- Sub-Saharan Africa remains in the grip of a fresh Covid-19 wave stretching health services and forcing some governments to re-impose at least limited restrictions.
- Following major supply disruption in Q2, the region's vaccine pipeline for the remainder of 2021 has improved.
- Yet vaccination rates are expected to improve only slowly off a very low base (except in South Africa), prolonging the prospect of successive pandemic waves and downside risks to economic recovery.
Of 55 African Union (AU) member states, 29 countries have reported a third Covid-19 wave, while 53 are reporting community transmission. The first major spikes driven by the Delta variant were registered in South Africa, Namibia, and Zimbabwe.
New Covid-19 cases have been increasing alongside a marked rise in hospitalizations and deaths, particularly in Southern Africa. This appears to have strained health services more so than during previous waves. According to the Africa CDC, daily cases peaked at 28 cases per 1mn during the second wave, but this rate has reached 33 per 1mn during the latest wave. In addition, the Africa CDC reports the region's average case fatality ratio (CFR) at 2.5%, above the global average of 2.2%.
In West Africa, Senegal – which runs one of the sub-region's most effective testing systems – broke its daily case record three times in a single week, with infections doubling in the space of days. While the spread of the pandemic is much less visible in countries with inferior testing capacities such as Cote d'Ivoire, Ghana, and Nigeria, Delta variant cases have been confirmed across the region.
Reluctant pandemic management
The WHO has attributed the third wave to a combination of factors, including ineffective use of public health measures and social distancing, new variants, and vaccine inequity. The surge has thus reignited debates around the reintroduction of containment measures. South Africa returned to lockdown “Level 4” restrictions on 27 June – a lighter version of the 2020 measures – and has extended these until end-July. By contrast, in West Africa, any restrictions on movement akin to the short-lived 2020 lockdowns appear highly unlikely and may only be considered in the event of a dramatic surge in pandemic-related deaths – which has yet to materialize in West Africa.
One risk factor is the 20-23 July Muslim Eid al-Adha festival, which could turbo-charge the pandemic spread, somewhat similar to India's Kumbh Mela festival in April. Accordingly, governments in West Africa with large Muslim populations have been pondering re-introducing restrictions on movement and social contact, albeit reluctantly so. In Senegal, President Macky Sall merely admonished his compatriots to avoid gatherings but also threatened to close borders and impose a new state of emergency in case the current case surge continues. In Nigeria, six states (including Lagos and the Federal Capital Territory) have been put on a'red alert' list allowing authorities to restrict celebrations and gatherings, and mosques have been advised to hold prayers outside.
After a mere 15mn doses were delivered to Africa between February and June, the vaccine supply pipeline is finally improving. Major donations by the US and French governments, among others, from their vaccine stockpiles, are about to provide a narrow bridge of supplies until more regular deliveries from the COVID-19 Vaccines Global Access Facility (COVAX) resume.
Ghana, for instance, expects to receive 2mn Pfizer-BioNTech doses from US stockpiles by mid-August. Nigeria, for its part, is now expecting the first major vaccine deliveries since March to arrive in July and August, including 3.9mn doses of the Pfizer-BioNTech vaccine donated by the US government via COVAX and 3.9mn AstraZeneca shots via the regular COVAX channel. Another 3.6mn Pfizer-BioNTech doses are expected via COVAX in Q3. By end-September, authorities have even penciled in the first-ever shipment procured via the African Union's Covid-19 Africa Vaccine Acquisition Task Team (AVATT), a massive 29.8mn doses of the Johnson & Johnson (J&J) vaccine. Similarly, Kenya is looking to bolster its supply pipeline beyond COVAX by allocating budget spending for additional vaccine procurement.
Overall, COVAX deliveries are now expected to ramp up to 90mn by August and 520mn by year-end. Up to 1.8bn doses could be delivered by December 2022, assuming all deals currently under negotiation are signed, all options are exercised, donations from individual countries are confirmed, and funding is secured. This could begin to make a dent in a massive vaccination backlog, with only about 3% of people partially or fully vaccinated across the whole continent.
As discussed previously, South Africa is emerging as an outlier in the vaccine race. While its vaccine rollout was slow to get off the ground, the country is now receiving large weekly vaccine deliveries, with 5.6mn Pfizer doses expected in August and J&J deliveries also due to resume. Despite recent unrest-related disruption to South Africa's vaccine rollout, on 21 July, a total of 257,492 jabs were administered – a daily record and in line with officials' daily target of administering 250,000 doses. The inoculation campaign looks set to accelerate as logistics improve with increased flexibility for'walk-ins' and vaccine hours extended to weekends. Vaccine hesitancy does not seem a major obstacle to achieving high vaccination rates; the Coronavirus Rapid Mobile Survey suggests the proportion of adults willing to get vaccinated increased from 71% in March to 76% in May.
Although global vaccine inequity remains of extreme concern for the region, there has been some progress regarding plans to create vaccine manufacturing hubs in South Africa, Rwanda, and Senegal – a push supported by the International Finance Corporation (IFC) and EU countries. On 21 July, South Africa's Biovac announced that it had been appointed to manufacture Pfizer- BioNTech vaccines, with production expected to commence in 2022 and reach 100mn doses annually. Combined with Aspen Pharmacare's fill-finish plant, which is contracted to deliver 31mn J&J doses to South Africa and 240mn to AU countries, South Africa appears poised to emerge as a major vaccine supplier to the continent.