- Official infection rates across sub-Saharan Africa (SSA) remain relatively low but concerns about an “India scenario” are growing amid a proliferation of variants.
- The region is quickly falling further behind in the global vaccine race, with only about 1% of the population vaccinated across all of Africa to date.
- The US decision to back an Intellectual Property (IP) protection waiver for Covid-19 vaccines at the World Trade Organization (WTO) is historic but will have little immediate impact on vaccine production and vaccine availability for poor countries.
Infection rates still low but ‘India concerns’ mounting
Official infection rates across sub-Saharan Africa (SSA) remain relatively low, representing merely 6.5% of global cases. However, due to extremely low levels of testing, and limited hospitalizations and media coverage, the true extent of the pandemic’s spread across the region is most likely grossly underreported and, as such, remains subject to much speculation and debate. One building block of the narrative that SSA may be more resilient to Covid-19 is attributable to the region’s very young population: as of 2019, 42.3% of the region’s estimated 1.1bn population was below the age of 15, compared with India, where merely 26.6% fall into this age bracket.
However, concerns about an “India scenario” playing out across the African continent may intensify in the coming weeks. Africa Centres for Disease Control and Prevention (Africa CDC) Director John Nkengasong has described India’s Covid-19 surge as a wake-up call for Africa, and has warned that shortages of healthcare workers, hospital beds, oxygen supplies, and vaccines could turn out to be even more overwhelming than in India. The WHO has reported that the B.1.617.2 Covid-19 variant first identified in India has been detected in a dozen countries, including in travelers from India in Kenya, Uganda, and South Africa. Cases of the B.1.1.7 – first detected in the UK – have also been confirmed. Scientists at the Krisp genomics institute in Durban have warned that new variants – including the B.1.351 variant first sequenced in South Africa, a variant detected in Rwanda and Uganda, two identified in Nigeria, and one highly mutated variant identified in travelers from Tanzania – have proliferated across Southern and Eastern Africa, especially along truck routes. According to the researchers, this “risk[s] that Africa could become a reservoir for variants,” which is arguably a matter of both regional and global concern.
Consequently, Nkengasong has called for fresh pandemic restrictions. Countries including Kenya, Nigeria, Uganda, Tanzania, and Rwanda have suspended flights to India, while South Africa has quarantined several travelers arriving by air and sea. An African health ministers’ meeting on 8 May could set the scene for further government announcements in the coming weeks.
Vaccine rollout falling further behind
Compounding concerns about the proliferation of variants is the fact that the region is quickly falling further behind in the global vaccine race. According to Our World in Data, just 14.24mn people across Africa, or 1.06% of the total population, had been vaccinated as of 9 May, compared to a 30% end-year target.
Up until now, as per the chart below, the bulk of vaccine supplies shipped to SSA have been AstraZeneca (AZ) shots manufactured by the Serum Institute of India (SII) via the COVID-19 Vaccines Global Access Facility (COVAX). However, Nkengasong fears that India’s suspension of exports in March could impact Africa’s vaccine rollout “for the weeks and perhaps months to come.” In fact, as of 6 May, COVAX had delivered less than 20% of its initial regional delivery schedule through May (see chart). Meanwhile, inoculation using what little supply has arrived in the region is hampered by logistical constraints on the ground. Anecdotal evidence also suggests that the suspension of the AZ vaccine over reports of blood clots by several European governments had a lasting effect on the jab’s local acceptance. In an extreme case, DR Congo, following the European example, first halted its AZ vaccination campaign and subsequently decided to pass on its delivery as it proved unable inoculate its population in time before the shots’ expiration date.
Even so, African countries that have received their first COVAX deliveries are expected to experience a supply gap as early as May or June. Regional officials are now hoping that additional vaccine supplies from China could be secured via COVAX. The WHO approved the Covid-19 vaccine produced by China’s Sinopharm on 7 May and is expected to consider Sinovac’s shot this week. Russia’s Sputnik V vaccine is also under assessment. Their inclusion could significantly alter the outlook for COVAX’s vaccine mix and supply timeline.
Whither ‘vaccine apartheid’?
The growing gap in vaccine equity worldwide has galvanized fresh action. Last week’s decision by the US government to back an Intellectual Property (IP) protection waiver for Covid-19 vaccines at the World Trade Organization (WTO) was seen as a historic breakthrough in an initiative, spearheaded by South Africa and India, that just a few months ago appeared to be going nowhere. However, European leaders have pushed back by arguing that suspending intellectual property rights will not resolve supply shortages. Instead, they have called for scaling up production via licensing deals, and increased exports of vaccine ingredients and finished shots – a pointed criticism of the US.
However, it is unlikely to have an immediate impact on vaccine production and vaccine access for poor countries, even assuming that consensus at the WTO can be reached quickly and the waiver be brought into effect. Equally important will be timely technology transfer agreements to expand production, production capacity, supply chains, and skills, and a decision on whether the waiver will apply only to Covid-19 vaccines or also to treatment and diagnostics. On the production side, even South Africa’s Aspen Pharmacare, which will produce up to 400mn doses of Johnson & Johnson’s Covid-19 vaccine at its Gqeberha plant, will only “fill and finish” the shots, illustrating how far away the region stands from being able to produce vaccines from start to finish.
The pandemic has certainly galvanized calls for vaccine production in the region. The African Union (AU) has recently announced an ambitious new partnership with the Coalition for Epidemic Preparedness Innovations (CEPI) – one of the COVAX partners – to manufacture vaccines at five research centers to be developed on the continent over the next 15 years. The target is to increase production of all vaccines used on the continent from the current 1% to 60% within 20 years, though at best this will be a long game, rather than a short-term fix.