The situation has become indefensible, according to one top health expert.
Across Africa, as the Omicron variant extends its reach, more than 80 per cent of the 1.2 billion people on the continent have yet to have a single dose of a coronavirus vaccine and only 8 per cent have received a full regime.
In the beginning, the problem was a lack of supply but as the production of doses has been ramped up around the world, the lack of shots in arms has been complicated by vaccine hesitancy, short shelf life and logistics. Eritrea, for example, has yet to start its vaccine roll-out.
“Millions of people in our region are without protection against Covid-19. This is simply dangerous and untenable,” said Dr Richard Mihigo, coordinator for the immunisation and vaccines development programme at the WHO’s Regional Office for Africa.
The problem is particularly acute in Nigeria, the continent’s most populous country with 206 million people.
So far, just 2 per cent of the public have been fully vaccinated – well short of the WHO’s goal of 40 per cent by the end of the year – but authorities are destroying more than a million vaccines it received from Europe.
According to Reuters, the vaccines expired in the short time before they could be administered.
“The vaccines that expired had been withdrawn and will be destroyed accordingly,” Nigerian Health Minister Dr Osagie Ehanire said last week. “The Ministry of Health … now politely declines all vaccine donations with short shelf life or those that cannot be delivered in time.”
In April, the Democratic Republic of Congo (DRC) donated 1.4 million AstraZeneca doses that it received to other countries before the doses could expire. South Sudan also early this year donated some of its vaccines because it was unable to deploy them before expiry. In addition, at least 200,000 Covid-19 vaccines had expired in Senegal without being used in the past two months and another 200,000 were set to expire at the end of December because demand was too slow, the head of its immunisation programme said on Monday.
Lawrence Gostin, a professor of global health law at Georgetown University in Washington, said rich countries were waiting until the last minute to donate surplus vaccines, with many approaching their expiration date.
“It treats countries in Africa as expendable, and not worth saving. It is the worst kind of greed,” Gostin said. “It’s scandalous.”
Mihigo of WHO said a team of experts was in Nigeria to investigate the issue.
“We have issued a strong statement stating firmly that it is important that these donations come with enough shelf life so that countries can plan and deploy these vaccines,” Mihigo said.
The WHO has also raised concerns that the DRC, Djibouti and Chad have been slow in deploying their vaccines. Although the DRC has received about 4 million doses, only 0.16 per cent, or 143,360 of its 89.6 million people, have received one dose – and the number falls further to a mere 0.06 per cent or 53,760 for those who are fully vaccinated.
Vaccine hesitancy is widespread in the mineral-rich central African nation mainly due to misinformation that doses can make people infertile or even kill them.
This escalated when several countries suspended vaccination campaigns for the Oxford-AstraZeneca vaccine amid concerns that it caused rare but fatal blood clots.
The cause was dealt a blow when President Felix Tshisekedi turned down AstraZeneca jabs in July over safety fears. He rolled his sleeve up in September for a Moderna Covid-19 vaccine shot but the damage had already been done as many Congolese remained reluctant to take the vaccine.
For much of the year, the problem had been a lack of supply. As recently as a few months ago, the continent was receiving as few as 2 million vaccines a week.
Now about 20 million doses are arriving and the delivery pipeline from the Covax Facility – a global initiative for fair access – “is promising”, according to Mihigo.
“We are expecting to receive between 800 million to almost 1 billion doses via Covax before the end of the year or in the first quarter of next year,” he said.
Some of these shots are coming from China. Chinese President Xi Jinping promised earlier this month to donate 600 million doses of Covid-19 vaccines to Africa and another 400 million doses would be jointly produced in Africa by Chinese and African companies.
The US and European countries have also promised to donate more vaccines. And India’s Serum Institute, which had suspended exports of vaccines to deal with a surge in coronavirus cases at home, restarted vaccine exports to Covax in November.
Mihigo said that as vaccine donations and deliveries rose “the issue today is not lack of demand through Covax, we now have enough vaccines that are going to come”.
“The challenge is deploying these vaccines,” he said.
“We are doing whatever it takes not only as the WHO but working with other partners such as [the Africa Centres for Disease Control and Prevention], Unicef and countries themselves to see how bottlenecks that are hampering the delivery of vaccines can be resolved.”
To increase the uptake of vaccines, countries such as Kenya and Nigeria have imposed vaccine mandates.
In Kenya, Health Minister Mutahi Kagwe said that from December 21, those who had not been vaccinated would not be able to access government services and not be allowed to some public places and buildings.
“You will not take a train without a vaccine … you will not fly out of Kenya without being vaccinated,” Kagwe said.
Kenyans would have to show proof of vaccination to enter national parks and game reserves, hotels, bars and restaurants, he said. Also, businesses, including small and medium enterprises serving 50 or more people a day, will have to put up signs telling patrons of the need for proof of vaccination before entry into their premises.
Since the country announced the measures on November 22, vaccination numbers have increased from 60,000 to 100,000 daily.
Ruth Mocheche, an entrepreneur based in Nairobi, was one of those motivated by the new measures to get her first shot.
She had been hesitant to take the jab fearing the side effects but now that the vaccines are available in most hospitals and clinics, even in rural areas, she felt there was no need to shy away from them.
“As a business lady, I didn’t see the need to take the vaccine but now that the government wants all businesspeople to get vaccinated, I recently took the first dose and the second dose will be in February,” she said.
But the government has an uphill task convincing many more to take the jab since only 8 million doses have been administered out of the more than 18 million vaccines delivered.
While vaccine mandates might address vaccine hesitancy, distribution challenges and a lack of vaccine supply will probably remain the key stumbling blocks in inoculation campaigns, according to Virag Forizs, an Africa economist at London-based consultancy Capital Economics.
She said that “while vaccine mandates might incentivise the take-up of jabs by those otherwise hesitant to do so, delivery issues will probably remain”.
Forizs said distribution challenges were likely to hold back inoculation campaigns even as vaccine supplies – the main obstacle so far – picked up to some degree.
In the meantime, the continent has reported more than 8.7 million Covid-19 cases and over 224,000 deaths with a case fatality rate of 2.6 per cent, according to the Africa CDC.
South Africa, whose scientists discovered the Omicron variant, has reported more than 3 million cases and about 90,000 deaths.
However, the WHO said there was encouraging data from South Africa that suggested that Omicron might cause less severe illness.
According to data on hospitalisations across the country, between November 14 and December 4, the intensive care admission rate was only 6.3 per cent – much lower than in July when South Africa was facing the peak linked to the Delta variant. “This is still a preliminary analysis and we will need at least another two to three weeks to determine Omicron’s full effects,” Mihigo said.
But what is more certain to hurt Africa is the move by more than 70 countries to impose travel bans that are mainly targeting southern African countries – some of which have yet to report any Omicron case.
South African President Cyril Ramaphosa, who on Sunday tested positive for Covid-19, warned that while the Omicron variant “appears to be dominating new infections in most provinces”, there was no evidence whether the Omicron variant was transmitted more efficiently, or that the variant increased the risk of reinfection.
“Yet, several countries have decided to isolate a number of countries on the African continent,” Ramaphosa said.
He said the travel bans would devastate the economies of Southern Africa countries that are dependent on tourism.