Vaccination against COVID-19 remains a challenge in Africa. The Delta variant is spreading on the continent and the third wave of the pandemic is causing fears of more sudden and concentrated arrivals of severely affected patients in hospitals. The situation is all the more worrisome given the lack of capacity to care for them. Some facilities are already saturated. The situation is particularly problematic in South Africa, where it's winter now, in North Africa (especially Tunisia), and in Uganda, so much so that the specter of an "Indian-style" scenario is increasingly being raised.

So far, just over 6 million cases and 155,000 deaths have been recorded on the continent. But these figures could be underestimated, as the data is fragmented. In all, 51 countries on the continent (including the Maghreb) have received roughly 70 million doses from various sources, and 18 million people are now protected by two jabs. That means that less than 2% of the African population has been vaccinated, numbers that are simply "unacceptable," the World Bank's director of operations, Axel van Trotsenburg, recently said.

"The Covax system was supposed to provide us with doses, but we can see that it not functioning very well," laments Dr. Moumouni Kinda, executive director of the NGO Alima, which has just launched a vaccination support and awareness campaign in six countries.

"The situation is very disparate. In some countries, there is a shortage of doses, in others people have received the first dose but are unable to get the second," he adds. "We must change our methods, otherwise the third wave that is hitting southern Africa will also arrive in West Africa and this will be a failure for everyone. We must opt for active vaccination, that is to say, we must sensitize the populations and go to them, not wait for them to come to the centers."

Complicating matters is the fact that a large part of the African population is also reluctant to be vaccinated. This mistrust is even fueled by some leaders. In addition to legitimate questions, there are prejudices and conspiracy theories about alleged attempts at poisoning or even disguised sterilization. Last December, only a quarter of respondents of a survey conducted by the African Union's Center for Disease Control (CDC) in 18 countries across the continent believed that coronavirus vaccines were safe. At the same time, 79% of respondents said they would accept an injection if it was proven safe.

We must stop thinking that in Africa, we do not vaccinate properly!

"Too much fake news is circulating, especially on social networks," says Dr. Amavi Edinam Agbenu, who works with the WHO's Africa division. "Citizens don't necessarily have all the data to analyze it and we are working to bring them information as soon as we can."

Media campaigns, creating informational videos, and support for state communication are now among the organization's priorities on the continent.

"Resistance to the vaccine has many sources: confusion in communication, lack of clear information, the reputation of AstraZeneca, which some European countries have suspended for a while," Alima's Dr. Kinda explains. "So we use community networks, people who are able to explain things to people. But we also need to be transparent about the side effects of vaccines, document them and inform seriously, to reassure people."

Complicating matters is the fact that a large part of the African population is reluctant to be vaccinated — Photo: Robert Bonet/NurPhoto/ZUMA

The NGO director also deplores what he calls "contradictory messages," explaining that some people who send doses to Africa refuse to allow nationals of our countries, even though they have been vaccinated, to enter their country. "This is very regrettable and does not reassure people," he says. "The suspicion must stop. We have a good experience with mass vaccinations. If necessary we are able to go to villages, to go door to door… We know how to do it. We must stop thinking that in Africa, we do not vaccinate properly!"

Amavi Edinam Adgbenu, a pharmacy doctor and expert in immunology, agrees. "African countries may have a limited income, but their health systems are often well trained and able to carry out large-scale vaccination campaigns," he says. "They are used to vaccinating more than 10 million people in one week against yellow fever, meningitis, or polio, for example."

In addition to the Covax package, which announced 31.5 million Pfizer doses for Africa by the end of August, the African Union has secured 400 million doses of the Johnson & Johnson vaccine, which requires only one injection. The shipments are expected to arrive in the third quarter of 2021. According to Dr. Matshidiso Moeti, WHO's regional director for the continent, the number of available doses are expected to be much higher in July and August. The WHO says that 25 million will be sent from the United States in the next few weeks and another 3.5 million from Norway, Sweden, France and the United Kingdom.

The rate of the use of vaccines received varies considerably from one region to another

The World Bank and several African leaders met earlier this month to discuss the development aid expected for the next three years, especially to fight the pandemic. But NGOs are concerned that donated doses will expire too quickly for countries to have time to roll out their campaigns.

Paradoxically, despite the shortage, batches of the vaccine have recently expired in the DRC, Health Minister Jean-Jacques Mbungani announced on July 14. And this is not an isolated case. Other countries are failing to administer them in time. In May, Malawi destroyed nearly 20,000 expired doses. The DRC, South Sudan and South Africa have also sent back doses, either because they were about to expire or because they refused the AstraZeneca vaccine, which did not work against the South African variant. Cameroon, seeing the deadline for its doses approaching, stepped up its vaccination campaigns last week. In all, some 20 sub-Saharan countries are still at risk, with some doses expiring by the end of the summer.

The WHO and CDC centers in Africa have been supporting governments for months in organizing their vaccination campaigns. Regular monitoring of stocks and their expiration dates has been put in place. "In some countries, the use of certain brands of vaccine has been frozen to clear priority uses," says Edinam Agbenu. Vaccination has also been opened earlier than planned to non-priority targets.

But the rate of the use of vaccines received varies considerably from one region to another. According to the latest figures available to WHO, Morocco, Angola and Rwanda have administered all their doses, followed closely by Nigeria, Malawi, Kenya, Tunisia, Ghana, Uganda and South Sudan, which have exceeded 90% use. Sudan, Côte d'Ivoire, Gambia, and Eswatini are at around 80%

Some 30 countries have been less quick to develop their vaccine campaigns and have used between 30% and 80% of their doses, while seven others are really lagging behind. Some started their campaigns late. And it is possible that not all data has been reported.

*This article was translated with permission from its authors.