OVER THE summer a lack of supply was the main problem. Africans queued from dawn for jabs of covid-19 vaccine, but most doses were going to rich countries. India, a big producer, banned exports. The results were grim. Senegal saw seven times the number of funerals as in normal times, according to some estimates. Gravediggers in other African countries were working overtime, too. Today only 7% of Africans are fully vaccinated against the disease.
In recent weeks, however, vaccine shipments to Africa have greatly increased. About 50m doses arrived in October, almost double the number that had landed in September. Uganda, which has administered 6m doses so far, expects to have received 21m doses by the end of this year—enough to inoculate almost every adult. With more shots on the horizon, the World Health Organisation is calling on all countries to vaccinate 70% of their total populations by mid-2022. Several African countries have set goals accordingly.
Yet the 70% target may not be achievable in much of sub-Saharan Africa, where large portions of the public seem reluctant to get the vaccine or are difficult to reach. Moreover, striving to reach it by mid-2022 may not be desirable. The median age in the region is less than 20. Building up herd immunity against covid is a worthy goal, but vaccinating loads of slim young Africans, who are at little risk of dying from the disease, often means diverting resources from more pressing health campaigns. The target “does not make much sense” for Uganda, where half the population are children, says Alfred Driwale, who manages the country’s vaccine programme.
Africa’s health workers are already overstretched. Among their priorities are delivering catch-up vaccinations for diseases like measles and tetanus. Millions of children missed these jabs during lockdowns, because their parents could not travel or were afraid of getting covid in clinics. In Moroto, a district in Uganda some 400km from the capital, Kampala, Hans Lokale, the local health officer, says that normally about 10% of children do not return for follow-up doses. Since the pandemic that figure has doubled. Kwaku Agyeman-Manu, Ghana’s health minister, says his covid programme has not distracted from other public-health efforts. But that may be because only 8% of Ghanaians have received a jab since the vaccines began arriving in March.
Jabs against covid and those for other diseases may end up competing for more than health workers’ time. In order to mount covid campaigns, some African countries have already dipped into their emergency stockpiles of syringes, which are usually reserved for outbreaks of infectious diseases such as measles and yellow fever. Just to replenish these stocks they will have to get hold of 25% more syringes than usual, reckons Unicef. That does not even take into account the syringes needed for the billions of covid jabs that would have to be administered to hit the 70% target. Compounding the problem is the nature of syringes used in Africa. These are specially designed to draw exactly the standard covid-vaccine dose and to disable the needle after one use. Both are crucial features because jabs are often given by poorly trained community health workers who may unintentionally spread infections such as HIV by reusing old needles.
When mulling priorities, some African health officials may note the growing evidence that covid has already swept through much of the region. A study in Mali, for example, found that about 60% of people had already been infected by January—and thus have some level of natural immunity. Covid may also be less deadly in Africa. Even when the outbreak was at its worst in Mali, hospital admissions among those with covid were rare. One obvious reason is that fewer people in Mali are obese or have diabetes, two conditions that exacerbate covid. Some studies suggest another reason: covid appears to be less severe in people who have had malaria in the past.
Whether or not the 70% target is desirable, many countries in sub-Saharan Africa will struggle to reach it. As of early November most of them had used less than half of the doses they had received (see chart). One reason is that many of the doses were donated by rich countries shortly before their expiry date. “They bring vaccines that are going to expire in two weeks,” says Dr Lokale. He has 2,000 doses that must be put into arms in the next fortnight. That would require nearly 4% of adults in his district to turn up at short notice.
Outside a health centre in Moroto, four people are sitting in the thin shade of an acacia tree waiting for more people to come before they can get a jab. Each vial of the vaccine given here contains 15 doses. Once it is opened it has to be used that day. In some places health workers urge people to gather friends and come as a group. A recent delivery of Sinovac’s vaccine has helped reduce this problem because it comes in single-dose vials.
Many people in Moroto are cattle herders who move periodically in search of fresh pasture. That can make it hard to track them down for a second dose. Dr Lokale is hoping for a shipment of Johnson & Johnson’s single-dose vaccine, which would solve that problem. As global vaccine supplies increase African countries could become more selective, choosing those that are better suited to their needs, says Gian Gandhi from Unicef.
A jab and a prayer
A harder problem may be persuading people to get a jab. In surveys taken in 15 African countries by Afrobarometer, a pollster, only 47% of respondents on average said they were likely to be inoculated and 39% believed that prayer is “much more effective” than the vaccine at preventing covid (though some were asked before jabs were available). When shots were offered to health workers at Moroto’s hospital, only half had them. Rumours that the jabs make people sterile, that Western countries are sending them to kill Africans and similar nonsense, circulate on WhatsApp. Even in villages with no internet, the same messages are relayed on the radio.
Low trust in government, a chronic state of affairs across Africa, is part of the problem. Fewer than half of respondents in the Afrobarometer surveys said they trusted their government to ensure vaccines were safe. But many people have more prosaic misgivings that could be solved with better outreach campaigns. Sayou, a 52-year-old guard in Dakar, the capital of Senegal, says he trusts the vaccines but is unsure that clinics are open on Sunday, his only day off work.
All this helps explain why the plastic chairs outside the covid vaccination room at a clinic in Dakar are empty. There is no shortage of vaccines, but only about ten people a day show up, compared with 50 or more not long ago. Cases of covid are low, says a nurse, “but if there is another wave, the whole world will come again.” Meanwhile, health officials must decide how best to deploy their limited resources. ■
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