4 barriers to broaden COVID-19 vaccinations in African countries

Only 15% of the African continent’s population is fully vaccinated for COVID-19 — just months away from the World Health Organization’s goal that countries reach the 70% threshold of vaccinating their populations by midyear.

While the dilemma last year was access due to global hoarding of vaccines by high-income countries, this year, slow in-country rollouts are hindering broader vaccination rates. Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said there are four barriers facing many countries as they work to administer shots into arms: storage; logistics around reaching remote areas; limited workforce surge capacity; and people’s willingness to get the jab.

“It's a combination of factors that is restricting the rapid uptake of vaccines,” he said during a news briefing on Thursday. “I think many countries are struggling. … It's not just a limited number of countries.”

The continent has procured 750 million doses of COVID-19 vaccines, and of that, countries have administered 65% — or 489 million doses, according to Nkengasong.

Inadequate storage. Many countries don’t have enough storage facilities for the incoming vaccines. Countries need well-managed warehouses, with the right types of refrigeration, Nkengasong said.

“A lot of the vaccines that are coming in — countries are challenged because they don't really have appropriate storage facilities to keep these vaccines in large amounts,” he said.

Reaching the last mile: Moving vaccines from storage facilities in urban areas to remote locations is also difficult. Countries need enough vehicles equipped to carry vaccines at appropriate temperatures for long distances. When the vaccines get to clinics, they also need refrigerator capacity, and to reach very remote areas, health workers need portable refrigeration. There is also a need for syringes. “Most of the time the vaccines come without those accessories,” Nkengasong said.

Limited labor: At each step of the vaccine delivery trail, countries need an adequate number of people to keep the systems running. Many countries are finding they don’t have adequate surge capacity for their workforce.

“Where are the health care workers to spread them across the entire country so that they can immunize very quickly?” he asked.

Unwillingness to get vaccinated: New cases on the continent are “significantly dropping,” according to WHO, and in tandem, many countries are scaling back containment measures. For example, in mid-March, Kenya dropped a nearly two years-long mask mandate. But as this happens, there is concern people might think there is no longer a need to get vaccinated.

“You still have to get vaccinated because of the unpredictability of this virus,” he said, adding that the continent typically experiences a trough in cases that lasts about two to three months, and then cases spike up again. “At any moment, we can see rebounds of this virus,” he said. “It takes only one or two cases to ignite, or to restart this serious transmission cycle,” he said.

But not all countries are struggling. There are 10 African countries that have fully vaccinated over 35% of their populations, Nkengasong said, including Botswana, Cape Verde, Lesotho, Mauritius, Morocco, Mozambique, Rwanda, São Tomé and Príncipe, Seychelles, and Tunisia.

“Most countries, 38 or so, are still way below that number,” he said.