TED CHAIBAN: Next three months vital in closing vaccine equity gap

The World Health Assembly that took place last week in Geneva, Switzerland, was likely to be one of the last opportunities to bring all 191 member states together and bend the curve of Covid-19 vaccination in low-income countries with the lowest vaccination rates, many of which are in Africa.

While the world desperately wants Covid-19 to be over, the pandemic remains a reality. In the past four weeks alone 14.8-million new Covid-19 cases and 47,477 deaths were registered worldwide, adding to a global count of 6.3-million lives lost.

In Africa we do not have a full picture of the true numbers of daily cases and deaths as testing has vastly reduced. SA — with the highest case numbers in Africa — is seeing an increase in daily positive cases driven by sub-lineages of the Omicron variant.

The next three months will be vital for closing the vaccine equity gap, which continues to threaten global health security. While 60% of the global population has been fully vaccinated, that rate drops to just 18% in Africa. This gap is unacceptable. There is ample vaccine supply to vaccinate all adults and adolescents globally. The challenge now is getting the vaccines into arms.

Addressing the vaccine equity gap will reduce Covid-19 cases and deaths, especially among the most at-risk groups. But making these investments now will also ensure the requisite processes, structures and investments are in place to strengthen health systems and prepare for the next pandemic. For instance, investments made now to improve the temperature-controlled storage and transport equipment required for vaccines — known as the cold chain — bolster countries’ ability to manage routine childhood immunisations, insulin supply or blood transfusions.

Beyond the benefits for countries’ people and health systems, vaccinations are critical for Africa’s economy. Persistently low vaccination rates increase the risk of new variants emerging and spreading with potentially disastrous consequences. The African economy is already feeling the weight of increasing sovereign debt, the spectre of food shortages and a potential escalation of an inflation-induced cost of living crisis, due to the war in Ukraine. Vaccinations are critical to avoid a repeat of the economic impact of the early days of the Covid-19 pandemic, which caused the GDP of Africa to contract 2.1%, according to the African Development Bank.

To support vaccine delivery in middle- and low-income countries, in January the UN Children’s Fund, World Health Organisation (WHO) and vaccine alliance Gavi launched the Covid-19 Vaccine Delivery Partnership (CoVDP), an inter-agency initiative building on existing resources globally, regionally and in-country to accelerate vaccination coverage in the countries facing the biggest challenges to reaching their vaccination targets.

Operationally, CoVDP focuses on the 34 countries that were at or below 10% coverage in January, many of which are in Africa and face the added challenge of responding to humanitarian emergencies. The partnership works with countries to understand barriers to vaccination and support them to access urgent funding, resolve operational bottlenecks and conduct the political advocacy needed to keep vaccinations on top of the agenda. Given the diverse range of challenges countries face, the support we provide is tailored and co-ordinated, with the countries themselves in the lead. 

The challenge is important because health systems in many countries were already fragile before the pandemic. The Omicron variant has also reduced the risk perception of Covid-19, especially as compared to an increasing number of competing health priorities such as continued concerns with polio, measles, yellow fever and ensuring better maternal healthcare.  

There have been several successes in improving vaccination numbers since January, and the number of countries with low vaccination rates has reduced significantly. Among the 34 countries with Covid-19 coverage rates of 10% or less in January 2022, 16 have made good progress, with countries such as the Central African Republic (CAR), Ivory Coast and Uganda reaching vaccination levels exceeding 20% of the total population.

Countries have deployed a variety of strategies to improve their vaccination coverage. A period of vaccination campaigns has been necessary to catch up. Consistent elements for success include strong political leadership at the highest level of government, close engagement with communities to ensure people have all the information they need to feel confident in the vaccine’s effectiveness and usefulness, the involvement of religious and community leaders and the use of multiple rounds of mass vaccinations.

In conversations with several country delegations on the sidelines of the World Health Assembly we discussed the strategies being used to increase vaccinations. The CAR is integrating Covid-19 vaccination with polio vaccination and the distribution of deworming and vitamin A tablets, and the country has seen vaccinations double from 10% in January to 20% now. In Mali, the involvement of community leaders and women’s groups and door-to-door information campaigns are contributing to greater sensitisation of the population to the benefits of vaccinations.

It is important for countries to set ambitious targets backed by concrete plans for implementation — prioritising full coverage of high-risk groups including healthcare workers, the elderly and those with comorbidities. It is also important that partners co-ordinate to provide countries with the resources needed to accelerate and expand national strategies, stimulate demand and overcome operational bottlenecks.

Governments, donors and development actors must support countries to implement national strategies and prioritise investments that have co-benefits for the wider health system, such as cold chain investments, training of healthcare workers and improved health information systems. Investment in primary healthcare and local production of health commodities are important to future pandemic preparedness.

Lessons learnt from the world’s most rapid immunisation rollout play a valuable role in planning and pandemic preparedness. Closing the vaccine equity gap remains possible, but this opportunity is gradually vanishing. If we are to succeed we need an urgent, concerted joint effort from governments, donors, religious and community leaders and members of the public. Let us use this time wisely.

• Chaiban is global lead co-ordinator for the Covid-19 Vaccine Delivery Partnership, a partnership between the World Health Organization, UN Children’s Fund and Gavi vaccine alliance.