Will countries reach the 70% vaccination target by mid-2022?

The detection of a new variant of the virus, Omicron, in several countries have prompted strong calls to address vaccine inequity globally. Over 8.03 billion COVID-19 vaccine doses have been administered globally as of Dec. 1, but a number of low- and middle-income countries still lag behind in vaccine coverage.

Just 3% of low-income countries’ population have been fully vaccinated. Among low-income countries, Rwanda has the highest full vaccination coverage at 22.63%, while Burundi, Chad, Democratic Republic of Congo and Guinea-Bissau have fully vaccinated less than 1% of their populations, according to World in Data.

These countries have already failed to meet the World Health Organization’s target of achieving 10% vaccination coverage in September 2021, and are in danger of missing the 40% target set by the United Nations agency for the end of December, as well as the goal of vaccinating 70% of every country’s population by mid-2022 if current challenges in supply and demand continue.

South Africa and Botswana, which first reported the detection of Omicron, have fully vaccinated just 24.11% and 19.58% of their populations, respectively.

Modeling and health experts Devex spoke to said it isn’t impossible to reach the 70% milestone, but it’s a tall order and will require significant efforts and investments that include securing the needed supplies, but also increasing vaccine acceptance and addressing gaps in countries’ capacities to deliver the doses. A country’s topography, demographics, and climate conditions could also affect their ability to reach the goal.

Getting to 70% vaccination coverage is no small feat, even in countries such as the United States, which is expected to reach 70% full vaccination coverage by April 2022, if current trends continue, said Dr. Shaun Truelove, assistant scientist in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

He said a new wave of COVID-19 could push more people to get the jab, but the opposite could also happen if cases plateau or slow down.

This makes him skeptical of the feasibility of reaching the 70% target even by the end of 2022, given the infrastructure and cold chain challenges in many countries around the world, as well as vaccine hesitancy. Some countries have also faced less severity and death when compared to the numbers in the U.S., which could affect how they perceive the need for vaccines, he said.

“As we have seen before, the desire to get vaccinated is often coupled with a perceived need/risk from the disease. Without that perceived risk, there is likely to be lower demand for vaccination,” Truelove told Devex in an email.

“The best strategy will be to try to get as many shots in arms as soon as possible, while the memory of the Delta wave is still fresh,” he added.

Tailored targets

A number of countries, particularly on the African continent, have a large youth population. In some of these countries, 1 to 14-year-olds account for more than 30% and 40% of their populations. They are not, however, currently part of national vaccination campaigns.

“This 70% is a target that has been set at a global level, and individual countries will need to look at their own population structure and then decide how much they want to invest in going down to the young age,” Dr. John Nkengasong, director at the Africa Centre for Disease Control and Prevention, said during a press briefing last week.

Dr. Richard Mihigo, coordinator of the vaccines-preventable diseases department at WHO’s regional office for Africa, told Devex that the motive behind the 70% vaccination target was that WHO hopes it will bring the world closer to controlling the pandemic and get back to some form of normality  — but the situation is likely going to be different depending on each country’s contexts.

“The question on [whether] is it aligned with the aspirations of the countries in the [African] region? To some extent, yes, that countries are now taking these different milestones, and trying to customize them based on their needs and their local contexts,” he said.

That means, for example, vaccinating 54% of the population in Ethiopia, which already covers all people 18 years old and above in the country. Vaccinating more than that will require that doses be given to those aged below 18 years old, but which is not yet the priority for Ethiopia and many other countries in the continent, he said.

But even reaching such a low vaccination target won’t be easy. Mihigo said by looking at the current pace of vaccine administration and each country’s performance in terms of weekly vaccine delivery, many countries in the region won’t meet their targets “if nothing different is done.”

“We are really now working with countries to help them to develop some sort of acceleration vaccination plans … and that will include a variety of strategies to make sure that the weekly vaccination rates can be increased dramatically. And sometimes, this will require maybe [a] five- to tenfold increase in terms of vaccination rates [from where] we are currently at,” he added.

It will also require additional resources, and collective effort by different stakeholders to address not just issues in vaccine supply, but also demand.

According to a recent WHO analysis, only 27% of health workers in the African continent are fully vaccinated. As mentioned in the analysis, recent studies have found that a large portion of health workers are hesitant in getting the jab due to concerns over vaccine safety and potential adverse side effects. In Ghana, only around 40% of health workers intended to receive a vaccine, and it is less than 50% in Ethiopia.

Combo challenges in the Pacific

Vaccine hesitancy is also one of the factors driving low vaccination rates in a number of Pacific nations, and could pose hurdles in reaching higher vaccination targets.

According to modeling by researchers at the Lowy Institute, the Solomon Islands and Vanuatu would only reach 70% vaccination coverage in 2023, while Papua New Guinea won’t reach this target even by 2026. Full vaccination rates in Vanuatu, the Solomon Islands, and Papua New Guinea are currently at 12.76%, 6.61% and 2.17%, respectively.

“Vaccine hesitancy is fueled by misinformation [and] disinformation. And this is rampant in Melanesia, but especially in Papua New Guinea, where Facebook is the main source of information,” said Alexandre Dayant, project director on development economics in Asia and the Pacific at the Lowy Institute and lead author of the report.

But there are other factors as well, such as a limited health care workforce, and geographical and logistical constraints. Papua New Guinea, for example, has a huge rural population and over 600 islands. The country’s highlands region is very difficult to reach by foot. In addition, the country only has 136 vaccinators for its almost 9 million population, and a vaccine acceptance rate of just 46%, the lowest in the Pacific, according to the report.

Thus, even if neighboring countries such as Australia and New Zealand, and COVAX send in massive volumes of doses to the country now, there’s a chance most will be wasted because of low demand and challenges in vaccine delivery, Dayant said. In September, Papua New Guinea decided to redistribute 30,000 doses of the AstraZeneca COVID-19 vaccine donated by New Zealand to Vietnam as the doses were nearing expiration.

In the Solomon Islands and Vanuatu, meanwhile, there are also challenges in reaching people living in small and remote islands where there’s limited cold chain infrastructure to transport the vaccines.

“I don't think that countries are doomed. There are many ways to reach the goal of [70%] vaccination … [but] it’s going to be a massive challenge because you need to invest massively in the systems over there,” while also addressing issues of hesitancy, he said.

Difficulties in crisis settings

Reaching the 70% milestone also poses challenges for countries prone to natural disasters, or experiencing conflict or civil unrest like Myanmar, where the health system is already stretched and people aren’t trusting the vaccines being provided by the current military government, Dr. Abhishek Rimal, emergency health coordinator for the International Federation of Red Cross and Red Crescent Societies in Asia Pacific, told Devex.

In Afghanistan, which is already suffering from an ongoing humanitarian crisis, supply challenges are compounded by a financial crisis, said Necephor Mghendi, IFRC Afghanistan’s delegation head. The arrival of the winter season that could last until March 2022 would also make it challenging to reach remote areas of the country like Badakhshan province, and may require other means of transportation, such as helicopters, which can be costly, he said.

Addressing inequities in supply, and getting the vaccines to people, particularly vulnerable ones in places of conflict, will be crucial.

In several countries with concurrent conflicts like Afghanistan and Myanmar, the health system is already stretched, leading to additional challenges.

“Only the availability of the vaccine is not enough to make sure people are vaccinated. It is also the delivery of the vaccine from the airport tarmac into the arms of vulnerable people,” Rimal said.