African countries to decline COVID-19 vaccines with short shelf lives

In Nigeria, where less than 2% of the population of 200 million is fully vaccinated against COVID-19, the government confirmed that at least one million doses of vaccines it received from donors have expired and will now be destroyed.

Africa’s most populous country received the fourth highest number of vaccines regionally — nearly 24 million doses — but has only managed to administer around half, with nearly 10 million doses still unused.

The destruction of one million expired doses implies that the country would have to quickly roll out the roughly 9 million doses that remain before they expire, while it strives to ensure that new doses coming from donors have adequate shelf lives.

Health experts said that though the continent has seen an increase in supply, the challenge now is to support countries in the quick administration of these doses before they expire, and ensure that going forward, doses received have shelf lives that align with countries’ capacity to administer them.

“We've moved from a situation where we were receiving 2 to 3 million doses per week towards the situation where we are receiving around 20 million doses per week,” said Dr. Richard Mihigo, coordinator of the Immunization and Vaccines Development Program at the World Health Organization’s regional office in Africa, at a press briefing.

Over 30% of countries on the continent have yet to use half of the COVID-19 vaccine doses they’ve received so far, even though the continent has the lowest vaccination rate globally, with only about 8.6% of the continent fully vaccinated.

While the continent has administered nearly 65% of its total vaccine supply, Burundi has administered less than 1% of over half a million doses it has received.

In April the Democratic Republic of Congo returned 1.3 million vaccine doses that it had received from COVAX — the international platform providing low- and middle-income countries with free doses of COVID-19 vaccines — before they expired. Though more than 90% of the nearly four million doses of COVID-19 vaccines that the country received have not been administered, in the week leading to Dec. 14, only 3,094 doses were administered in the country. In comparison to Lesotho, which has administered about 95% of vaccine doses it received, 593,076 doses were administered within the same period.

Longer shelf lives

To reduce wastage, the Nigerian government announced that it would no longer accept donated vaccines with short shelf lives as they exert undue pressure on both the health care workers and the people, according to Dr. Faisal Shuaib, the executive director and CEO of Nigeria’s National Primary Health Care Development Agency.

He said that due to vaccine scarcity in the past, the country had previously been accepting vaccines with short shelf lives from international donors in order to quickly use them and provide some level of protection for citizens.

“Under those conditions, we saw Federal, State and Local Government health personnel working diligently to ensure all vaccines are utilized before expiration,” he said.

A similar position is also being advanced by the Africa Centres for Disease Control and Prevention, WHO, and COVAX.

At the International Conference on Public Health in Africa, Dr. Ahmed Ogwell Ouma, deputy director of Africa CDC, said Wednesday that the center is now telling African countries not to accept doses approaching their expiry dates.

“Just don't. It's not a donation anymore. If someone is giving you vaccines that are going to expire in less than three months, that is dumping,” he said. “We are encouraging our members that don't take anything like that because it's a headache. It's going to expire in your hands if you don't have a system that is ready to be able to absorb it."

WHO and COVAX have also called on donors to ensure the vaccines they are donating have an adequately sufficient shelf life for countries to be able to administer them.

“We have seen the issues that are being created by the vaccines that are coming with very short shelf lives. They tend to create or pose additional challenges to countries when it comes to the rollout of these vaccines,” Mihigo said.

Some of the challenges that have been made public so far include the shortage of syringes, inadequate health workers for widespread vaccination exercises, last-mile vaccination logistics, storage, transportation, and misinformation.

Microplanning and mandatory vaccination

Beyond the challenges posed by vaccines with short shelf lives, Dr. John Nkengasong, director of Africa CDC, also noted that individual African countries’ vaccination initiatives are also facing challenges that are specific to each respective country, and as such, are being dealt with by microplanning to provide technical support tailored to each country.

“We recently had a large number of countries, including the DRC, gather in Rwanda, where we discussed with them ways to support them, developing precisely what we call microplanning,” Nkengasong said at a press briefing. Adding that the organization also met with another 16 countries in Morocco to discuss microplanning for their respective countries.

Going into the New Year, Nkengasong said that Africa CDC will be increasingly engaging with countries to provide them with very specific technical support to advance their vaccination uptake.

“We are not going to win the war against this pandemic if we are not vaccinated, period,” he said. “We have been fighting for access to vaccines. And if the vaccines are now coming in and our people are not receiving the vaccines then it will become extremely unfortunate.”

To boost national vaccine uptake, some African countries have directed workers in public service to get vaccinated within a given period. Togo banned access to premises of state-run institutions for people with no COVID-19 vaccine in October. The South African government has begun consultations to introduce “measures that make vaccination a condition for access to workplaces, public events, public transport and public establishments.”

Nkengasong said vaccine mandates will become unavoidable if people do not willingly go out on their own to get vaccinated. Adding that since the vaccine passport policy introduced by some western countries proved effective in increasing vaccine uptake, African countries with low vaccine uptakes may also be advised to consider similar policies.

“I will not be surprised that in the coming months, the leadership of the continent will begin to ask for a vaccine passport to travel,” he said. “But we don't need to get there if we just do the right thing.”