One year into the Covid-19 pandemic, African countries are staring at a daunting new triple challenge: vaccine shortage, vaccine hesitancy, and perception of dwindling virus risk.

Health officials see what happens elsewhere in the world – especially India right now – and worry which regions will get hit next.

Vaccine hesitancy

Even amidst grim vaccine shortages, some countries are destroying their first consignment of COVAX vaccines, which are now past their expiration dates. Millions of doses delivered to the continent were never used and have been stockpiled in warehouses across the continent. Malawi and South Sudan are the latest countries said to be planning to destroy expired shots, with a number of Western African countries only a few weeks away from having their COVAX vaccine supply expire.

Amid the scramble for vaccines and controversy regarding the inequitable distribution between the rich and poor countries, it is difficult to comprehend the looming destruction of shots. The COVAX facility, supported by goodwill and global solidarity, is the best opportunity for these countries. COVAX is a partnership that aims to secure and equitably allocate two billion doses of Covid-19 vaccines by the end of 2021. The vaccines are targeted for WHO-defined priority populations, including frontline health care workers and other groups at high risk.

However, while rich countries have vaccinated over 40% of their population, Africa, with over 1.3 billion people – 16% of the world’s population – has received only 2% of the supply. To the dismay of public health experts, these countries are also not distributing the shots that they have. This could be due to the perception that the virus risk is dwindling, vaccine hesitancy on the continent, and misinformation regarding Covid-19 and vaccine safety concerns.

Compared to countries in other regions, the case counts and deaths in African nations are low – the continent has confirmed 120,000 deaths and more than 4.5 million total Covid-19 cases – with one-third of the caseload taking place in South Africa. This pales in comparison to India, Brazil, the United States and a number of European nations.

Vaccine hesitancy and conspiracy suspicions were already noticeable and widespread when the US and EU governments recently paused the distribution of the Johnson and Johnson and AstraZeneca vaccines. But while immunisations with these two vaccines have resumed in the US and EU, in Africa the ramifications of the two pauses reverberated across Sub-Saharan Africa (SSA), with the safety and effectiveness of all vaccines called into question.

Although the rare cases of blood clots and other side effects were thoroughly investigated and reported, they could not dispel the shadow cast on immunisation efforts broadly. Despite the continent’s history of multinational immunisation initiatives – starting with the launch of the WHO’s Expanded Program on Immunization in May 1974 – confidence in the Covid-19 vaccines declined after the initial coverage of safety concerns.

The global effort to end the pandemic hangs in the balance. While high-income countries are working to accelerate access to Covid-19 vaccination, more low- and middle-income countries need to make this a priority. The paradox is, vaccination is slow on the continent, while vaccines are kept in the warehouses. Yet, according to the Africa CDC, African countries will need to vaccinate about 70% of their population by the end of 2022 to avoid the continued spread of the disease.

The slow pace of vaccination, allowing the pandemic disruptions to continue, also imperils routine immunisation efforts. Almost half of the countries in SSA have reported a disruption in their childhood vaccination efforts over the past year. These disruptions resulted in measles outbreaks reported in the DRC, Cameroon, and six other African countries since the pandemic began. More than half of the 50 countries that have postponed mass immunisation campaigns – placing 228 million people, mostly children at risk for preventable diseases – are in SSA.

Bottom line

With the increase in anti-vaxxers, hesitancy, and the perception of dwindling virus risk, any number of African countries have the potential to become the next Covid-19 hotspot. Governments must exercise patience in lifting pandemic restrictions, as doing so without increasing vaccination rates is a recipe for a hotspot.

To boost immunisation rates, governments must invest resources as well as their energy in distributing the vaccine. Public outreach is the key to reducing vaccine hesitancy, and government spokespeople must stress the importance of getting vaccinated. Immunisation efforts should start with the health workers who have to vaccinate everyone else, and then expand to the general public. Investments in transportation and supply chain logistics will help better distribute the vaccine shipments. International partners and donors should be recruited for badly needed resources to make all of this work.

Not every part of the world is suffering from an increased caseload of Covid-19 infections, but almost everyone on the planet is plagued by pandemic fatigue. SSA is no different. But this fatigue only feeds complacency, and there is no room for any of that when there are no barriers to stopping an outbreak.

As an American baseball manager once said: “It’s never over until it’s over.” These are wise words that we all should value in the second year of the pandemic. –