COVID vaccine supply struggles are easing, but in 44 countries — most of them in Africa — less than 20% of the population is fully vaccinated. In 19, the rate is under 10%.
The big picture: Those countries "have doses now, and they know that there are more doses available," says Seth Berkley, CEO of the Gavi vaccine alliance and point person for the global COVAX initiative. After a year of waiting for vaccine doses, the primary concern is now delivery.
State of play: Africa CDC director John Nkengasong last month asked countries to pause vaccine donations until the second half of the year.
- Rather than a sudden glut of vaccines, he said African countries need steady, predictable shipments that can be used before they expire.
Last week, Nkengasong laid out four key challenges to rolling out shots:
- Inadequate storage facilities to preserve vaccines.
- Transport and logistical issues in terms of getting doses and supplies like syringes (which often aren’t included with donations) to remote locations.
- Shortages of health care workers to administer shots.
- Vaccine hesitancy.
Breaking it down: Berkley says storage is now less of a limiting factor thanks to improved cold chains and deployment of non-mRNA vaccines in harder-to-reach areas. But other challenges that vary country to country remain, requiring COVAX to tailor "bespoke plans."
- In Nigeria, for example, the focus is on coordinating deliveries at the state level. In Tanzania, political will was the main factor, though that is changing, Berkley says. Both countries have 5% vaccination rates.
- In many countries, the top priority is to hire, train and pay health workers.
- Vaccine hesitancy is also a much bigger factor than in previous vaccination campaigns that Gavi has run successfully in countries like the Democratic Republic of Congo (DRC). Berkley blames social media and "the politicization of the vaccine in the West."
By the numbers: Berkley notes that 15 countries have hit the 10% vaccination threshold just since January, while the overall vaccination rate across the 92 low and middle-income COVAX countries has climbed to 42% (compared to 58% globally and 66% in the U.S.).
- But individual country rates vary widely, from 80% in Vietnam and 64% in Nepal to less than 1% in Burundi and the DRC.
- In some “very fragile countries” like Niger, South Sudan, Syria and Yemen, it will take significant time and funding to meaningfully increase coverage, Berkley says.
- COVAX is "rationing the last money we have," but will seek $1 billion for vaccine delivery at a fundraising event next week.
What's next: While the WHO has set a goal of 70% vaccination for every country, around half of the countries COVAX is working with have set lower targets, Berkley notes.
- He says the focus should be on protecting vulnerable people and the capacity of health care systems, rather than ending the spread altogether.
- Thus, even in countries with relatively low vaccination rates, COVAX will prioritize boosters for vaccinated but high-risk people over first shots for the general population.
What to watch: Case counts in Africa and elsewhere are currently relatively low, and fatigue with the virus is high. The pandemic is also competing with other priorities.
- "Complacency is a huge problem right now" for both governments and the general public, Berkley warns.
