Covid-19 Africa - Afrikan Heroes

Covid-19 Africa: What is happening with vaccine supplies?

August 1, 2021

By Peter Mwai

There are growing concerns that supply shortages in many African countries are holding back the continuing rollout of their vaccination programmes. The World Health Organization (WHO) says a large number of poorer countries relying on the global vaccine sharing scheme Covax do not have enough doses to continue vaccinating.

The UN and the Africa Centres for Disease Control (CDC) have already urged countries with surplus supplies to donate them to parts of Africa where they’re needed.

Matshidiso Moeti, regional director for WHO in Africa

What is happening with second doses?

Many African countries followed advice from the WHO to administer as many first doses as possible and not stockpile vaccines for second doses.

It had said in May that providing a first dose to as many people as possible was the highest priority.

Some countries have also been under pressure to use vaccines urgently or risk them passing their expiry dates.

Why some African countries are struggling to use their vaccines

These factors have contributed to a major shortage of doses for second jabs, principally of the AstraZeneca vaccine.

Ghana has been using doses redistributed from DR Congo to administer second doses. Most African countries have got their vaccines under the Covax scheme, and these were largely sourced from the Serum Institute of India.

However, India halted vaccine exports in response to its own urgent needs, and manufacturers faced issues with ramping up production in a short space of time.

How does the Covax scheme work?

The Covax programme – backed by the WHO and other multilateral bodies – aims to supply 600 million doses to Africa, enough to vaccinate at least 20% of the population.

The WHO says Africa needs 200 million doses to vaccinate 10% of its population by September this year.

“As supplies dry up, dose-sharing is an urgent, critical and short-term solution to ensuring that Africans at the greatest risk of Covid-19 get the much-needed protection,” says WHO’s Matshidiso Moeti.

How has the vaccine rollout progressed?

In Africa, only about two doses of vaccine have been administered per 100 people, compared with an average of 68 doses per 100 in high-income countries.

And less than 1% of Africa’s population has been fully vaccinated.

Deliveries of vaccine supplies under the WHO-backed Covax programme started in February, and most countries in Africa signed up and received vaccine doses.

Some countries are also getting donations from China, Russia, India and the UAE.

Only Tanzania, Burundi and Eritrea are yet to receive vaccines.

Now, some countries have exhausted the initial vaccine supplies they received from the Covax scheme, while others have had a slow uptake of jabs.

The slow rate of vaccination is caused partly by issues around distributing the vaccines, such as the lack of health infrastructure and staff.

But there are fears that vaccine hesitancy and scepticism could be playing a role.

“While we call for vaccine equity, Africa must also knuckle down and make the best of what we have,” said Matshidiso Moeti, regional director for WHO in Africa.

Seven African countries have used up all of vaccines they received through Covax and another seven have administered over 80%.

But 23 countries have used less than half of the doses they have received so far, including four countries now seeing resurgence in cases.

There are now more than a million AstraZeneca doses in 18 countries that need to be used before their expiry at the end of August, the WHO says.

What’s happened to vaccinations in South Africa?

South Africa, the country on the continent hit hardest by coronavirus, has been slow to administer Covid-19 vaccines.

The government says this was caused by factors out of its control. It delayed an initial vaccination plan using the AstraZeneca vaccine due to concerns about its efficacy against a new variant of coronavirus.

It sold on the vaccine doses it had bought from India to the African Union, which distributed the doses elsewhere.

It started vaccinating on 17 February after receiving the Johnson & Johnson vaccine, which is administered as a single dose and has been shown to be effective against the variant.

But the programme was put on hold in mid-April because of concerns about rare blood clot cases in the US. Vaccinations resumed in late April.

It started vaccinating using the Pfizer vaccine in mid-May.

So far, more than two million out of the population of 59 million in South Africa have been vaccinated – about half a million of them with the Johnson & Johnson vaccine (which is a single-dose) and the rest with the Pfizer vaccine.

This piece was originally published on 20 February 2021, but is updated regularly to include the latest information.

Peter Mwai is of the British Broadcasting Corporation (BBC)

Kelechi Deca

Kelechi Deca has over two decades of media experience, he has traveled to over 77 countries reporting on multilateral development institutions, international business, trade, travels, culture, and diplomacy. He is also a petrol head with in-depth knowledge of automobiles and the auto industry

COVID-19: examining theories for Africa’s low death rates By Kevin Marsh and Moses Alobo

October 8, 2020

As the threat of a COVID-19 pandemic emerged earlier this year, many felt a sense of apprehension about what would happen when it reached Africa. Concerns over the combination of overstretched and underfunded health systems and the existing load of infectious and non-infectious diseases often led to it being talked about in apocalyptic terms.

***Kevin Marsh, a Professor of Tropical Medicine, University of Oxford***

However, it has not turned out quite that way. On September 29th, the world passed the one million reported deaths mark (the true figure will of course be higher). On the same day, the count for Africa was a cumulative total of 35,954.

Africa accounts for 17% of the global population but only 3.5% of the reported global COVID-19 deaths. All deaths are important, we should not discount apparently low numbers, and of course data collected over such a wide range of countries will be of variable quality, but the gap between predictions and what has actually happened is staggering. There has been much discussion on what accounts for this.

As leads of the COVID-19 team in the African Academy of Sciences, we have followed the unfolding events and various explanations put forward. The emerging picture is that in many African countries, transmission has been higher but severity and mortality much lower than originally predicted based on experience in China and Europe.

We argue that Africa’s much younger population explains a very large part of the apparent difference. Some of the remaining gap is probably due to under reporting of events but there are a number of other plausible explanations. These range from climatic differences, pre-existing immunity, genetic factors and behavioural differences.

***Moses Alobo, Programme Manager for Grand Challenges Africa, African Academy of Sciences***

Given the enormous variability in conditions across a continent – with 55 member states – the exact contribution of any one factor in a particular environment is likely to vary. But the bottom line is that what appeared at first to be a mystery looks less puzzling as more and more research evidence emerges.

The importance of age

The most obvious factor for the low death rates is the population age structure. Across multiple countries the risk of dying of COVID-19 for those aged 80 years or more is around a hundred times that of people in their twenties.

This can best be appreciated with a specific example. As of September 30th, the UK had reported 41,980 COVID-19 specific deaths while Kenya, by contrast, had reported 691. The population of the UK is around 66 million with a median age of 40 compared with Kenya’s population of 51 million with a median age of 20 years.

Corrected for population size the death toll in Kenya would have been expected to be around 32,000. However if one also corrects for population structure (assumes that the age specific death rates in the UK apply to the population structure of Kenya), we would expect around 5,000 deaths. There is still a big difference between 700 and 5,000; what might account for the remaining gap?

One possibility is the failure to identify and record deaths.

Kenya, as with most countries, initially had little testing capacity and specific death registration is challenging. However, Kenya quickly built up its testing capacity and the extra attention to finding deaths makes it unlikely that a gap of this size can be fully accounted for by missing information. There has been no shortage of ideas for other factors that may be contributing.

A recent large multi-country study in Europe reported significant declines in mortality related to higher temperature and humidity. The authors hypothesised that this may be because the mechanisms by which our respiratory tracts clear viruses work better in warmer, more humid conditions. This means that people may be getting less virus particles into their system.

It should be noted however that a systematic review of global data – while confirming that warm and wet climates seemed to reduce the spread of COVID-19 – indicated that these variables alone could not explain most of the variability in disease transmission. It’s important to remember that there’s considerable weather variability throughout Africa. Not all climates are warm or wet and, if they are, they may not stay that way throughout the year.

Other suggestions include the possibility of pre-existing protective immune responses due either to previous exposure to other pathogens or to BCG vaccination, a vaccine against tuberculosis provided at birth in most African countries. A large analysis – which involved 55 countries, representing 63% of the world’s population – showed significant correlations between increasing BCG coverage at a young age and better outcomes of COVID-19.

Genetic factors may also be important. A recently described haplotype (group of genes) associated with increased risk of severity and present in 30% of south Asian genomes and 8% of Europeans is almost absent in Africa. The role of these and other factors – such as potential differences in social structures or mobility – are subject to ongoing investigation.

More effective response

An important possibility is that the public health response of African countries, prepared by previous experiences (such as outbreaks or epidemics) was simply more effective in limiting transmission than in other parts of the world.

However, in Kenya it’s estimated that the epidemic actually peaked in July with around 40% of the population in urban areas having been infected. A similar picture is emerging in other countries. This implies that measures put in place had little effect on viral transmission per se, though it does raise the possibility that herd immunity is now playing a role in limiting further transmission.

At the same time there is another important possibility: the idea that viral load (the number of virus particles transmitted to a person) is a key determinant of severity. It has been suggested that masks reduce viral load and that their widespread wearing may limit the chances of developing severe disease. While WHO recommends mask wearing, uptake has been variable and has been lower in many European countries, compared with many parts of Africa.

So is Africa in the clear? Well, obviously not. There are still plenty of viruses around and we do not know what may happen as the interaction between the virus and humans evolves.

However, one thing that does seem clear is that the secondary effects of the pandemic will be Africa’s real COVID-19 challenge. These stem from the severe interruptions of social and economic activities as well as the potentially devastating effects of reduced delivery of services which protect millions of people, including routine vaccination as well as malaria, TB and HIV control programmes.

Research agendas

Major implications of the emerging picture include the need to re-evaluate African COVID-19 research agendas. While many of the priorities originally identified may still hold, their relative importance is likely to have changed. The key point is to deal with the problems as they are now rather than as they were imagined to be six months ago.

The same thing applies for public health policy. Of course, basic measures such as hand washing remain essential (regardless of COVID-19) and wearing masks should be continued while there is any level of COVID-19 transmission. However, other measures with broader effects on society, especially restrictions on educational and economic activity, should be under continuous review.A key point now is to increase surveillance and ensure that flexible responses are driven by high quality real time data.

Kevin Marsh is a Professor of Tropical Medicine, University of Oxford. Moses Alobo is Programme Manager for Grand Challenges Africa, African Academy of Sciences.