Africa faces major obstacles to accessing Covid vaccines

  • As expected by The Economist Intelligence Unit, Africa is experiencing a resurgence in Covid‑19 transmission that threatens to impose much heavier losses in terms of public health outcomes compared with the events of 2020.
  • Most African countries have had little success in gaining access to current and future supplies of Covid‑19 vaccines and find themselves at the periphery of the global scramble for inoculation.
  • Some countries will benefit from their relative wealth, strategic importance to vaccine-producing nations and strong logistics offering to secure early access to vaccines through the COVAX Facility, but most will rely upon collective bargaining and the goodwill of the international community.
  • Transport, storage and distribution issues will present a major challenge for the delivery of vaccines across much of Africa, which will contribute to slow-starting and slow-moving national vaccination programmes, leaving the majority of Africa unvaccinated by the end of 2021.
  • The mass rollout of vaccines will be delayed and the drip feed of supplies could see mass vaccinations begin during the first half of 2022 and a significant proportion of the population vaccinated by early 2024.
  • African states could benefit from widespread vaccination programmes in major overseas trade and investment partners, but the lack of mass vaccination across much of the continent will contribute to a subdued economic recovery in 2021 and 2022.

As we expected, Africa appears to have avoided the worst of the Covid‑19 pandemic in terms of health outcomes in 2020, especially when compared with the number of confirmed cases, related death toll and pressure on healthcare services that was experienced in Europe, North America and parts of the Middle East and Asia. However, a second wave of the virus, now spreading across the region, is threatening to overwhelm hospitals and sap emergency medical facilities. The major economies of Egypt, Nigeria and South Africa have experienced a sharp increase in transmission and a steady rise in coronavirus-related deaths since early December, which has also been the case in the Democratic Republic of Congo (DRC), Mozambique, Senegal, Sudan, Zambia and Zimbabwe, and more could follow this path in the weeks ahead. Deteriorating public health outcomes and concerns over the appearance of a more transmissible variant of Covid-19 have placed even more pressure on public officials to start vaccination programmes. Unfortunately, Africa has had little success to date in securing access to current and future production of vaccines.

Most African states will face a tough time in securing Covid-19 vaccines during much of 2021 because of production constraints on international pharmaceutical companies, stockpiling by major vaccine-producing nations and the scramble for early access to vaccines by the world’s richest countries. A few African states could benefit from their participation in clinical trials to secure early access to vaccine doses, while a handful may benefit from their strategic importance as vaccine storage and distribution hubs. Currently, there is no primary vaccine development in Africa, but there are a few potential sites for production of vaccines under licence that could provide access to vaccine doses in late 2021 or 2022. Most countries in Africa will rely upon the goodwill of the international community and equitable distribution initiatives to access significant quantities of vaccine doses and at an affordable price, but the timeline and scale of delivery of existing arrangements is highly uncertain and only a small proportion of national populations is likely to be vaccinated in during 2021.

Few advance purchase agreements

African states have had little reported success in securing advance purchase agreements (APAs) for Covid‑19 vaccines directly with international pharmaceutical companies. Egypt has large deals in place with the US-German alliance Pfizer-BioNTech, the UK-based alliance Oxford-AstraZeneca, the Russian Direct Investment Fund (responsible for marketing the Sputnik V vaccine) and the Chinese company Sinopharm. Nigeria expects to receive its first shipment of 100,000 doses of the Pfizer-BioNTech vaccine by the end of January, while the government is reported to be in discussions with Chinese companies to secure deals for their cheaper and easier to store vaccines. South Africa has negotiated a deal to secure the Oxford-AstraZeneca vaccine that was subject to a clinical trial in the country and could start to receive first shipments in February of a 24m-dose deal. Kenya has contracted advance supplies with Oxford-AstraZeneca for 24m doses that could start arriving in February and Ethiopia is likely to have brokered deals with Chinese vaccine producers given the established and evolving logistics routes for medical supplies between the two countries.

Morocco has pre-purchased a combined total of 65m doses of the Sinopharm and Oxford-AstraZeneca vaccines and rollout is expected to start in the first quarter of 2021. Algeria has agreed to buy Chinese and Russian vaccines and hopes to start vaccinating before the end of January with inoculation ramped up during the first quarter of 2021. Meanwhile, the Senegalese government is in talks with Sinopharm to secure 200,000 doses initially and start vaccinating health workers by the end of March. Other evidence of APAs negotiated bilaterally between national governments and international pharmaceutical companies is scarce, although some small and higher-income states such as Seychelles have already begun rolling out vaccines.

The region appears to have had some success in pursuing vaccine supply arrangements through collective bargaining that involves the African Union (AU) and through the World Health Organisation (WHO)-led vaccine distribution initiative, the COVAX Facility. The AU is reported to have reached an agreement to receive 270m vaccine doses in total from Pfizer-BioNTech, Oxford-AstraZeneca (through its production facilities at the Serum Institute of India) and US-based Johnson & Johnson, although the latter’s vaccine is yet to emerge from clinical trials. At least 50m of the 270m doses could arrive in the second quarter of this year, with the remainder intended for dispatch during the second half of 2021 and 2022. However, these collective agreements are merely intentions to supply rather than finalised sale contracts, and actual procurement processes must run their course. Negotiations over the finer details to formalise the deals are ongoing, which creates an element of uncertainty over how many doses will be made available and when these will be delivered. Uncertainties are exacerbated by the imbalance between immense global demand for vaccines and limited production capacity, as well as by the major storage and distribution issues encountered across much of Africa. The AU aims to vaccinate 60% of the continent’s population within a timeframe of two to three years, although even this could be difficult to achieve.

Reliance on global initiatives

Timely and affordable access to Covid-19 vaccines in Africa will to a large extent depend on the goodwill of the international community and, specifically, the ability of a major global vaccine distribution initiative to deliver. The COVAX Facility, which is championed by the WHO and governed by the public-private health alliance Gavi, aims to provide all participating countries with enough vaccines to inoculate up to 20% of their populations by the end of 2021. Currently, Africa is expected to receive about 600m vaccine doses from the COVAX Facility in 2021 with staged shipments beginning in the first half of the year.

All countries in Africa have signed up to the COVAX Facility and seven states in Africa have signed commitment agreements or submitted non-binding confirmations of intent to participate, which entails financial contributions to help secure vaccine doses. A further 46 African states fall into the group of 92 low- and middle-income countries that are eligible for the Gavi-COVAX Advance Market Commitment (AMC), which aims to provide donor-funded vaccines and achieve the same target of vaccinating 20% of an eligible country’s population by the end of 2021.

The COVAX Facility has an ambitious agenda and could face serious challenges that delay and extend the delivery schedule well into 2022 for many of the world’s poorer nations. A major issue is the fact that the world’s most developed and richer countries are snapping up a large proportion of scheduled global vaccine supply for their own use rather than wider global, equitable distribution. Also, the facility is under financial pressure as it struggles to reach a US$6.8bn fundraising target (by mid-December it had raised US$2.4bn) to fulfil its inoculation targets. Even under a best-case scenario, assuming agreed vaccine supplies are delivered and distributed, the stated goal of the COVAX Facility would mean that the vast majority of people living in Africa would not have received a vaccination in 2021 and this would probably remain the case in 2022.

Regional vaccine logistics hubs

A few countries in the region are seeking to establish vaccine storage and distribution hubs that could help them to secure early access to vaccines and facilitate their national vaccine rollout plans. Egypt, Ethiopia, Kenya and South Africa are the front-runners in building relations with international pharmaceutical companies and investing in vaccine supply chain infrastructure. Egypt has been identified as a potential storage and distribution hub owing to its strategic location, strong logistics offering and local manufacturing capabilities in the pharmaceutical sector. In addition to this, Egypt has granted legislative and regulatory approval for local manufacturing operations to begin producing the vaccine developed by the Chinese company Sinovac, while a Memorandum of Understanding (MoU) is in place to produce the Russian Sputnik V vaccine.

Ethiopia has moved quickly to participate in an international cold-chain vaccine distribution network that links Chinese vaccine production sites to hubs in Dubai and Addis Ababa. To support this initiative, Ethiopian Airlines has teamed up with Cainiao Smart Logistics Network, the enormous logistics arm of the Chinese e‑commerce giant Alibaba, to help to create a cold-storage air bridge connecting to vaccine producers in China. Ethiopian Airlines proved a crucial and capable transport partner in 2020 by leveraging its fleet and established service routes to distribute tonnes of personal protective equipment and medical supplies across Africa. Kenya has unveiled an ultra-modern pharmaceutical storage facility at Jomo Kenyatta International Airport, which, together with the use of Kenya Airways’ multiple service routes, aims to help to establish logistics operations for the rapid distribution of Covid‑19 vaccines nationally and across Africa. South Africa will aim to leverage its participation in clinical trials, advanced logistics offering and strategic importance to establish vaccine transport and logistics hubs to support national and pan-African vaccine rollout strategies. Investment in new facilities in Johannesburg has bolstered the country’s ability to handle temperature-sensitive medical products.

Major vaccine distribution challenges

Countries such as Egypt, Ethiopia, Kenya, Nigeria and South Africa have relatively advanced logistics infrastructure and reasonably good international connectivity that will facilitate the import and distribution of Covid‑19 vaccines to support their ambitious vaccine rollout plans. However, healthcare systems in these countries are under pressure from a resurgence or second wave of Covid‑19 that will complicate matters, while enormous and dispersed populations combined with poor health services and logistics reach in rural communities or the smaller cities and towns will adversely affect the pace of vaccine rollout. In addition to this, Ethiopia and Nigeria have major issue surrounding crime, corruption and insecurity that could further delay the rollout of vaccine doses in some hard to reach areas.

Africa’s most fragile and security challenged countries, which tend to be among the poorest, will sit firmly at the back of the queue for access to vaccines. In addition, their vaccine rollout plans will be adversely affected by a lack of effective healthcare sectors, weak or inadequate local pharmaceutical transport and storage facilities (including limited supply of cold- and ultra-cold-storage facilities) and highly unstable or insecure delivery environments.

Warring factions in Libya recently signed a peace deal but the country’s medical, transport, storage and power supply infrastructure has been severely compromised, which will delay and disrupt the rollout of vaccines. Similar conditions are found in countries such as Burkina Faso, the Central African Republic, Chad, the DRC, Mali, Somalia and South Sudan where prolonged conflicts and poverty have significantly undermined healthcare systems, as well as the transport and storage infrastructure needed for the distribution of medical supplies.

Vaccine rollout plans

Rollout strategies in terms of when they start, how fast they progress and how far they extend will be affected by factors such as available national finance and international connections to facilitate vaccine imports, the quality of vaccine storage and distribution facilities, and the stability and security of the medical supply and general logistics environment. Bearing these and other factors in mind, we have grouped states across Africa into three broad groups based on the start and likely speed and extent of vaccine distribution. Inoculation programmes will be implemented in phases, which are likely to begin with the vaccination of healthcare and other front-line workers followed by the most vulnerable groups in society, leading on to the vaccination of younger and healthier social groups.

Potential vaccination rollout schedules

The initial distribution of Covid-19 vaccines will be skewed towards the wealthier and more strategically important nations in Africa, as well as those with established and emerging transport hubs. These factors place the relatively wealthier countries of Egypt, Kenya, and South Africa, together with the internationally connected and strategically important Ethiopia, at the head of the queue for vaccine distribution among countries in the region. These countries have rollout plans that hinge on enough vaccines becoming available from the finite pool of global supplies and a rapid ramp‑up in vaccine distribution during the second half of 2021 that could see a significant proportion of their populations get vaccinated during the second half of 2022. Some smaller but high-income countries could experience more rapid vaccine deployment, including Mauritius and Seychelles, while Algeria, Morocco and possibly Senegal could benefit from early access to Chinese and Russian vaccines.

Later access to Covid-19 vaccines will be an issue for some countries that are struggling financially and largely reliant on global equitable vaccine supply initiatives, have storage and distribution issues, and have weak healthcare systems coupled with large and hard to reach populations. These countries could see front-line medical staff and some vulnerable groups begin to be vaccinated in the second half of 2021, with the start of mass vaccination plans among the wider population delayed until the end of 2021 or the beginning of 2022. A significant proportion of the population could be vaccinated by the second half of 2023 subject to the availability of vaccine doses through collective bargaining and the COVAX Facility. Countries that fall into this category include Angola, Benin, Botswana, Cameroon, Côte d’Ivoire, the DRC, Ghana, Mozambique, Namibia, Nigeria, Tanzania, Togo, Tunisia, Uganda and Zambia.

Some countries will find themselves lagging far behind in terms of access to Covid‑19 vaccines. These will be the poorer and more troubled states that will receive smaller, late shipments and experience a prolonged rollout before a significant proportion of their populations is vaccinated. These countries will be heavily reliant on the goodwill of the international community and could receive some donor-funded vaccine shipments in late 2021 and early 2022 to start inoculating front-line healthcare workers and the most vulnerable. The mass rollout of vaccines will be delayed and the drip feed of supplies could see mass vaccinations begin during the first half of 2022 and a significant proportion of the population vaccinated by early 2024. Falling into this category are Burkina Faso, the Central African Republic, Chad, Congo-Brazzaville, Libya, Mali, Madagascar, Niger, Somalia, South Sudan, Sudan and Zimbabwe.

Possible positive disruptors to these vaccine distribution timelines that could bring forward mass vaccination outcomes for some countries are the potential for local production under licence arrangements in countries such as Algeria, Egypt, Morocco and South Africa, as well as the intentions of Russia and China in distributing cheaper vaccines much more widely and quickly to increase their strategic footprint in the region.

Stuttering economic recovery

Various Covid-related factors will work against a rapid economic recovery in Africa during 2021. These include limited access to global vaccine supplies, gradual and phased vaccine rollout plans for those lucky enough to get hold of vaccine doses, immense challenges posed by vaccine transport, storage and distribution deficiencies, and the resurgence of Covid‑19 transmission in parts of the continent. Some countries will fare better than others in accessing vaccines and distributing these to their citizens, but most people in Africa will not be inoculated by the end of 2021 and this will probably remain the case in 2022. Nevertheless, looser Covid‑19 restrictions compared with 2020, improving conditions in major overseas trade and investment partners, continued access to international finance and more bullish commodity markets should help the region to return to modest growth in 2021.

New more transmissible variants of Covid-19, a growing sense of lockdown fatigue and seriously weak healthcare systems are major downside risk factors that could easily elevate the health and economic costs of the pandemic in 2021, and derail any short-term recovery, leading to a prolonged slump in economic activity and a deterioration in financial stability.

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