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While western countries scramble with their booster rollout to deal with the Omicron wave, only 8.4% of people in low-income countries have had at least one Covid vaccination dose.
The gap in the vaccination rates between high- and low-income countries is wider than ever. We cannot keep turning a blind eye to it.
The vaccines being distributed to African countries under the Covax scheme are often close to expiry and their delivery is ad-hoc at best. In Nigeria, where only 2% of the population is fully vaccinated, they just had to destroy more than a million vaccines that were close to expiring.
Nigeria is not the only country struggling. In Ghana, where 7.4% of the population is vaccinated, Fred Osei-Sarpong, representative of the World Health Organization said: “The receipt of vaccines with a short shelf life puts excessive pressure on the staff and makes it difficult to adequately plan for effective vaccine delivery.”
These short shelf lives seriously impede the delivery of vaccines to rural areas. We have worked with Benjamin Ongeri, health supply chain specialist with Crown Agents in Kenya – where 7.2% of the population is fully vaccinated – on the delivery of medicine for neglected tropical diseases (NTDs). He says: “There are enormous challenges in getting medicines to the last mile. We know this from years of working with NTDs. It is very hard to reach people who are most affected since they are vulnerable, often marginalised, and live in remote locations with poor roads and infrastructure.”
The same challenges have slowed the uptake of Covid vaccines. And this is exacerbated by the fact that these vaccines require cold (or ultra-cold) chain logistics infrastructure that is often nonexistent in these areas.
It also doesn’t help that the vaccines mainly being administered in Africa are those the west has decided not to accept.
“In Ghana, at the initial stage of the vaccine rollout, a high demand was generated,” said Osei-Sarpong. Then there were no vaccines. The break in the rollout affected communication efforts and this gap created the space for misinformation and rumours to thrive.
According to the WHO vaccine strategy, published in October, the goal is to have 70% coverage across the world by June 2022. How can this target be achieved?
Will freeing up intellectual property rights, often cited as a possible solution, bridge the widening gap? Neither Osei-Sarpong nor Ongeri believes it is the answer. For a country to start producing vaccines from scratch would be a massive challenge. According to Ongeri: “Countries like Kenya have begun this journey by targeting the final filling of vaccine vials locally which is still quite challenging given the need for state-of-the-art pharmaceutical manufacturing plants that will guarantee safe production with no chance of contamination.”
A lot more will be required in terms of technology transfer and building the expertise needed to fully produce vaccines locally, these cannot be achieved in the short to medium term.
The answer lies in global funding mechanisms such as Covax – provided they can guarantee a pre-planned availability of vaccines. More equitable distribution of the jabs on a structural basis with longer shelf lives will allow for realistic and efficient planning.
“With the provision of funds for operations and the availability of vaccines, Ghana will be able to strategise and meet the coverage set by WHO,” says Osei-Sarpong.
Added to common elements such as the lack of sufficient vaccines with adequate shelf life, each country has its own unique set of circumstances that lead to a low vaccination rate. So, with funding made available, each country can tailor their efforts to combat those circumstances and make sure the vaccines can reach the last mile.
In Kenya, Ongeri says they need the resources to undertake door-to-door vaccination campaigns as they do for childhood immunisation.
Where there exists a well-functioning delivery system, nations have high vaccine delivery rates. Kenya, for example, has an estimated 80% coverage for childhood vaccines. In Ghana, it’s above 90%. The goal set out by the WHO may not be as unreachable as it appears.
It is not just in the interest of the countries with a shortage of vaccines that urgent action needs to be taken. As the UN secretary-general, António Guterres, said: “None of us is safe until we all are.”
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