine, the situation is worse.”

He reiterated that the concept of solidarity was hollow and the pandemic experience showed that African countries were largely on their own.

African countries, he said, should invest in manufacturing their own vaccines because the will is there.

“The pandemic has been characterised by racism, and white supremacy,” he said. 

“We were slapped in the face with troubles and Africa was closed. It was said at the beginning of the pandemic that Africa will be shut out and known as the continent of Covid-19. These words came true.”

He challenged African researchers that as much as they are holding high-income countries to account, the more difficult work is doing so for African heads of state.

“Our leaders should walk the talk. Why is it that over 20 years [since the Abuja Declaration], we have not been able to manufacture our own vaccines? We need to make all the declarations that we made a reality,” he said.