The shocking imbalance in vaccine access between Africa and the Global North is reflected by the stark difference in the number of vaccine doses that have been administered. Headlines have been dominated by the fact that only 2% of the world’s Covid-19 vaccines have been administered in Africa to date. But while this is a concerning statistic, it is necessary to take a closer look at the nuances between countries on the continent, not only in terms of supply but their capacity to roll out doses.
Burn rate or the daily number of doses administered is a good indicator of how well countries are able to absorb their available supply. The chart below shows that the number of daily doses administered has been growing on average, with spikes after mid-July most likely the result of increased supply. But the seven-day rolling average of doses administered per day has slipped from 1.9 million to less than 1 million, a number which needs to rise to at least 2 million if the continent is to absorb incoming vaccines.
Daily Covid-19 doses administered in Africa
Source: Our World in Data
Still, there remains high variations between countries. Using averages and peak daily doses administered per capita, we ranked the efficiency of vaccine rollout in countries across sub-Saharan Africa. The results reveal that some are performing significantly better than others, with Botswana, Rwanda and South Africa among the countries with a relatively quick vaccine rollout. In contrast, Chad, the Democratic Republic of the Congo (DRC) and South Sudan have the least effective rollout campaigns.
The vaccine rollout campaigns of sub-Saharan countries by daily doses
Source: TBI analysis using Our World in Data
The relative successes can be attributed to community engagement and effective digital infrastructure while key challenges that are hindering rollouts include vaccine hesitancy and poor health-care infrastructure.
Community Engagement and Digital Infrastructure: Success Factors
Botswana has recorded the highest number of daily doses administered since beginning its vaccination campaign in March, and has the potential of becoming the first African country to protect its entire adult population. While this is, in part, due to the relatively small population size, this quick vaccination coverage can also be attributed to extensive community engagement and multi-sectoral coordination within government. Ahead of doses arriving, the government conducted surveys to gauge public perceptions about vaccinations, setting up a national “ArmReady” information campaign to inform the public. In addition, effective financing including resource mobilisation, and constant monitoring and evaluation tools based on data collection, strengthened Botswana’s early rollout.
South Africa has recorded the second highest number of daily doses administered. Underpinning its campaign is the Electronic Vaccination Data System, a digital infrastructure that enables effective rollout from scheduling, registering and recording vaccinations to monitoring supplies and site capacity. While a well-functioning digital tool to facilitate rollout is not a silver bullet, it can enable an efficient rollout campaign when combined with flexible strategies, advanced cold-chain infrastructure and effective management of settings, supply chain and staffing.
Rwanda meanwhile has been exemplary in its approach, with early success as a result of cross-government coordination, digital-data management and technology infrastructure, and proactive communication with the public.
Vaccine Hesitancy and Resource Shortages: The Challenges
South Sudan and the DRC have had two of the least effective rollouts in sub-Saharan Africa to date. Lack of funding for transportation, training of health-care workers and community outreach have been the primary reasons for the slow rollout in Sudan, while a key obstacle in the DRC has been vaccine hesitancy. Doubt has been cast on Covid-19 vaccines due to the temporary halt of AstraZeneca and subsequent disposal of jabs that were close to their expiry dates. These factors, along with the view that Covid-19 is a low-risk issue, have encouraged hesitancy among the general population. Although the recent inoculation of the DRC’s president and first lady could increase confidence, there needs to be holistic and context-specific community engagement to encourage the general population to take up available shots.
In order to increase the continent’s rate to two million shots or more administered per day, governments should consider how countries such as Botswana, Rwanda and South Africa have achieved vaccination rates of more than 10 per cent, while equally factoring in the challenges that nations such as the DRC and South Sudan have come up against. Both the international community and national governments need to scale up their investments in absorption capacity to prevent the worsening of the public-health crisis in Africa.