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What do we know about vaccine procurement and distribution in East Africa?

This article was published on
July 20, 2021

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As of July. 16, 2021 the block of countries that make up East Africa have administered the highest rate of COVID-19 vaccine doses on the continent. The shots that have been given in East Africa are mainly AstraZeneca doses obtained through the vaccine-sharing alliance COVAX. The vaccine rollout strategy in East Africa prioritizes at-risk groups and relies heavily on community health workers to give out the shots.

As of July. 16, 2021 the block of countries that make up East Africa have administered the highest rate of COVID-19 vaccine doses on the continent. The shots that have been given in East Africa are mainly AstraZeneca doses obtained through the vaccine-sharing alliance COVAX. The vaccine rollout strategy in East Africa prioritizes at-risk groups and relies heavily on community health workers to give out the shots.

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As of July 16, 2021 the block of countries that make up East Africa have administered the highest rate of COVID-19 vaccine doses on the continent. The shots given in East Africa are mainly AstraZeneca doses obtained through the vaccine-sharing alliance COVAX. The vaccine rollout strategy in East Africa prioritizes at-risk groups and relies heavily on community health workers.

Of the 3.4 billion COVID-19 vaccines given globally (as of July. 16, 2021) 0.21 percent have been administered in East Africa. East African countries started receiving vaccines under the COVAX program in February 2021 and in limited quantities. Ethiopia leads the regional count with 2.5 million doses administered, followed by Kenya, which has administered 1.73 million doses. Tanzania is set to receive its first vaccines in the coming weeks. Burundi and Eritrea to date have no public plans for obtaining COVID-19 vaccines.

COVID-19 is causing the world’s largest vaccination drive. This makes the supply chain and rollout extremely complex. Logistics are further complicated by different storage and dosing conditions of the various COVID-19 vaccines. For East African countries, the end-to-end logistics are even more challenging because of limited infrastructure and logistics management systems that are crucial to vaccine deployment. Including but not constrained to:

  • Requirements for keeping the shots cold. The needs vary between standard refrigeration at 2-80C to ultracold refrigeration between -80 to 600C. This cold requirement also causes challenges in the distribution of vaccines as well
  • Weak data collection systems. Many countries lack accurate data to estimate the human and financial resources needed, determine at risk groups, and health system capacities to deliver the vaccines
  • Limited trained workforce. The population of community health workers are the main source of reaching remote populations
  • Poor health communication to promote uptake and address vaccine hesitancy
  • Ineffective governance and oversight in vaccine delivery

Allocations of vaccine doses by COVAX are based on each country’s “readiness factor” which includes logistical and legal evaluations of how ready the country is to give out the shots. East African countries have prioritized target groups based on age, pre existing conditions, and occupation. Vaccine delivery relies on health facilities, outreach sites, and most heavily on community health workers.

The global divide in acquiring COVID-19 vaccines and uptake is driven by several factors including:

  • Vaccine hoarding: Thirty-five high-income countries pre-ordered vaccines doses in excess to fully vaccinate their entire populations. This blocked out East African countries from accessing limited global supplies. Access was further hampered when India halted vaccine exports under the COVAX scheme.

  • Logistical challenges: some East African countries received vaccine doses closer to expiry and had to discard the vaccines, return them to COVAX or donate them to other countries. For instance, Malawi destroyed 20,000 doses and South Sudan returned 72,000 doses to the COVAX program. While hard to reach remote populations, political instability and insecurity have posed substantial challenges to the success of COVID-19 vaccination in the region. As did safety concerns around the AstraZeneca vaccine.

  • Vaccine hesitancy: has been fueled by several factors including myths and misinformation. With some leaders such as the late John Magufuli denying the existence of COVID-19. Public distrust of government response to COVID-19 is also linked to vaccine hesitancy, as is corruption.

Though East Africa has been active in in the COVAX facility and its national health agencies have mostly worked to obtain vaccines for their residents, many more vaccines will need to be procured and distributed in the region to stop the spread of COVID-19.

Context and background

In East Africa, COVID-19 vaccination rollout has been slower and more complex than the rest of the world. The region has three ways of acquiring COVID-19 vaccines: through COVAX, African Vaccine Acquisition Task Team, and bilaterally, from government to government.

Less than two percent of African residents have been fully vaccinated and the 50 million doses already administered in the country account for only 1.6% of the world's total COVID-19 vaccine distribution.

Resources

  1. Burundi says it does not need COVID-19 vaccines, at least yet (Associated Press)
  2. Monitoring COVID-19 vaccinations (World Health Organization)
  3. A year of denying COVID-19 Tanzania orders COVID-19 vaccines (Wall Street Journal)
  4. Small group of rich nations have bought more than half of the future supply of COVID-19 vaccines (Oxfam)
  5. Malawi destroyed almost 20,000 doses of the AstraZeneca Vaccine (BBC News UK)
  6. Crime and no punishment: Why Africa’s ports are vulnerable to counterfeit COVID vaccines (Health Policy Watch)
  7. What is going on with Kenya’s COVID-19 vaccine drive (AlJazeera)
  8. Distributors 'sneaked' Russian vaccine into Kenya for sale at Sh11, 000 per jab (Breaking Kenya News)
  9. How embassies are tackling COVID-19 vaccinations (Devex)
  10. COVID-19 vaccine challenges: What have we learned so far and what remains to be done (Science Direct)

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