With 47 African countries now rolling out COVID-19 vaccines and over 17 million doses given on the continent, early insights from Africa’s largest-ever immunization drive offer hope, inspiration and early, yet vital lessons. Here, we shine a light on key lessons emerging from countries that have made strong progress, including Angola, Ghana, Mauritius and Rwanda.

Planning and preparation is crucial

Nearly 40 African countries developed national vaccination plans before COVID-19 vaccines began arriving in bulk on the continent, many with support and guidance from WHO.

This early, wide-ranging preparation is paying-off, as countries with good plans and logistical capacities already in place began vaccinating their priority populations the fastest.

Ghana, the first African country to receive vaccines through the COVAX facility, reached over 470 000 people in areas with the highest number of COVID-19 cases in just 20 days, including over 60% of its first phase target population and around 90% of all health workers.

‘Pre-listing’ populations includes mapping populations, screening people and scheduling appointments for vaccination in advance. Good pre-listing has been key element in the most rapid and well-targeted COVID-19 vaccine roll-outs.

Angola’s electronic pre-registration system helped ensure the right people were vaccinated and that they know where and when to get the vaccine. SMS messaging, email confirmations and QR codes for on-site verification has also proven useful in preparing to deliver second doses, as well as collecting data to monitor the safety of vaccines.

“Vaccination started on March 10, and in two weeks we had vaccinated over 70 000 people from priority groups across the country, including over 35 000 health workers,” explains Dr Alda de Souza, Manager of Angola’s National Expanded Programme on Immunization.

Angola has also invested heavily in cold chain logistics and storage facilities to ensure that all COVID-19 vaccines, including those that must be stored at ultra-cold temperatures, can be used in the country in the coming months.

Strong logistical preparations and coordination have also been key to reaching people in remote areas. In Ghana, mobile vaccination teams backed by community mobilizers reached elderly people living in far-flung communities.

Mauritius, Rwanda and many other countries held wide-ranging vaccine rollout simulation exercises in advance, and countries that conducted these have typically seen smoother rollouts as well as having stronger regulatory and safety procedures put in place.

For vaccination teams, the provision of personal protective equipment (PPE) along with training and supervision is key to ensuring that vaccinations are delivered safely.

“It’s very important to note that infection prevention has been a key part of the vaccine roll-out,” says Fred Osei-Sarpong, a WHO Immunization Officer in Ghana. “The vaccinators are wearing masks, observing regular hand hygiene and sticking to the safety protocols.”

Existing health systems give a strong base

“In Rwanda, we built our COVID-19 vaccination programme on the experience from other diseases,” says Dr Sabin Nsanzimana, Director General of the Rwanda Biomedical Centre.

“We plugged in to the [existing] system, which was easier and faster, and we had capacity to store vaccines that require special conditions, including from fighting Ebola. We had teams that were trained in rolling out vaccines at the central, district and community levels.” 

Along with over 40 countries in the WHO African Region, Rwanda also made use the WHO’s COVID-19 Vaccine Country Readiness Assessment Tool to guide and monitor preparations.

The country is rolling out three different types of vaccines – the Oxford/AstraZeneca, Pfizer-BionTech and Moderna vaccines - each with unique cold chain storage and transport needs.

Building on its existing infrastructure, Rwanda boosted its capacity to store and move Pfizer vaccines at ultra-cold temperatures and began vaccinating widely within just two days of the first vaccines arriving.

The Pfizer and Moderna vaccines are given in hospitals and the AstraZeneca vaccine is used in health centres across the country. Target groups were pre-listed for each vaccine.

Angola also leveraged its strong existing systems and experience, building it’s COVID-19 vaccination drive on systems set up to deal with a deadly outbreak of yellow fever in 2017.

For Ghana, the COVID-19 vaccine roll-out builds on years of experience in eliminating wild polio virus and other mass and routine immunization campaigns.

Communicate early, strategically and persistently

Communications must start early to prepare communities to receive the vaccine, and must be part of wider outreach plans to stop the spread of the disease.

Early evidence from across Africa shows that many are eager to get the vaccine, despite very limited supplies. Yet battling hesitancy among some older people, as well as managing demand and eagerness among the young has been a challenge in some countries.

Ghana’s communication and demand generation for COVID-19 vaccines has been strong, with clear audiences, messages and well-planned work with radio, TV, social media and through trained spokespeople, influencers, partner organizations and among communities.

Actions were informed by prior public assessments and analysis that help track opinions and shift approaches in line with public concerns over time.

Political leadership is key to fighting vaccine hesitancy and Ghana’s President received country’s first COVID-19 vaccine live on national television on 1 March.

He was shortly followed, also on live TV, by the Vice-President, and the vaccination drive kicked off in earnest the following day with a former President, politicians, judges, state councillors, royals and religious leaders from a number of faiths all getting the jab. 

“We relied on facts and figures and we got information out quickly,” notes Fred Osei Sarpong. “We decided to work with facts, with truth, so that helped us build up confidence.”

“Everything was communicated on different channels in advance,” Osei-Sarpong continues. “In rural communities, information centres often have PA systems, so with our partners we made use of them to help make sure people know where and when to get the vaccine.”

Broad partnerships are crucial

A huge national endeavour needs a whole of society approach, both before and during the rollout of COVID-19 vaccines.

With strong leadership and coordination from the Ministry of Health, partnerships across and beyond government have proved crucial in countries that have shown early successes.

Angola, Ghana, Mauritius and Rwanda have all stressed the need for multi-sectoral partnerships to be in place at the national, district and local levels, including with international partners and business, especially if official resources are over-stretched.

“Coordination in Ghana is excellent, from the highest levels down to each district,” notes Osei-Sarpong. “We’re getting good data from the field to feed into the higher decision-making bodies, and regional and district leaders lead the charge at their own levels.”

Partnerships are also important in generating demand for vaccines and in communicating with communities, where religious and cultural leaders are often respected and followed.

Risks and challenges

Despite a promising start, some African countries are rapidly running out of COVID-19 vaccines. Others face delays through a lack of funds or limited planning.

As of 12 April, less than 2% of the 780 million COVID-19 vaccine doses given globally have been administered in Africa. More doses are urgently needed to keep up the momentum and to meet the objectives detailed in each country’s vaccine roll out plan.

“The only real challenge we have is that we need more doses to reach our target of vaccinating 60% of our population by next year,” explains Dr Sabin Nsanzimana in Rwanda.

WHO Africa has made a strong appeal to the international community to ensure the continent is not left behind and that the world can end the pandemic together, as no country is safe until all countries are safe.

Through the ‘Lessons in COVID-19 vaccine rollout’ webinar and publication series, WHO is working to collate, showcase and share country experiences in Africa for policy makers and public health professionals. Research on the impact of COVID-19 vaccines is also underway.