Within one year, Africa has gone from waiting for its first COVID-19 vaccine shipment from the WHO-supported global COVAX facility to having excess doses available that some countries are  struggling roll out efficiently.  Reflections on the first anniversary of the massive COVAX vaccine rollout. 

On 24 February 2021, Health Policy Watch reported the global COVAX facility delivered its first doses In Accra, Ghana’s capital city.  It was a feat that WHO Director General Dr Tedros Adhanom Ghebreyesus described then as the culmination of many months of planning, research, negotiation & coordination.

“But it’s just the beginning. We still have a lot of work to do to realize our shared vision for vaccine equity by starting vaccination in all countries within the first 100 days of the year,” he said.

One year later however, hundreds of millions of doses have now been received by more than 50 African countries, and the challenge now has shifted to the ability of countries to efficiently roll out available vaccines. 

Addressing journalists on Thursday, Dr Phionah Atuhebwe, “new vaccines introduction officer” at the WHO Regional Office for Africa, said when the first shipment of COVID-19 vaccines was received by the COVID facility to Ghana, it came with a wave of hope and excitement that the milestone would signal a turnaround in the pandemic that was raging through the world and the continent.

A year later, around 680 million doses have been delivered to Africa. 65% of these from COVAX, 6% from the African Vaccine Acquisition Trust, and the rest from bilateral deals and donations.

But the continent lags behind the rest of the world. “Only 13% of the African population has been fully vaccinated in comparison with 55% globally,” Atuhebwe said.

At the same time, the picture is not all gloomy, she said noting that “over 400 million doses of these have been administered amidst excitement and disappointments, some highs and many lows. Africa has taken on the largest vaccine rollout in its history.”

Aurélia Nguyen, managing director of the Office of the COVAX Facility, at Gavi, the Vaccine Alliance told reporters that despite the severe supply setbacks experienced for COVAX during most of 2021, a "new paradigm" is happening today.  

“I'm happy to say that COVAX is operating under a new paradigm with current supplies that is now able to meet demand,” she said. “We have the ability to be responsive to countries' individual vaccination strategies. And this means ensuring that countries have stocks in countries so they can administer literally as fast as they are able to. It also means operating longer term feasibility [assessments] on supply.”

Nagging problems remain with roll-out in the 18 countries in the region that have fully vaccinated less than 10% of their populations - including three countries that have not yet vaccinated even 1% of their population fully. Moreover, 29 countries have used less than 50% of the vaccine stocks that they currently have at hand. 

Among the 24 countries that are reporting complete data on vaccination, only 21% of adults over the age of 50 years have been fully vaccinated; and only 11% of people with comorbidities are reported to be fully vaccinated in 20 countries that are providing this data.

“Worryingly, a sizable proportion of the highest risk populations in Africa remains unvaccinated,” Atuhebwe told journalists.  And even if Omicron passed over region with comparably fewer deaths, lack of vaccination still leaves people more vulnerable to future SARS-CoV variants, experts worry.  

Still aiming for 70% target

Even if Omicron is receding now, the WHO remains committed to a 70% vaccination goal for the continent - as a means of protection against future threats.  

“Countries have recognized this and are stepping up the pace rapidly as we race towards the mid-2022 target of fully vaccinating 70% of the world's population,” Atuhebwe said.

Of the 20 priority countries identified by the WHO in the African region for intensified support in vaccine rollout, 10 are currently conducting mass vaccination campaigns, which aim to reach at least 100 million people by the end of April.

Kenya setting an example

Kenya is one of the countries setting a new pace for scale-up.

During the first two weeks of the new campaign in February, Kenyan health services reportedly tripled the number of vaccine doses administered, as compared to the two previous weeks. In Guinea Bissau around 125,000 doses were administered during a two week campaign in February, as compared to 11,000 in the whole month of January, WHO officials reported.

WHO said mass vaccination campaigns will be rolled out in a phased approach in 2022 not only in these priority countries, but also in other countries across the continent. Gavi, UNICEF, Africa CDC, the World Bank and other partners are all working to support countries with the logistics, financing, planning and implementation of the campaigns, as well as helping to ensure that there is a robust social mobilization to drive demand for vaccines.

At a separate briefing, the Africa CDC forecasted that by the end of the first quarter of 2022, Africa will have received a total of nearly 304 million vaccine doses of vaccines from both AVAT and COVAX. 

AVAT’s Q1 2022 forecast is 44.6 million doses while Covax’s delivery forecast for the same period is 261.1 million. Some 13.2 million doses are also expected by AVAT as donations. Moreover, 25 African Union Member States are now offering booster shots (Pfizer BioNtech, J&J) following “full” vaccination with either a one- or two-dose regimen.

Strong coordination to get to 70%

Improved coordination among vaccine donors, AVAT, COVAX and African countries remains crucial if the continent will achieve the target of vaccinating 70% of its population by mid-2022, asserted Dr John Nkengasong, Director of the Africa CDC, in a separate briefing on Thursday. .

“COVAX and AVAT coordinate all the time. We talk all the time. We talk to vaccine donors and we speak to issues of expiration — what are the conditions of the vaccines you want to donate? When do they expire?

"We now take the responsibility to engage with member states. That is what we mean by coordination so that we don’t get ourselves in a situation where Donor A is giving vaccines to a country and Donor B is not aware,” Nkengasong said.