The Challenges Africa Poses to COVID-19 Vaccinations

Roughly 432 million vaccines have been dispersed across the African continent. Still, COVID-19 vaccination rates stand at 7.35% for the continent, with many countries hovering around 1%, according to the Africa Centers for Disease Control.

But millions of vials of Johnson & Johnson — one of the continent’s most available vaccines — are creeping toward their six-month expiration date.

Despite the steady trickle of vaccines into the continent by way of COVAX, a global vaccine-sharing initiative, and the African Union’s African Vaccine Acquisition Task Team (AVATT), many countries are still struggling to overcome the challenges of vaccine administration in regions where yearly flu vaccine campaigns aren’t the norm and most people’s vaccination records end with childhood.

Dr. William Moss, who specializes in epidemiology and international health at Johns Hopkins University, cites obstacles in meeting what he refers to as the four D’s of an effective vaccine campaign: doses, delivery, demand and data.

“Having sufficient vaccine supply has been a major challenge … (Additionally) being able to get vaccines that are in the country into the arms of people requires a cold chain system and a transport system (as well as) health care workers to be able to deliver them.”

Beyond logistical challenges, vaccine hesitancy, which Moss notes has been “particularly challenging around the world, including very much in the United States,” has also been a major roadblock to mass vaccination. Hesitancy is especially prevalent in the case of countries with greater access, like South Africa.

To date, 25.5% of South Africans have been fully vaccinated against COVID-19, according to the Africa CDC, which falls short of the World Health Organization’s year-end goal of 40%.

In the months prior to wider vaccine availability, skepticism and rumors festered. A familiar narrative of low faith in the government, pandemic-induced economic anxieties, and historical distrust toward Western intervention have been a recipe for high levels of hesitancy.

Mpumi Zokufa, a health promotion manager with Médecins Sans Frontières in Khayelitsha, a township that is part of the greater Cape Town metropolitan area, cites a number of myths in circulation — from the belief that the vaccine would “change people's DNA” to suspicion around its faster production relative to other viruses such as H.I.V. and even wider doubts regarding the provenance of the virus.

Many of these myths have proliferated across digital platforms such as Facebook and WhatsApp and in the sermons of religious leaders.

“They believe that the government is controlling what happens with COVID, which of course, we know is not true,” Zokufa says. Coupled with the economic fallout of the pandemic and the rise of organized and petty crime, many have been struggling financially.

“In Khayelitsha, there was a lot of crime (during the worst of the pandemic). People were hijacked. There were also syndicates of people coming and...(demanding that businesses) pay them a percentage. People closed their businesses because they couldn't afford to pay,” she recounts.

Médecins Sans Frontières is working in conjunction with the South African government to combat the misinformation via community engagement, education, and the establishment of pop-up vaccination sites across the township and country.

While they are finding success, increasing numbers from 40 to 50 people to 150 people vaccinated on a slower day, Zokufa finds that they are “very low” relative to the population of Khayelitsha, which estimates place at more than 2 million.

However, an unexpected light in the struggle to increase vaccination rates has appeared within the last month: children.

Just last month, South Africa began vaccinating children aged 12 years and older, a cohort that Zokufa expresses is doing “very well” relative to people aged 40 years and older.

“I was a bit surprised when I saw that the younger generation is really coming out. (Due to) programs happening in schools…they have more information than maybe their parents or grandparents,” she adds. “Some parents will come and get vaccinated because their child has been vaccinated.”

Following the discovery of the omicron variant, child hospitalizations in South Africa for the virus are climbing, though cases have been relatively mild.

Still, high COVID-19 vaccination rates are a long way off in South Africa and the world as a whole, especially as they relate to hesitancy.

The difficulty with COVID-19 vaccine demand comes as no surprise, given increasing vaccine hesitancy even in “countries where vaccination levels are very high” for the last few years, says Dr. Ali Mokdad, the chief strategy officer of population health at the Institute for Health Metrics and Evaluation (IHME).

Two years ago, the U.S. saw measles outbreaks due to an uptick in anti-vaccine activism.

The case has been much the same for COVID-19. Mokdad says he has found that the approach to COVID throughout the pandemic showed a lack of international cooperation regarding the communicability of hesitant attitudes as well as overall vaccine access:

“We didn't look at the pandemic as a global issue. Each country protected itself and protected its own ends.”