In February, we wrote about the window of opportunity to vaccinate Africa before its fifth wave. This window has now closed and the fifth Covid wave will catch many African countries almost as “unvaccinated” as the last one.
Since the fourth wave, the continent’s vaccination rate has inched upwards from 10 per cent to 17 per cent; only seven countries have coverage rates above 40 per cent.[_] Central and Western Africa have made the least vaccination progress since the fourth wave (see Figure 1).
Figure 1 – Regional vaccination rates in Africa in fourth wave versus fifth wave
Fourth wave vaccination rate
Fifth wave vaccination rate
These gaps mean that hundreds of millions of eligible unvaccinated people – many of whom are concentrated in Central and Western Africa – remain under-protected against a virus where the worst could still be ahead of us.
We know that Africa is at the beginning of its fifth wave thanks to South Africa’s superior surveillance capabilities, which have repeatedly forewarned us of its continental and global arrival – often with the only reward being the punishing travel restrictions imposed by the Global North in relation to South Africa and its neighbours. The Omicron sub-variants driving this wave – BA.4 and BA.5 – are more transmissible and evasive than the original variant that drove Africa’s fourth wave in January.
Some high-income countries, such as certain members of the European Union, the United Kingdom, and the United States, are making decisions to cut testing and lift restrictions. They are letting the virus spread and mutate largely unmitigated, acting as if the pandemic is over. Denmark has even temporarily halted its vaccination programme. For these countries, there is flexibility: they have tens of millions of vaccines in stock, are the beneficiaries of vaccine, diagnostic and antiviral-treatment inequity, and have the financial and human resources to quickly ramp up again when there is a resurgence of cases or a new variant.
In Africa, the situation is more uncertain. Many governments are addressing the challenges of vaccine absorption and low demand among their populations – with some deploying innovative techniques, such as Ghana’s “Operation 2.5 million doses in 5 days” campaigns or Burkina Faso’s bi-monthly vaccine-intensification campaign. However, they simultaneously face serious economic shocks – due in no small part to Covid and, more recently, the Russia-Ukraine conflict – strains on limited human and financial resources, and pervasive under-access to the tools needed to safely manage the virus. Inevitably, many African countries will need to balance resources between Covid and existing initiatives that were high-priority before the pandemic, including routine vaccination against diseases such as yellow fever and rotavirus, and public-health programmes such as HIV treatment, malaria control and TB surveillance. Covid has exacerbated what was already a challenging health environment.
South Africa: The Global Leader in Covid Detection
Figure 2 shows the correlation between increases in test positivity in South Africa and an impending wave across Africa. As test positivity increases beyond 20 and 30 per cent, we observe the momentum of the wave, which normally lasts around 60 to 90 days.
Because testing has fallen drastically worldwide, including across Africa, it is difficult to track the real-time increase in infections but based on the South African experience we can confidently estimate that a continental surge has begun.
Figure 2 – Daily new confirmed Covid-19 cases and test-positivity rates
What’s Next in the Covid-19 Pandemic?
Despite 253,000 reported Covid deaths, there has been a perceived lack of severity to previous waves which has, in part, resulted in Covid being viewed as lower priority for the allocation of resources and government attention. Contrary to this perception, WHO recently estimated that the number of deaths directly and indirectly associated with the pandemic in Africa is more than 1.25 million. This illustrates the difficult position that many African countries find themselves in: not all these deaths would have been from Covid – some would be due to other causes and diseases resulting from the wider impact of the pandemic on health systems and society. African countries are balancing limited financial and human resources as well as non-Covid health threats with the responsibility to safely manage Covid.
This is made even more difficult by Covid’s unpredictability: no one can be sure what the next phase of the pandemic entails.
What we do know about the next phase largely emanates from South Africa’s experience – it is the “canary in the mine” for the continent. It has taught us that prior infection from Omicron is not sufficient to prevent subsequent infection, that a new variant isn’t needed for new waves of infection to spread, and that vaccination is a much more reliable and safe way to maintain immunity than infection.
Based on this information, there will be recurrent Omicron waves that will disproportionately affect the unvaccinated. This may hit different countries at different times depending on the country profile, leading to elongated waves of infection, exacerbating pandemic exhaustion, and influencing the public and political appetite to continue to safely manage Covid alongside other more visible and acutely deadly threats.
Despite the hopeful consensus, there is no certainty that the pandemic is on a steady and predictable trajectory.
How Might Countries Prepare for This Wave?
We are observing a continental vaccine uptake rate well behind the cadence of Covid waves, which will leave hundreds of millions of Africans exposed to the virus. African governments have the vaccines to protect their populations from the worst effects of the pandemic; they now need to continue to intensify their efforts to increase uptake to ensure that when a sixth wave hits, their countries are far more vaccinated than during this current wave.
In the future, we know that epidemic and pandemic threats will continue to emerge. Through a concerted focus on epidemic preparedness, African countries will be able to better manage these concurrent threats, and many are already beginning to make the long-term investments in this regard – for example, the creation of national institutions such as the Nigeria CDC, and regional institutions such as the Africa Centres for Disease Prevention and Control (Africa CDC) and the West African Health Organisation (WAHO). This work is complemented by the efforts of the Tony Blair Institute, which works alongside these organisations to support their capacity-building and pandemic-preparedness efforts and serves as an example of the type of country-centred support that the international community and donors should prioritise.