Twenty-two African countries are experiencing a surge in COVID-19 infections, yet the vaccination rollouts on the continent have ground to a halt because of lack of supply.

African vaccination figures, as recorded by the Africa Centers for Disease Control and Prevention, are dismal. Apart from the tiny island state of Seychelles, only Morocco’s vaccination rate is in the double digits with 16.7% of its population fully vaccinated.

The next highest are Equatorial Guinea (6,26%), Tunisia (2,93%) and Zimbabwe (2,6%).

In terms of numbers, Egypt has delivered the most vaccinations, which by Monday had topped 3,3 million. But in a country with a population of over 100 million, and each person needing two vaccinations, this means that only 0,39% of Egyptians are fully vaccinated.

Meanwhile, Uganda has virtually run out of vaccines and oxygen, as COVID-19 cases increased by 2,800% in the past month. Its test positivity rate is 21.5%. Last week, the country entered a new 42-day lockdown in a bid to contain cases.

Results of COVID-19 tests done on 13 June 2021 confirm 1,422 new cases. The cumulative confirmed cases are 64,251. pic.twitter.com/3aQmfdPgjR

— Ministry of Health- Uganda (@MinofHealthUG) June 15, 2021

South Africa officially entered its third wave last week and is reporting over 5000 new cases per day with a test positivity rate of over 15%. On Tuesday night, President Cyril Ramaphosa announced that the country would move immediately to lockdown Level Three with a longer curfew, more limits on public gatherings and curbs on the sale of alcohol. The Democratic Republic of Congo, Namibia, Zambia and Kenya are also battling increased cases.

“The steep increase in Africa is especially concerning because it is the region with the least access to vaccines, diagnostics and oxygen,” World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told the global body’s biweekly COVID-19 briefing on Monday.

“A recent study in the Lancet showed Africa has the highest global mortality rate among critically ill COVID-19 patients, despite having fewer reported cases than most other regions,” he added.

Most African countries have relied on the COVAX-facility for vaccines, but these supplies dried up in late March when the global vaccine platform’s key supplier, the Serum Institute of India, redirected all its AstraZeneca vaccines to address India’s pandemic.

To date, COVAX has supplied 37 of the 55 African states with vaccines. Almost 60% of African countries are reliant solely on AstraZeneca, according to the Africa Centres for Disease Control, and many countries have only administered a single dose to citizens with no idea of when they will receive supplies to administer the second dose.

Countries that have been able to reach more than 1% of their populations have done so largely because they have had other vaccine sources besides COVAX – primarily China’s Sinopharm, which is available in Morocco, Egypt, Tunisia, Seychelles, Zimbabwe and Equatorial Guinea among other countries. Some of the north African countries also have access to Russia’s Sputnik V vaccine.

Two Million J&J Vaccines Destined for South Africa Have to be Destroyed

South Africa decided not to use the AstraZeneca vaccine following research which showed diminished efficacy against the Beta variant (B1.351) dominant in the country and has bought Pfizer vaccines – reportedly at great cost – as well as Johnson & Johnson vaccines.

However, South Africa’s worst fears were realised over the past weekend when all two million Johnson & Johnson COVID-19 vaccines ready for distribution in the country were found to be made from batches that the US Food and Drug Administration (FDA) ruled unsuitable last Friday.

Last week, the country officially entered a third wave of the pandemic but it has only administered 1,350,000 vaccines – which translates into 0,5% of its population being fully vaccinated as two-thirds of these are the two-dose Pfizer vaccine.

With a drip supply of the costly Pfizer COVID-19 vaccines arriving every week, doses have been strictly rationed to health workers and those over the age of 60. 

Johnson & Johnson has undertaken to replace the two million doses by the end of June – but they were expected to have been dispensed in early May, which means that the rollout is running two months behind schedule.

However, Ramaphosa said on Tuesday night that “the pace of vaccinations has steadily picked up, and we are now vaccinating around 80,000 people a day at over 570 sites in the public and private sector. This number will grow rapidly in the weeks to come, as we aim to protect as many vulnerable people as possible.”

Officially, South Africa has been the worst affected on the African continent with over 1,7million COVID-19 cases. The official COVID-19 death toll is over 57,000 but “excess deaths” of 166,794  were recorded between 3 May 2020 and 5 June 2021, according to the SA Medical Research Council (SAMRC). The peaks and troughs of these excess deaths correlate almost exactly with the COVID-19 waves.

Huge ‘Excess Deaths’ in Egypt 

Meanwhile Egypt appears to have completely under-reported the impact of COVID-19. Between March 2020 and May 2021, it claimed a death toll of little more than 13,000 – yet its excess mortality for this period was over 175,000, according to the University of Washington’s Institute for Health Metrics and Evaluation (IHME). This means that it has more deaths than South Africa, even when that country’s excess deaths are taken into account.

Egypt has the highest obesity rate on the continent, so its death rate is in keeping with global trends.

It is likely that the impact of the pandemic is much greater in a number of other African countries, but only a handful have functioning civil death registration systems – namely Egypt, South Africa, Tunisia, Algeria, Cape Verde, São Tomé and Príncipe, Seychelles and Mauritius.

In a preprint article based on the world mortality dataset, academics Ariel Karlinsky and Dmitry Kobak report that they found the highest undercounts of excess mortality in Uzbekistan (30), Kazakhstan (12), Belarus (15), Egypt (13), and Russia (6.7). 

“Such large undercount ratios strongly suggest purposeful misdiagnosing or underreporting of COVID-19 deaths,” according to the authors.

Countries Need Logistical Support to Prepare for Vaccine Rollouts

Last Sunday, the G7 countries announced that they would be donating 870 million doses to countries in need – primarily through COVAX. However, many of these will be Pfizer vaccines that need to be stored at ultra-cold temperatures.

Dr Mike Ryan, WHO’s Director of Health Emergencies, warned that the logistics around cold chain management and vaccination rollouts was complex.

“Countries need assistance in preparing for that. A second tragedy will be to have vaccines and not be able to use them properly,” Ryan told Monday’s WHO press briefing on COVID-19.

“There is underfunding right now of basic preparedness in many, many countries. We would urge donors and others to not only just fund vaccines, but to fund the operations needed to deliver those vaccines, and to fund the agencies like UNICEF, like ourselves and other NGOs who are working very closely with governments to improve their capacity to deliver vaccines,” urged Ryan.

Meanwhile, a statement from the COVAX partners this week in response to the G7 donation also urged support for countries for rollouts.

“Facing an urgent supply gap, COVAX is focused on securing as many shared doses as possible immediately, as the third quarter of this year is when the gap between deliveries and countries’ ability to absorb doses will be greatest,” said the partners in a media statement.

“In anticipation of the large volumes available through the COVAX Facility deals portfolio later in the year, COVAX also urges multilateral development banks to urgently release funding to help countries prepare their health systems for large-scale rollout of vaccines in the coming months,” it added.

The Democratic Republic of the Congo has already sent some of 1.7 million of its COVAX-donated vaccines to other countries because it was unable to distribute them before their expiry date. Meanwhile, South Sudan intends to destroy 59,000 vaccines that have expired and Malawi earlier destroyed 20,000 expired vaccines despite being told by Africa CDC and other bodies that they could be used. 

Image Credits: WHO, WHO African region .