Author: Africa-Europe Foundation Debate
Site of publication: Mo Ibrahim Foundation
Type of publication: Report
Date of publication: January 27th, 2022
The COVID-19 toll in Africa: Africa hit midler?
As of 26/1/2022, cumulative COVID-19 cases per 1 million population are nearly 25 times higher in the European Union (EU) than in Africa: 10.7 million COVID-19 registered cases in the 54 African countries (for a population of over 1400 million), compared to the 81.2 million in the 27 EU countries (for a population of 445 million).
Cumulative COVID-19 deaths per 1 million population are nearly thirteen times higher in the EU than in Africa. With a population that is more than three times larger, Africa only accounts for 4.2% of global cumulative COVID-19 deaths compared to 16.8% in the EU.
But the impact of COVID-19 in Africa may be greatly under-estimated: according to World Health Organization (WHO), about only one in seven COVID-19 infections are being detected in Africa.
Furthermore, WHO seroprevalence studies in 11 African countries estimated that in fact up to about 68% of the population could have some conferred COVID-19 immunity (as of September 2021).
Vaccine inequity: Africa’s population vaccination rate is barely over 10%, compared to 72% in the EU
According to WHO, 70% of population should be vaccinated by end of 2022 to reach immunity level. Under current vaccine rollout projections, it is estimated that most African countries will not achieve mass immunisation until 2023. In the continent’s poorest countries, it may not even be reached until 2024.
But the impact of COVID-19 in Africa may be greatly under-estimated: according to World Health Organization (WHO), about only one in seven COVID-19 infections are being detected in Africa
As of 27/1/2022, COVID-19 vaccine doses administered in Africa account for less than half of the amount administered in the EU, for a population that is more than three times larger.
Only seven out of 54 African countries have reached the 2021 year-end WHO target of fully vaccinating 40% of their people, compared to 26 out of the 27 EU countries. Only Seychelles and Mauritius have achieved the mid-2022 target of fully vaccinating 70% of their population, compared to more than half (14) of EU countries.
The immediate challenge: level up Africa’s population COVID-19 vaccination rate
140 COVID-19 vaccines are currently in clinical development, with ten of them already in the phase 4 of human clinical trials.
Bilateral purchasing deals made by 19 African countries amount to 315.0 million confirmed procurement doses, plus 85.4 million potential procurement doses.
Purchases made at continental level amount to 330 million confirmed procurement doses, plus 180 million potential procurement doses.
In December 2020, under the strong impulsion of the European Commission, France, WHO and the Bill & Melinda Gates Foundation, the ACT-A (Access to COVID-19 Tools Accelerator) was created as a global collaboration mechanism to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines.
As the vaccine pillar of ACT-A, COVAX is co-managed by GAVI, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and the WHO.
According to the COVAX Global Supply Forecast published in December 2021, while the global vaccine-sharing scheme aimed at having made 2 billion doses available by the end of 2021, it missed its delivery target. As of 17 January 2022, COVAX has only shipped over 1 billion COVID-19 vaccines to 144 participants.
A key challenge: In Africa, multiple distribution bottlenecks
- Health workers: Several of the COVID-19 vaccines pose additional challenges even for trained health workers, such as requirement to be removed/unpacked from ultra-cold chain refrigeration or mixing in-situ.
- Basic equipment shortages: A shortage of syringes – in particular a 0.3ml syringe version required to deliver the Pfizer dose – is slowing delivery in many places according to the WHO.
- Vaccine hesitancy: Over the past few years, there has been a growing surge of vaccination refusal.
- Last mile and reaching rural and marginalised communities: Any mass vaccine campaign requires refrigerated vehicles, cold chain packaging, tracking and visibility tools, as well as relevant transport networks.
The long-term challenge: building Africa’s vaccine autonomy
Africa accounts for 25% of the global vaccine demand but currently imports 99% of its routine vaccine needs.
At global level, vaccine manufacturing is concentrated in developed countries, and India. About 70% of global vaccine drug substance manufacturing sites are located in Western Europe (40%) and North America (30%).
Africa accounts for 25% of the global vaccine demand but currently imports 99% of its routine vaccine needs
In Africa, only 10 local vaccine value chain players are currently operating. The ten local vaccine value chain players are located in Nigeria (2), South Africa (2), Algeria (1), Egypt (1), Ethiopia (1), Morocco (1), Senegal (1) and Tunisia (1).
Multiple challenges to address on the road to Africa’s vaccine manufacturing autonomy
- Intellectual Property Rights/technology transfers: Two alternatives to the TRIPS waiver are already possible within current provisions:
- Voluntary licensing agreements (VLAs) enable a patent holder to allow others to manufacture, import, and/or distribute its patented products.
- Compulsory licenses (CLs) enable governments to allow others to manufacture, import and/or distribute patented products without the consent of the patent owner.
- Ensuring the relevant market size: A sustainable approach to developing vaccine manufacturing capacities requires reliable demand for large volumes to support the production scale required to be cost-competitive.
- Governance/regulatory/quality control frameworks: continent-wide harmonisation under the African Medicines Agency (AMA) is not yet a reality and national regulators face capacity constraints.
- Expertise/health workforce capacities/R&D: A few ongoing tech transfers have provided experience, but there are still skills shortages of pharmaceutical, biotechnology and industrial talent.
- Infrastructure environment: A fully reliable infrastructure is required for vaccine production, specifically at energy and water facility levels. Intracontinental transport facilities will also be key.
- Access to finance, and partnerships with the private sector: Initial investments made in local vaccine manufacturing have included the use of non-traditional financing models such as public-private partnerships (PPPs) and joint ventures. These will need to be enhanced and expanded.
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