Covid-19: The tinderbox of the pandemic in Africa: the challenge of an unvaccinated continent | Society

The low vaccination rate in Africa, located around 7% of the population with the complete guideline compared to 44% worldwide, is one of the greatest challenges facing the world to end the covid-19 pandemic. Experts agree that dose access problems due to hoarding by rich countries they have been the main factor that explains these data, but not the only one. Added to this are the complications of distribution of some vaccinations that arrived late and health systems with scarce resources to face complex immunization campaigns, and mistrust in a continent where a clear strategy has been lacking and where the perception of risk due to covid-19 is lower.

In Africa, only 241 million vaccines have been administered of the 8 billion inoculated worldwide, according to Our World in Data. “Something that this pandemic is teaching us is that everything is global, that it is very important that vaccination rates are high in all countries to prevent new variants from appearing,” explains Anna Roca, epidemiologist at the School’s Gambia Unit. of Hygiene and Tropical Medicine of the University of London. “Although in South Africa they were the first to discover it, it is not clear where it started the omicronBut what is evident is that in two weeks it will be present in many countries, it is transmitted very quickly ”, adds the specialist.

The world health authorities and the scientific community have been repeating it like a mantra for months: leaving low-income countries behind in vaccination is a threat to everyone. “A year ago, when we began to see some countries reach bilateral agreements with manufacturers, we warned that the poorest and most vulnerable would be trampled on in this global stampede for vaccines. And that is exactly what has happened ”, recalled this week Tedros Adhanom Ghebreyesus, director general of the World Health Organization (WHO),“ but we cannot end this pandemic if we do not solve the vaccine crisis ”. Rich countries have received 15 times more doses per capita than low-income countries, according to Unicef.

The challenge in Africa is not only that the roads reach the airports of the big capitals; then they have to inject themselves. The Covax initiative, that has failed In its goal of distributing 2 billion vaccines among low-income countries by the end of 2021, it is an example: hundreds of thousands of doses have had to be thrown away in Africa because of the narrow margin between delivery and expiration. “Covax did not work as planned. But not everything has been a problem of shortages, a clear strategy has also been lacking, “says Eric Delaporte, epidemiologist at the University of Montpellier. Maintaining the cold chain or reaching beyond the capital has been a headache for many countries. According to the WHO, one in four vaccines arrived in Africa has not been administered.

The erratic and improvised supply, without a forecast that would allow adapting the immunization campaigns to the stock, has not contributed to generating the necessary trust. An example is Senegal. “This country experienced a peak of cases during the third wave of last July. People were concerned and flocked to get vaccinated, but in August the doses ran out and many people were left without immunization. When more vaccines arrived in September, those people no longer came back, so by the end of the month they had expired. 200,000 vaccines were destroyed in October, ”explains Alice Desclaux, a medical anthropologist at the Research Institute for Development in Senegal.

Of 2 billion vaccines planned in 2021, Covax has delivered 590 million. A spokesperson for this mechanism attributes it, in addition to the hoarding of rich countries, export restrictions or lack of transparency from manufacturers. “The big challenge now is to maintain supplies and make them more predictable, as well as working with countries to expand their capacity to absorb doses. The second point is important, as they need time to prepare for any large-scale vaccine rollouts. In recent weeks, donors and manufacturers have begun to provide more accurate data, after a year in which doses and transparency have been very low, “he says.

For many countries this is the largest vaccine deployment in their history, Covax insists, and in some cases “they will have to deal with more than five times the volume of vaccines they normally face. They will also deliver it to parts of the population that they normally do not have to address. Vaccines are usually given to infants or adolescents, but many countries do not have a vaccination program for adults. Also, while most countries have implemented massive campaigns before, they have a one or two year lead time and can therefore plan accordingly, including having a predictable supply. While with covid-19 vaccines, we are talking about a supply that comes from multiple sources and the timing of delivery is often unpredictable, “he reports. Alejandra Agudo.

Infected undetected

The shortage of doses, at least until the summer, and logistical problems created an unfavorable breeding ground among the population. The official figures for the pandemic in Africa – 8.7 million cases and 223,000 deaths for some 1,300 million inhabitants – do not reflect reality. The limited capacity to test and the mild or asymptomatic nature of the vast majority of infections, mainly due to the youth of the population, have hidden that the virus has circulated much more than the statistics say. “Now we know it from seroprevalence studies,” says Delaporte. “We carried out an investigation in six countries in West and Central Africa and after the second wave, there were between 45% and 55% of people with antibodies that had been infected, especially in the big cities,” he adds.

However, despite this widespread circulation of the virus, millions of Africans have a very different feeling. “Nekut fii”(An expression in the Wolof language that means“ he is not here ”), responds the young waitress Fatumata Kande when asked about covid-19, using the tagline that has become popular in the Gambia when referring to the pandemic, which is perceived as a white disease. “It has not been the same throughout the continent. In South Africa it has hit as in Brazil or in Europe, but if we look at West Africa we see that the severity is less. And it is not only explained by the youth of the population ”, adds Anna Roca. Scientists are investigating other factors that may have reduced severe cases, such as increased exposure to malaria and other human coronaviruses or contact with a type of parasite that modulates the immune response.

The doubts that have arisen around the world about the side effects of some vaccines, such as AstraZeneca’s – mostly used by Covax – have also had a notable impact on the African continent. “It is not a phenomenon exclusive to Africa”, Delaporte recalls, but when France announced that it would not give a health pass to people vaccinated with the type of AstraZeneca distributed on the continent and from India, suspicions spread. “Mistrust exists, but we cannot blame the population, there has been no strategy or clear communication about vaccines,” Desclaux points out.

Africa has also not been left out of the other epidemic, that of fake news and rumors about vaccines. While in Europe or the United States the comments about microchips and DNA alterations spread, in many corners of Africa there are fears of supposed side effects and, above all, that it causes infertility. As the NGO Care has warned, there are African countries where only one woman for every three men has been vaccinated due to these false beliefs. In Malawi or Somalia, married women of childbearing age resist puncture. This is a recurring rumor: during the polio vaccination campaigns in Nigeria in past decades many communities resisted because they said it was a covert attempt to sterilize children.

To try to reduce external dependence, Africa has launched a race to start up vaccine production centers. In recent months, three different projects have emerged in South Africa, Rwanda and Senegal, where the idea is to make anticovid vaccines with messenger RNA, but also to tackle other diseases. They all hope to start production in 2023 and for this, agreements have been signed with companies such as BioNTech and Biovac. But, for now, we will have to keep waiting for global solidarity. This week Chinese President Xi Jinping promised 1 billion extra doses for Africa, in a plan in which political and economic interests also come into play.

–