In the race to get COVID-19 vaccines, Africa is lagging behind. The World Health Organization (WHO) and the African Centers for Disease Control (CDC) have warned that this continent does not have the financial resources nor is it prepared for a large vaccination campaign that will allow it to achieve group immunity this year.
The acceptance by the population in a continent where the impact has been less and the logistics of a product that will need a cold chain are, together with access to sufficient vaccines, the other challenges that Africa faces, that also lives a second wave of cases much more intense than the first.
“It is not realistic to suggest that we are going to reach 60% of the immunized population in one year”, the percentage considered minimum to achieve group immunity, says Phiona Atuhewbe, head of Introduction of New Vaccines at WHO Africa. “It would take 12,000 million dollars (about 9,800 million euros) that we do not have,” he insists.
The lack of financial resources of the African governments and the signing of bilateral agreements between the richest countries in the world and the companies that manufacture vaccines to obtain more than enough doses for their population pose a serious threat to this continent.
While vaccination has already started in more than 40 countries around the world, especially in the global North, where the debate revolves around logistical issues to speed up the process, in Africa the great challenge is how to access vaccines.
“It is a moral problem,” said John Nkengasong, director of the African CDC at a press conference a few days ago, “it will be terrible to see this distrust between the North and the South regarding a common good such as vaccines.”
The United Nations estimates that only 3% of Africans will be vaccinated in March and only 20% by the end of the year. The alert also comes at a key moment. It is true that Africa, with 3.1 million cases, barely represents 3.2% of global infections and that mortality has been lower than in other continents, but the second wave is hitting hard.
To try to avoid discrimination against the most disadvantaged, Covax was created , a public-private initiative that aims to facilitate access to the vaccine to the world’s population in an equal and rapid manner.
All African countries have joined, and it is thanks to it that by the end of 2021 20% of the African population will be vaccinated, starting with risk groups, such as the elderly or with pathologies such as diabetes or high blood pressure, health personnel and social workers.
“But this is not enough,” insists Atuhebwe, “we are going to solve the initial access, but we will need additional doses for group immunity of vaccines that, from what we are hearing, are very expensive.”
In Nkengasong’s view, it will most likely take two to three years to achieve such immunity, but this requires mounting the largest adult vaccination campaign Africa has ever known. Dr Matshidiso Moeti, WHO regional director, believes that governments must react.
A recent analysis by this body reveals that only half of the countries have identified their priority population and are developing plans to reach them and that only one in four governments have plans to access supplementary financial resources.
Among the countries that have taken the most lead in Africa to seek the necessary vaccines are Morocco and Egypt, two of the most affected by the pandemic on the continent , which have negotiated with a Chinese pharmaceutical company.
For its part, South Africa, the nation with the most cases and deaths, has opened talks with several companies and plans to produce some vaccines in its territory, as does Nigeria. It will be precisely in these countries and Kenya where vaccination will begin earlier thanks to their participation in different trials.
“Of the 42 countries that have begun to vaccinate, 36 are rich and six are of medium-high level,” criticized last week the director of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, who added.
“This it is clearly a problem, and this is getting worse because there are countries that are seeking new agreements [with manufacturers] offering to pay more ”. As usual, the WHO did not directly target anyone, but the message is clear. “This jeopardizes our commitment to ensuring equitable access. We have to act to achieve this, ”added Adhanom.
Another of the great challenges of immunization will be acceptance, although this has been increasing in recent weeks. A recent Africa CDC study revealed that four out of five Africans would get vaccinated if this measure is shown to be safe and effective.
However, experts remain concerned about the rejection, especially in rural areas. Alice Desclaux, a physician and health anthropologist at the Dakar-based Institute for Development Research (IRD), says that “in part it has to do with prudence, with fear of side effects.” But not all.
In his opinion, resistance to the vaccine is also induced on the one hand, by false news from anti- vaccine groups in the North that arrive through social networks and, on the other hand, with social representations typical of Africa.
“There are rumors that say that the objective is to cause infertility and reduce demography, that we are facing a plot by which whites introduced the disease to sell vaccines, that Africans already have the antibodies and do not need it or that religion and traditional medicine protects them, ”says Desclaux.
To counteract false information, different international organizations are immersed in the design of a communication strategy that can be used throughout the continent. Julienne Anoko, an anthropologist and head of communication and social sciences at WHO Africa, is part of this group.
“Whenever there is vaccination there are conspiracy theories, but you have to go beyond rejection and understand the reasons in order to reduce people’s concerns,” he says. In his opinion, clear information and the participation of health agents in the process are key to take into account.
Other experts agree that acceptance is a factor to work very seriously. “But it is not just a phenomenon that occurs in Africa and it always happens here, we will solve it”, confides Phionah Atuhewbe. For Desiré Ekanga, WHO consultant, crisis management expert and co-investigator of the Ebola vaccine trial in Congo, community consent is essential.
“The population is not psyched for this vaccine, here the covid-19 has not represented the same urgency as in Europe and other parts of the world. The experience gained with Ebola will be useful, but it is not the same context, ”he explains.
This expert is committed to strategies such as the health agents themselves being vaccinated in front of the population and the mediation of community leaders.