Africa’s largest-ever vaccination drive is well under way. All but one of Africa’s 54 nations are rolling out COVID-19 vaccines and around 250 million doses have been given on the continent.

Yet just 3% of the almost 8 billion doses given globally have been administered in Africa, and only around 8% of Africans are fully vaccinated, compared with more than 60% in many high-income countries.

It’s been ten months since the first vaccines arrived in Africa and as shipments increase, World Health Organization (WHO) is helping African countries review and refine their COVID-19 vaccine rollouts.

So far, 23 African countries have undertaken ‘intra-action reviews,’ that evaluate all areas of a country’s vaccine rollout, from coordination and planning, to training, logistics, monitoring, service delivery, vaccine safety and risk communications and community engagement.

Twenty-three African countries also have already updated their National Vaccine Deployment Plans based on recommendations from these reviews.

“With an unprecedented vaccination campaign in both speed and scale, there is inevitably some fine-tuning as we go. WHO is central to supporting this, and there are many valuable best practices and lessons emerging that countries can share,” says Dr Richard Mihigo, WHO Immunization and Vaccines Development Programme Coordinator for Africa.

Certain lessons are context specific, but recurrent themes are emerging across the region.

The best planners get the best results

With strong government commitment and engagement from the outset, more than 40 countries finalized their National Vaccine Deployment plans before the first vaccines arrived. These countries have typically fared better than those with less developed or no plans.

In Botswana, which is one of the six African countries to reach the WHO global target of fully vaccinating 40% of its population by the end of December 2021, emergency operation centres at the national and district levels handled operational issues, such as coordinating transport.

Ethiopia, which has used 80% of its available vaccines, used a reverse logistics system to bring back vaccine doses from areas where they were underutilised, and redistributing them to areas with higher demand, thereby avoiding the expiry of precious doses.

In Ghana, in addition to the focus on protecting the elderly, populations were prioritized for vaccination based on vulnerability and the potential risks of exposure on the job. Good planning also helped the country make use of innovative tools, such as drones, to reach far-flung communities.

“We’re at a pivotal moment in this pandemic,” said Dr Mihigo. “With improved vaccine deliveries we must be hard at work dismantling barriers to effective, widespread vaccination. Countries must boost funding and support to vaccine delivery operations and logistics and tackle any hesitancy,” he adds.

Limited funds and commodities hold Africa back

Africa faces a US$1.3 billion shortfall for operational costs, including cold-chain logistics and travel costs and payment for vaccinators and supervisors, as well as a looming shortage of syringes and other crucial commodities.

Many challenges could be better tackled with reliable funding, including training vaccinators and ensuring sufficient support staff, improving software for data capture and making sure that every country has enough freezers and logistics elements.

“COVID-19 knows no borders,” says Dr Phionah Atuhebwe. “If just one country lags behind in immunizing, the virus is given space to mutate into more dangerous variants. Leaving ethical reasons aside, this is why high-income countries must step up and help lower-income countries acquire the right resources to vaccinate, no matter what the financial cost.”

Demand must rise

As vaccine supply improves, so too does demand.

It is hard to quantify the levels of demand for vaccines, but information shared by a range of African countries indicates that mistrust and misinformation are driving down demand.

“Fighting misinformation that fuels vaccine hesitancy is by no means easy,” says Dr Gilson Paluku, an Immunization Officer covering central African countries for WHO. “Low demand is contributing to low uptake.”

A few countries are struggling to administer even 50% of the available doses, yet many African countries are finding creative ways to drive up demand.

Ghana’s Misinformation and Rumour Management Taskforce works at the national and regional levels to address false claims. Senegal’s toll-free call centres provide facts to uncertain members of the public. Botswana surveyed its population to understand overall risk perception and then took to social media with its #ArmReady campaign to increase public demand.

The WHO-hosted Africa Infodemic Response Alliance (AIRA) brings together African fact-checking organisations, big data, AI and innovation bodies and leading inter-governmental and non-governmental organisations to share facts around COVID-19 and vaccines.

“Misinformation is omnipresent, and when vaccine hesitancy affects uptake, countries face the logistical nightmare of having to quickly redistribute doses so none are wasted.” says Dr Paluku.

Africa’s mass-vaccination experience is paying off

African countries are no strangers to vaccinating large swathes of their population against diseases like the measles, polio, and Ebola, and many countries are drawing on these experiences, as well as the existing infrastructure for them in their COVID-19 vaccine rollouts.

South Sudan is using vaccine accountability tools adapted from its polio campaigns to keep track of how well vaccines are distributed and utilised at the service delivery level.

Countries that previously fought Ebola outbreaks or engaged in preventative vaccination campaigns already had the ability to store vaccines at extremely cold temperatures —a requirement for the Ebola vaccine and some COVID-19 vaccines.

Building on their experience with Ebola, Liberia set up vaccination sites in frequented locations like churches, mosques, banks and markets. Similarly, the Democratic Republic of Congo established sites in prisons, military areas and at mining sites.

Go digital

Good data is crucial for mass-vaccination campaigns, and keeping it real-time and relevant requires the right software and systems to be in place.

Data can be used for anything from registering the public for vaccination and keeping track of what vaccines are available where and in what quantities, to supporting health authorities to make informed decisions about where vaccines are needed. Good data is also crucial to keep track of any adverse effects, and to monitor the safety of the vaccines in the population.

“Digitized data helps us plan, monitor, and adjust vaccination methods in a fast-moving environment, where everything is fluid,” says Dr Paluku.

Most countries tried to go digital during the COVID-19 vaccination process, aiming for real time data capture and registration to make the vaccination experience smoother.

Ghana used QR codes to verify vaccinated individuals. In Ethiopia, messaging platforms helped keep track of vaccinations at the provincial level. Angola encouraged its citizens to pre-register for vaccinations to avoid overcrowding at immunization sites and several countries have made good use of digital platforms to monitor adverse events following immunization.

But there is much room for improvement in Africa’s ability to capture data that can inform action in real-time. 

The WHO Africa Regional Office continues to technically and financially support intra-action reviews in African countries, and has established mechanisms to regularly collate and update the lessons from these different countries to share in Africa.