Alvin M. Keeling 
The biggest vaccination campaign ever in Africa is well underway. All but one of Africa’s 54 countries are the deployment of COVID-19 vaccines and about 250 million doses have been administered on the continent.
Yet only 3% of the nearly 8 billion doses administered worldwide have been given in Africa, and only about 8% of Africans are fully immunized, compared to over 60% in many high-income countries.
It has been ten months since the first vaccines arrived in Africa and as shipments increase, the World Health Organization (WHO) is helping African countries review and refine their COVID-19 vaccine deployments.
So far, 23 African countries have undertaken ‘intra-action reviews, ”Which assess all areas of a country’s vaccine deployment, from coordination and planning to training, logistics, monitoring, service delivery, vaccine safety and risk communication and community engagement.
Twenty-three African countries have also already updated their national vaccine deployment plans based on the recommendations of these reviews.
“With a vaccination campaign unprecedented in speed and scale, there are inevitably adjustments as you go. WHO is essential to support this, and there are many emerging best practices and valuable lessons that countries can share, ”said Dr Richard Mihigo, WHO program coordinator for immunization and vaccine development for Africa.
Some lessons are context specific, but recurring themes emerge across the region.
The best planners get the best results
With strong government commitment and commitment from the start, more than 40 countries have finalized their national vaccine deployment plans before the arrival of the first vaccines. These countries have generally fared better than those with less developed plans or without plans.
In Botswana, which is one of six African countries to reach the WHO global goal of fully immunizing 40% of its population by the end of December 2021, emergency operations centers at national and regional levels districts dealt with operational issues, such as transportation coordination.
Ethiopia, which used 80% of its available vaccines, used a reverse logistics system to bring vaccine doses back from areas where they were underutilized, and redistribute them to areas of greatest demand, thus avoiding the expiration of precious doses.
In Ghana, in addition to the emphasis on the protection of the elderly, populations have been prioritized for vaccination based on their vulnerability and potential risks of exposure at work. Good planning has also helped the country to use innovative tools, such as drones, to reach remote communities.
“We are at a pivotal moment in this pandemic,” said Dr Mihigo. “As vaccine deliveries improve, we need to work hard to remove barriers to effective and widespread immunization. Countries need to increase funding and support for vaccine delivery operations and logistics and face any hesitation, ”he adds.
Limited funds and raw materials hold Africa back
Africa faces a deficit of US $ 1.3 billion for operational costs, including cold chain logistics and travel costs and payment of vaccinators and supervisors, as well as a shortage of syringes and other essentials.
Many challenges could be better met with reliable funding, including training vaccinators and ensuring sufficient support staff, improving data entry software, and ensuring that each country has enough freezers and equipment. ‘logistical elements.
“COVID-19 knows no borders,” says Dr Phionah Atuhebwe. “If a single country lags behind in immunization, the virus has room to mutate into more dangerous variants. Leaving aside ethical reasons, this is why high-income countries must step up and help low-income countries acquire the right resources to immunize, regardless of the financial cost. “
Demand must increase
As the supply of vaccines improves, so does demand.
It is difficult to quantify demand levels for vaccines, but information shared by a range of African countries indicates that mistrust and misinformation is driving demand down.
“Tackling the misinformation that fuels reluctance to vaccinate is by no means easy,” says Dr Gilson Paluku, immunization officer covering countries in Central Africa for the WHO. “Low demand contributes to low adoption. “
A few countries are struggling to deliver even 50% of the available doses, but many African countries are finding creative ways to increase demand.
The Ghana Disinformation and Rumor Management Task Force is working nationally and regionally to tackle false allegations. Senegal’s free call centers provide facts to uncertain members of the public. Botswana surveyed its people to understand the overall risk perception, then turned to social media with its #ArmReady campaign increase public demand.
WHO hosted Alliance for Infodemic Response in Africa (AIRA) brings together African fact-checking organizations, big data, AI and innovation bodies, and leading intergovernmental and non-governmental organizations to share facts about COVID-19 and vaccines.
“Misinformation is rampant, and when vaccine hesitancy affects adoption, countries face the logistical nightmare of having to redistribute doses quickly so none are wasted.” Dr Paluku said.
Africa’s mass vaccination experiment pays off
African countries are no strangers to vaccinating large swathes of their populations against diseases like measles, polio and Ebola, and many countries are building on these experiences, as well as the existing infrastructure for them in the deployment. of their COVID-19 vaccine.
South Sudan is using vaccine accountability tools adapted from its polio campaigns to track the effectiveness of vaccine distribution and use at the service delivery level.
Countries that have already battled Ebola outbreaks or engaged in preventive vaccination campaigns already had the capacity to store vaccines in extremely cold temperatures — a requirement for the Ebola vaccine and some COVID-19 vaccines.
Based on its experience with Ebola, Liberia has set up vaccination sites in popular places such as churches, mosques, banks and markets. Likewise, the Democratic Republic of Congo has established sites in prisons, military zones, and mining sites.
Go digital
Good data is crucial for mass immunization campaigns, and keeping it real-time and relevant requires the right software and systems in place.
The data can be used for everything from registering the public for vaccination and tracking which vaccines are available, where and in what quantities, to helping health authorities make informed decisions about where. where vaccines are needed. Good data is also crucial for keeping track of any adverse reactions and for monitoring the safety of vaccines in the population.
“Digitized data helps us plan, monitor and adjust vaccination methods in a fast-paced, fluid environment,” says Dr Paluku.
Most countries have tried to go digital during the COVID-19 vaccination process, with the goal of capturing and recording data in real time to make the vaccination experience smoother.
Ghana has used QR codes to verify who has been vaccinated. In Ethiopia, messaging platforms have helped track vaccinations at the provincial level. Angola encouraged its citizens to pre-register for vaccinations to avoid overcrowding at vaccination sites, and several countries have made good use of digital platforms to monitor adverse events after vaccination.
But there is still a lot of room for improving Africa’s ability to capture data that can inform action in real time.
The WHO Regional Office for Africa continues to technically and financially support intra-action reviews in African countries and has put in place mechanisms to collect and regularly update lessons from these different countries to share in Africa. .
