COVID-19 shots are finally arriving, but Africa can’t get them all into arms

SEKENANI, Kenya — When a group arrived at
the Sekenani health clinic in rural Kenya for their COVID-19
vaccines recently, staff told them there were no doses left and
that they should come back soon.

For some, it meant a long wasted journey on foot and a day
away from their cattle herds.

Yet Narok county, where the clinic is located, was not short
of vaccines; nearly 14,000 doses were sitting in a fridge in the
nearest town, 115 km away. A mix-up with county officials meant
Sekenani did not get enough, two health workers said.

“We had to say sorry. It’s not a good feeling, when somebody
comes and they want the vaccine, and we don’t have it,”
clinician Mike Nalakiti, 27, told Reuters.

The small failure in a village 270 km southwest of the
capital Nairobi is an illustration of the challenges African
nations now face as they battle COVID-19: even though vaccine
supplies are finally ramping up, getting needles into arms is
proving the hard part.

Successful vaccination campaigns in Africa are vital to
ending the pandemic globally, health experts say. The
continent’s low inoculation rates encourage viral mutations like
the new Omicron variant spreading across South Africa, which has
prompted another spate of international travel bans.

Only 102 million people, or 7.5% of the continent’s
population, are fully vaccinated, according to the World Health
Organization, which warned vaccine inequity will prolong the
pandemic.

African governments have been crying out for higher vaccine
deliveries this year, but production constraints and hoarding by
richer countries severely limited supplies until recently.

Shortages of funds, medical staff and equipment, as well as
vaccine hesitancy, were already hobbling inoculation campaigns
in some parts of Africa. The anticipated surge, comprising
millions of jabs in the coming weeks, could expose those
weaknesses further, experts warn.

About 40% of vaccines that have arrived so far on the
continent have not been used, according to data from the Tony
Blair Institute for Global Change, a policy think-tank.

The rate of vaccine use will have to rise four-fold to keep
up with expected supply in coming months, the institute says.

“We are all, like you, very concerned that countries are not
picking up the vaccines. The uptake is not as we would have
loved to see,” head of the Africa Centres for Disease Control
and Prevention John Nkengasong said.

Fridges and motorbikes

Vaccination rates vary widely across Africa, a continent of
well over a billion people, and some health systems in
relatively small nations and in North Africa are having more
success.

Cape Verde, an archipelago nation off West Africa with a
population of about 600,000, has vaccinated nearly 65% of
adults, rivaling some European countries.

In Democratic Republic of Congo, a restive country in
Central Africa with a population of nearly 90 million, the
number is 0.1%.

In some ways, Kenya is doing relatively well. East Africa’s
largest economy has received nearly 5 million doses in the past
two weeks after months of slow supplies.

On Dec. 1, it vaccinated a record 110,000 people and aims to
maintain that rate for the next 30 days, said Willis Akhwale,
head of the government’s COVID-19 vaccine task force. That would
bring the total vaccinated to 10 million out of a population of
47 million, he said.

Yet in the rural Sekenani clinic at the edge of the famous
Maasai Mara Game Reserve, where elephants and lions roam,
challenges abound.

The clinic started offering COVID-19 vaccinations four weeks
ago. It keeps running out of doses and has only one reliable
fridge, which is also used for routine immunisations, said
clinical officer Gerald Yiaile.

Staff need motorbikes to take vaccines to the community,
semi-nomadic livestock herders from the Maasai ethnic group who
struggle to afford transport for healthcare, he said.

He applied to local authorities for funds for mobile
vaccination and has not heard back.

“We have been forced to ask the community to come to us
instead of us going to them,” Yiaile said.

Not enough money

African nations scrambled to ready their health systems
earlier this year as global vaccine-sharing scheme COVAX began
delivering doses in small quantities months after wealthy
countries began inoculations.

Cash-strapped countries were short
of cotton wool, fridges, face masks and trucks.

COVAX deliveries were then disrupted after COVAX’s major
supplier India halted
vaccine exports. The pause gave countries time to improve
vaccination rollout without being inundated. They did so to
differing degrees.

The GAVI vaccine alliance, a co-leader of COVAX, initially
did not prioritize investing in the ultra-cold chain equipment
needed for mRNA shots like Pfizer’s because it expected the bulk
of doses to be the cheaper and easier-to-administer AstraZeneca
shots produced in India, Reuters reported
in September.

As vaccine deliveries to Africa soar, absorption of large
volumes is expected to represent a major challenge for many poor
countries, particularly because a substantial volume will be
from Pfizer, GAVI said in internal documents prepared for its
board meeting last week and seen by Reuters.

Even Kenya, which has the ultra-cold chain capacity to store
3 million Pfizer doses, is worried its cold chain will get
constrained by the influx, threatening its routine immunization
program, Akhwale said.

Cameroon in Central Africa had 244 vaccination centers at
the start of its vaccine rollout in April, and now has 1,000,
said Njoh Andreas Ateke, deputy head of the immunization
program.

But health workers and officials say that power outages and
lack of staff have compromised vaccines.

The country has one refrigerated truck suitable to transport
vaccines, said Leonard Kouadio, Unicef’s health section head in
Cameroon. It needs at least 2,500 more fridge temperature gauges
and more trucks to increase distribution, he added.

Mali, one of Africa’s largest and poorest countries, has two
refrigerated trucks to carry vaccines long distances. Some
health workers fled their posts in the north because of
insecurity caused by an Islamist insurgency, said Unicef health
program manager in Mali, Abdoul Gadiry Fadiga.

The country expects to receive about 3.5 million doses
between now and the end of March, more than double the number it
has received since inoculations began, Fadiga said.

Mali has enough cold chain capacity to deal with the initial
rush of doses until March, Fadiga added, but it still needs 288
fridges and freezers for its full rollout, only 10 freezers of
which had arrived.

Funds have been slow to materialize. The World Bank has
approved $9.8 billion for emergency health responses, including
for vaccine deployment, in developing countries globally, but so
far only $4.4 billion has been disbursed.

Mali and Cameroon await support.

A World Bank official said disbursements were happening
“very fast.”

Reaching out

Even when help arrives it can backfire. Donors have
sometimes sent African nations vaccine batches nearing
expiration, in some cases rendering them unusable.

Countries desperate for vaccines, including South Sudan and
Congo, had to send some back because they could not distribute
them in time. Namibia warned
last month it may have to destroy thousands of out-of-date
doses.

South Africa asked
Johnson & Johnson and Pfizer to delay delivery of vaccines
because it had too much stock.

A key difficulty in administering vaccines is community
skepticism, sometimes driven by religious belief and mistrust of
Western drug companies and their own governments. Insufficient
education about COVID-19 vaccines enables rumors to spread.

That can be the result of local staff and budget shortages,
health workers from across the continent told Reuters.

Ethiopia is worried that vaccines might expire before they
are used due to low demand, and is trying to overcome vaccine
hesitancy through outreach to communities via local religious
and civil society groups, said Muluken Yohannes, a senior
adviser to Ethiopia’s health ministry.

“Currently, developed countries … have satisfied their
vaccine needs. As a result, they are pushing leftover vaccines
… to developing countries. However, the golden period to
absorb these vaccines has already passed,” he said.

Kenya has ramped up its vaccine rollout with social media
and television and radio ads promoting vaccines. Posts on the
health ministry Twitter feed urge pregnant and breastfeeding
mothers to get vaccinated.

Not everyone gets the message. Nicky Theron, 20, who works
at a clothing shop in the town of Talek, is five months pregnant
and scared of the jab. She doesn’t follow any government Twitter
accounts.

“I have never heard of anybody who is pregnant receiving the
vaccine,” she said.

Some feel they could be persuaded if someone came to explain
in person.

Julius Tuyioto, who herds livestock on arid plains in
southern Kenya, hears the government warn of the dangers of
COVID-19 on the radio. But the disease hasn’t hit his community;
he says it doesn’t feel real.

“There is no civic education on why we should be vaccinated.
No one is telling us,” Tuyioto told Reuters outside his mud
brick home in Narok County, to the chime of goat bells.

Last month, the government sent vaccines by motorbike to the
nearest primary school, five kilometers away, he said. But he
did not hear about it until the third and final day, when it was
too late for him to go.

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