Understandably, African countries are currently focused on procuring enough Covid-19 vaccines for their populations amid limited supply and stockpiling by wealthier nations. While vaccine access and equity are of major global concern, efforts to develop, produce and obtain vaccines will be in vain unless governments can effectively deploy them once in hand.
The end-to-end logistics required for a vaccination campaign of this scale are highly complex, and they are especially challenging in sub-Saharan Africa where infrastructure vital to deployment (such as cold-chain refrigeration and digital data collection) and funding are limited.
According to the World Health Organisation Africa Vaccine Introduction and Readiness tracker, just 51 per cent of 46 countries assessed are equipped overall to deliver vaccines to their populations. African governments need to urgently set to work validating their distribution frameworks and mitigating gaps in preparedness.
The consequences of being underprepared once vaccines have begun to arrive are serious and far-reaching. Premature expiration of vaccines (resulting from inadequate cold chains or staff training, for example) will result in financial loss from the investment in those doses as well as underserved communities, lower coverage rates and, ultimately, a slower timetable to reaching population immunity. Failing to efficiently deliver vaccines means the virus will continue to spread, causing needless excess morbidity and death. It could also mean the segmentation of lower-coverage countries from the global economy, leading to huge economic losses and exacerbating global inequities. And with every new transmission, the virus has an opportunity to mutate, increasing the likelihood that a mutation could occur that renders existing vaccine regimens ineffective.
Rwanda’s rollout provides African governments with a blueprint for success
Fortunately, there is already a blueprint for African governments on what it will take for successful vaccine delivery. In less than two weeks, Rwanda has vaccinated 340,000 people, or 2.7 per cent of its population. While still significantly short of the 2021 target of 20 per cent, Rwanda is a top performing country in Africa and among LMICs. It’s possible to identify four elements behind its early success.
Whole-of-government coordination. Start-to-finish vaccine delivery demands management and coordination of diverse stakeholders across a range of complex activities. Rwanda established a coordinating mechanism bringing together decision-makers from all ministries and levels of government. This approach facilitated the successful transport of AstraZeneca vaccines from the central distribution hub in Kigali to 14 remote areas of the country within 24 hours, with little advance notice. The task brought together the Ministry of Health, Defence, Rwandan police and local health centres and this coordination ensured that Rwanda would be ready to begin administering vaccinations across the country on 5 March.
Tailored last-mile delivery. Effective vaccine rollout will require a tailored approached for getting the vaccine from its last distribution hub and into people’s arms. Local population demographics, cold-chain capacity and staffing resources all vary by community, influencing how last-mile logistics and service delivery play out. Based on a cold-chain analysis completed in late 2020, the government of Rwanda identified areas that would be more suited to certain vaccines than others. After receiving 240,000 AstraZeneca jabs and 100,000 Pfizer jabs though its initial 3 March COVAX delivery, the government managed risks to local settings, shipping AstraZeneca to more remote areas with weaker cold-chain capability and distributing Pfizer in the capital Kigali, where the cold-chain infrastructure was better equipped to keep vaccines colder.
Digital data and technology infrastructure. Technology and the use of data have been at the heart of Rwanda’s Covid-19 response. Systems with real-time data reporting, analysis and insights will help to inform timely decision-making, from early warning of pressure points to algorithmic optimisation of rollouts. As part of its rollout, the country is pushing to digitise its health record-keeping nationally. Eliminating paper records is enhancing the ability of health teams and government to track health indicators in real-time and to digitally certify the status of those who have been vaccinated – a critical feature for meeting international standards to rejoin the global economy.
Proactive communication with the public. All efforts to develop, produce and deliver a vaccine to an inoculator are futile if there is no arm ready to receive the jab. Since the arrival of the first COVAX shipment, the government of Rwanda has kept the public informed of the deployment progress. Daily updates from the Ministry of Health, on Twitter, TV and radio and in print media allow citizens a window into the rollout operations. Trusted community leaders have been engaged to help those invited for vaccination to know where to go and to understand the benefits of vaccination on their community. Transparency builds trust in the process.
Rwanda’s experience illustrates that an effective rollout is possible with the right elements in place. However, because most governments in Africa are still acutely underprepared to effectively distribute Covid-19 vaccines to their most vulnerable populations, partner governments and international organisations must strengthen their financial and logistical support immediately.
In South Sudan, over 100,000 COVAX doses are expected to arrive this week, yet the country has severely constrained funding to operationalise its National Vaccine Deployment Plan. Lack of funding limits the number of vaccination centres and increases the risk of low coverage, while also implying that vaccines could sit unmoved from central warehouse shelves, potentially expiring before use.
No country is safe until every country is safe, and it is in the interests of the international community to assist governments everywhere to close gaps in preparedness. The pandemic does not end with successful vaccine development and procurement. It ends with successful vaccine deployment.