As Africa awaits next Covid19 vaccine supplies, WHO survey shows cold chain gaps persist

By Chinedu Asadu

Posted on Thursday, 29 July 2021 08:08
South Africa’s President Cyril Ramaphosa visiting Aspen Pharmacare's production site in Port Elizabeth on 29 March. Lulama Zenzile/Die Burger/Gallo Images/Getty

Amid a third wave of the pandemic in Africa, only 1.3% of the population have so far been fully vaccinated against Covid-19, with 1.35 billion people still at risk of contracting the virus.

A WHO survey has revealed the struggle of African countries in the race against the pandemic: some countries still lack the capacity to store and distribute vaccines to residents who need them the most.

The WHO Africa regional office has called for ‘a lot of work’ to be done in Africa if the continent is to catch up in the race against the Covid-19 pandemic, citing a survey which found that many districts in some African countries are still not fully prepared to store vaccine doses.

Dr Matshidiso Moeti, the WHO Regional Director for Africa, told a media briefing on 22 July that African countries need to “ramp up significantly three to five times their capacity to roll out the vaccine”.

“We have carried out a WHO survey of 34 countries to see how ready they are in terms of cold-chain capacity and we found that about 30% of countries have over 50 or half of their districts, with gaps in cold chain, refrigerating capacity,” she said. “That means there is a lot of work to do in the next few weeks.”

But the Covid-19 cold chain capacity challenge is even more widespread, according to the detailed findings of the survey provided to The Africa Report by the WHO Africa regional office:

  • 31% (11 countries) have over 50% of districts with gaps in cold chain capacity.
  • 29% (9 countries) have districts with 20–50% cold chain capacity gaps.
  • 40% (14 countries) have districts with less than 20% cold chain capacity gaps.

What this means is that there are just a handful of African countries that can get vaccine doses to residents who need them the most: rural dwellers, who mostly include the aged and those with little access to equipped medical and isolation centres.

Vaccines destroyed

It also adds to the continent’s headache with regards to distribution. In April, South Sudan became the second African country to destroy thousands of Covid-19 vaccine doses that expired before they were administered.

Gavi, the Vaccine Alliance, one of the most critical stakeholders helping countries vaccinate their citizens, told The Africa Report that it continues to support nations seeking help in improving their ultra-cold chain capacity.

“To support of Covid-19 immunisation, Gavi is also in the process of securing an additional >4,500 vaccine fridges and freezers, 180 walk-in cold rooms and 150,000 passive transport devices for AMC participants as well as dedicated ultra-cold chain freezers. 71 countries have applied for this support so far,” Cirũ Kariũki, a media consultant with Gavi, said via email.

She adds that the equipment was “specifically designed for developing country settings” and “to be robust in a field setting”.

The time to get people ready to be vaccinated is not when the vaccines are landing, but now in the narrow window that we have to do all of this.

Of the 3.79 billion doses administered in the world, only about 61.3 million are in Africa.

On 1 March, Côte d’Ivoire and Ghana became the first African countries to administer the Covid-19 vaccine provided by COVAX, the WHO-Gavi vaccine coalition. Nearly four months later, the continent has received a total of 82.7 million doses from COVAX.

Data from the Africa Centres for Disease Control and Prevention (Africa CDC) shows that 73.6% of the doses have so far been administered. A few countries, including Nigeria, are already exhausting their supplies while Tanzania, Eritrea and Burundi are yet to start their vaccination campaign.

The statistics present a stark contrast from what is happening in developed nations, where as of Tuesday July 27, more than 90% of 3.89 billion doses given had been administered. In countries like America, you can get a vaccine dose from a nearby drugstore.

“We are in the middle of a third wave and 53% of our member states, that is 29 countries, are experiencing a severe third wave,” John Nkengasong, director of Africa CDC, said at a briefing attended by The Africa Report. “Of that, 20 countries are experiencing a more aggressive third wave than the previous second wave, and two countries –  Algeria and Tunisia – are already seeing a fourth wave.”

“Our goal is to bend the curve as quickly as possible, so it can relieve the burden on the heath system,” he says.

About 90% of African countries are likely to miss the September target of vaccinating 10% of their citizens unless the continent receives 225 million more doses, WHO said.

To build their capacity, the Biden administration is sending another tranche of vaccines to seven countries in the continent, White House officials told The Africa ReportBut, for some, storing the doses when they arrive remains a challenge at the district level.

No power supply

Unlike other vaccines distributed across Africa every year, the Pfizer-BioNTech and Moderna vaccines initially require storage temperatures of -20 degrees celsius and -70 degrees celsius respectively.

Getting the sophisticated freezers – which typically cost between $10,000 and $20,000 each – is extremely difficult for most countries in the continent where at least one in three people, or about 490 million citizens, live in extreme poverty.

But despite the US Food and Drug Administration (FDA) approval for the Pfizer vaccine to be stored at normal refrigerator temperatures for up to a month, not many countries in the continent can distribute the supplies beyond their national level in a fast and easy manner.

Vaccine deployment systems need to be resilient to ensure efficacy along the supply chain, especially for countries in Africa and other less developed regions where strong health systems remain a challenge.

Moreover, even if African countries are to only use the AstraZeneca and Johnson & Johnson vaccines – which require regular refrigerators – only 28% of health facilities in Sub-Saharan African, for instance, are said to have access to reliable power supply.

The problem also goes beyond Covid-19: more than half of African countries have not achieved the Global Vaccine Action Plan target of at least 90% coverage of routine vaccines with a working cold-chain system.

Building cold chains is a critical factor in “protecting lives and stimulating economic recovery”, according to a World Bank report published in April 2021.

The report adds that “vaccine deployment systems need to be resilient to ensure efficacy along the supply chain”, especially for countries in Africa and other less developed regions where strong health systems remain a challenge.

At the WHO Africa briefing, Moeti said that to get every eligible African vaccinated against Covid-19, countries must “work multi-sectorally” to ensure that at the local level, “the government and civil society are working together in supporting delivery”.

“The time to get people ready to be vaccinated is not when the vaccines are landing, but now in the narrow window that we have to do all of this,” she said.

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