COVID-19 vaccine unpredictability complicates country-level planning

Many African nations are facing challenges planning for rollouts of COVID-19 vaccines because supplies are unpredictable, according to Dr. John Nkengasong, director at the Africa Centres for Disease Control and Prevention. They are receiving doses in relatively small amounts, often with little warning about when they will arrive or what type of vaccine they will get.  

“The biggest challenge is predictability on access to vaccines,” he said during a press briefing on Thursday. “There are about six different vaccines out there, they come in all kinds of forms, and they require different conditions to roll them out. How can you plan?”

The continent is experiencing what Nkengasong describes as a COVID-19 “vaccine famine,” as high-income countries hoarded global supplies, leaving many African countries to weather third and fourth waves of the pandemic, with their health systems overwhelmed with severe cases. Only 2.5% of the continent is fully vaccinated.  

COVAX failed to deliver promised doses after its supply chain fell apart in March, but there was an uptick in shipments to African nations in July, as high-income countries began to donate doses after vaccinating substantial portions of their populations.

Over the past week, 13 million doses have been administered across the continent — triple that of the previous week, World Health Organization regional director for Africa Matshidiso Moeti said during a press briefing Thursday. In the month of July, African nations received more doses from COVAX than the months of April to June combined.

But the donations from the facility now flowing to the continent are sporadic and unpredictable, and Nkengasong said some of the donations have “very short” shelf lives.

“It's very difficult to plan when you don't know what supply is coming. I think this is a huge challenge. ... with smaller numbers of vaccines arriving in countries from multiple channels, it makes it a challenge to plan,” said Amanda McClelland, senior vice president of preventing epidemics at Resolve to Save Lives.

Beyond the doses from COVAX, the African Union made Johnson & Johnson vaccine doses available for purchase to countries, which some started receiving this month. Nkengasong said the schedule around the delivery of these doses is more predictable.

He said that some countries have decided they will use the J&J vaccine in hard-to-reach areas because it only requires one dose — a plan countries can make because they’ve been told the type and timeframe of when they will receive the vaccines.

“You vaccinate and you leave. That is the power of predictability of access to vaccines,” he said. “But if they don't know when the vaccines will come, what type of vaccines, it is difficult to make such calculations.”

But access to vaccine supplies is not the only problem. Some African countries struggled to roll out vaccines quickly before expiry. In some cases, funding and planning for in-country rollouts have been an afterthought.

To ensure the incoming doses are effectively rolled out, WHO asked African countries to conduct self-assessments, examining the challenges they’ve had in rolling out doses.  

“The self-assessment reports really help countries to track their operational readiness for this phase of the rollout. It helps WHO to identify the operational gaps so that we can better support countries. With the new supply coming in, there is an increasing complexity to operations and we want to help countries maximize administration and minimize wastage,” Dr. Phionah Atuhebwe, new vaccines introduction officer at WHO Africa, told Devex.

This includes district-level microplanning, which examines the local needs and context. These plans are important because they ensure “all the required logistical, financial, human resource and operational inputs are mobilized and ready at the local level and complemented with the resources from the national level, to enable a smooth implementation of the vaccination activities,” she said.

Thirty African countries have submitted their self-assessments, she said.

Of these, only about half of the countries conducted COVID-19 intra-action reviews, which are an exercise intended for countries to course-correct any errors from the first rollouts.

During a WHO-convened meeting of the continent’s health ministers last week, Dr. Abdou Salam Gueye, the regional emergency director at WHO Africa, said that of the countries that submitted self-assessments, about one-third did not update national level deployment plans and more than 40% of countries that responded did not update district plans.

“If we do good district micro planning, it’s going to help the population understand better, it’s also going to help the health workers deliver the right vaccine to the right people,” he said.

He added that some countries are not taking advantage of available funding to bankroll their rollouts. This includes Gavi, the Vaccine Alliance’s COVID-19 Vaccine Delivery Support funding, which only about half of the 47 countries in the WHO’s Africa region have applied for.

“There is funding that is available, but countries are not applying for it,” he said. “This is free funding; it is not a loan.”