Africa needs a billion Covid vaccines, but supply is slowing down

Has Africa taken its foot off the pedal in the race to secure enough Covid-19 vaccines for all? Data collected by UNICEF shows an alarming drop-off in shipments arriving across the continent since the start of 2022, yet at the same time the only factory which produces vaccine shots locally is in danger of closing down. In an interview with Reuters, Aspen Pharmaceutical managers claim that the plant in Gqeberha, which began producing a version of the Johnson & Johnson vaccine last year, has yet to receive any orders from neighbours in the region.

There are other plants capable of producing Covid-19 vaccines currently in the works around the continent, and as Benjamin Kagina writes at The Conversation, this is encouraging and marks a turnaround for thinking about local production.  

The challenge for Aspen’s plant - and any other that opens - is twofold. According to a statement released by Gavi, the vaccine alliance which co-ordinates the COVAX programme through which most vaccines in Africa are procured, demand for Covid-19 vaccines has dropped off to the point where it is not currently placing any large orders. Gavi head, Dr Seth Berkley, Tweeted that while Aspen’s plant is important, we “have to tackle reduced demand. We won't be safe anywhere until we're safe everywhere.”

On top of that, Gavi’s statement said that it’s down to Johnson & Johnson to decide where orders are procured from. 

On Thursday, President Cyril Ramaphosa warned the 2nd Global Covid-19 Summit that local manufacturing capabilities would vanish unless “Multilateral agencies and philanthropists [procure] vaccines and boosters from African manufacturers to ensure the developing capabilities on the continent.”

No alarm about a fifth wave?

So what has happened to demand for vaccines? Certainly not the vanishing of the virus. 

As winter kicked in over the course of April, so South Africa saw a general uptick in the number of Covid-19 cases reported every day (it looks a lot like a fifth wave). This went from 1 692 on 1 April to 6 372 by the last Wednesday of the month. No doubt the increase was spurred by the easing of restrictions and the many public holidays, but the rise in cases hasn’t (yet) been accompanied by an increase in hospitalisations or deaths. 

According to official stats from the South African government, somewhere in the region of a third of the population has received at least one vaccine shot to protect against Covid-19, but the number of people turning up to be jabbed has fallen from a peak of over a million a week in August 2021 to just 40 432 in mid-April. 

UNICEF has been collecting data about vaccine procurement around the world in its Covid-19 Vaccine Market Dashboard, and its numbers suggests South Africa is not at all unusual when compared to its neighbours. The data is not perfect: it is gathered from public sources rather than directly from health departments, and only tracks deliveries of vaccines, rather than individuals vaccinated. The ratio of vaccines to vaccinated will likely vary greatly depending on type of vaccine and domestic distribution challenges. 

Nevertheless, it’s a good starting place for investigation, and ADH’s partners at Media Hack have already investigated this dataset to establish that African countries seem to have paid more for vaccines than other countries.

UNICEF’s data shows that although South Africa was quick off the mark procuring large quantities of vaccine by mid-2021, out of 45 countries tracked in sub-Saharan Africa, South Africa comes almost dead middle for doses received per capita (20th), with enough supply for around 36% of the population. Small countries, such as Seychelle, Mauritius and Cabo Verde naturally top the list, because procuring small batches of vaccines is relatively straight forward. But Rwanda, Uganda, Angola and Ghana have all received enough vaccines to inoculate more than 40% of their populations.

By comparison, deliveries in, say, France, have remained high. The chart below shows monthly deliveries in France and Nigeria as an absolute number - bear in mind Nigeria has three times the population.

Our methodology in establishing vaccines per capita is a little rough. Some vaccines require one dose per person, but 30% of shots delivered to the continent are the Johnson & Johnson vaccine (of the type produced at Gqeberha), which requires only one dose. In addition, average ages in African countries are low: in some cases as much as 50% of the population is under 15, who generally receive a lower dose, if at all. Using population estimates from World Population Review, then, we are using a number of 1.5 doses per person as an estimate for the amount of vaccine required for full coverage, a number we feel also accounts for wastage.

Using this very rough calculation, enough vaccine has been delivered to protect just over 29% of people living in sub-Saharan Africa. Not bad, but way below the worldwide total of 69% reported by Our World in Data (OWID). Without taking into account booster shots, that means that a conservative estimate is that the continent needs another billion or so doses in order to vaccinate everyone against Covid-19.

Where do the doses come from?

The chart below shows deliveries from all manufacturers, especially Johnson & Johnson, AstraZeneca, Pfizer, Sinopharm ramped up rapidly from 30m doses in September last year to a peak of 116m doses in December, but then dropped just as rapidly. In March 2022, just under 25m doses arrived on the continent, about the same as July last year.

Africa’s taste for J&J should, in theory, be good news for Gqeberha. But how were these doses procured? Many countries have sourced vaccines from multiple suppliers through multiple agreements. UNICEF categorises deliveries as sourced via direct deals, the COVAX network,  the African Vaccine Acquisition Trust or as donations. The importance of COVAX is illustrated in the chart below, which shows the ratio of vaccine deliveries in each country by procurement source. Only South Africa, Zimbabwe and Mauritius appear to have gone their own way sourcing more than a quarter of vaccines through individual agreements, with the rest of the continent receiving vaccine donations or working through collective routes. Donations are a significant source in some countries, but certainly not overwhelming.

A similar illustration shows the dominance of the Johnson & Johnson vaccine too. It also highlights the importance of China as a supplier as well as Western companies.

While we cannot verify UNICEF’s data and it may not be a comprehensive source, it suggests two things. One, the pace of vaccination orders has slowed in an alarming fashion. Two, Africa needs at least a billion more doses - if it orders them locally it would be a massive shot in the arm for the local pharmaceutical industry.

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For up to date information on the status of vaccination across Africa, check out Africa Data Hub’s Vaccine Tracker.