European Commission president Ursula von der Leyen this week vowed to fight the pandemic in “every corner of the world”, citing the bloc’s deliveries of vaccines to poorer countries as a key part of that effort.
But health officials in Africa, a central focus of Europe’s donation effort, complain of a still-sluggish rollout. They say deliveries sometimes arrive at short notice and in unpredictable quantities, carrying inadequate shelf lives. The haphazard nature of the deliveries risks throwing some national vaccine campaigns into confusion, they say.
The concerns carry particular weight given the spread of the Omicron coronavirus variant, which was first detected in southern Africa and appears to be more easily transmissible than previous versions of the virus. Health experts have repeatedly warned that insufficient inoculation in poorer regions could lead to the emergence of more virulent strains.
The African continent’s rate of double vaccination stands at less than 10 per cent, compared with two-thirds of the EU population and nearly 60 per cent in the US. EU officials acknowledge that accelerating vaccinations in Africa is now their key challenge. “We all have an interest [in getting] the African vaccination rate higher,” said one official.
The European Commission says its member states have shared 353m doses to date — mostly via Covax, the World Health Organization-backed initiative to provide equitable access to vaccines — ahead of its year-end target of 250m.
Doses actually delivered stand at 124m, however, according to new figures from the IMF. That is well behind the US, which has shipped or delivered 205m donated vaccines on a comparable basis, the IMF numbers show. The EU says it aims to share 700m doses by mid-2022, while the Biden administration has pledged to share over 1.1bn doses.
Health officials across Africa are urging government donors and pharmaceutical companies to improve the volume and predictability of deliveries. The EU said this week it has delivered just under 55m doses to Africa — a continent with a population of 1.3bn people.
“There needs to be visibility of how many doses are coming, when those doses will be available and are they going to be bundled with syringes. That helps countries to plan ahead and use these vaccines optimally,” said Dr Richard Mihigo, co-ordinator of immunisation and vaccine development at the WHO regional office for Africa.
“But the reality on the ground is completely different. The announcements and the arrangements are coming in an erratic manner. The quantities are often so small that even big countries are saying the transaction costs are too high,” he said. That added to the impression that African countries were being delivered “leftovers”.
A joint statement from organisations including the African Vaccine Acquisitions Trust and the Africa Centres for Disease Control and Prevention last month also said donations had been “ad hoc, provided with little notice and short shelf lives”, which risked undermining public confidence.
In May, Malawi incinerated nearly 20,000 expired doses rather than using them and risking a public backlash. And an official involved in Nigeria’s vaccine rollout said about 600,000 doses that arrived in the west African country from Europe in October had a remaining shelf life of six to seven weeks and had recently expired.
Commission officials say donors have faced obstacles in getting doses into recipient countries. The process has, for example, involved negotiating complex, trilateral contracts between each vaccine producer, a representative EU member state and the Gavi vaccine alliance/Covax.
Officials then need to wait for the doses to be made available by drug companies. They also have to ensure recipient countries are prepared to receive the doses, including by having in place the cold storage facilities, infrastructure, regulatory permissions and correct equipment, including syringes, to administer them.
Stop-start deliveries can contribute to vaccine hesitancy, said Dr Ayoade Alakija, co-chair of the African Vaccine Delivery Alliance, as it means that governments could not plan properly for large rollouts.
There was also an impression that Africans were being given unwanted stock, which did not help, she said. “High-income countries are saving what they consider to be the gold standard for themselves,” she said. Mihigo singled out European delivery of Pfizer doses as being notably slow in comparison with US deliveries of the drug. “We don’t understand why there is a hold-up.”
EU officials dismiss the idea that the bloc is hoarding vaccines, pointing out that it has exported 1.4bn doses. The commission has not released a product breakdown of EU donations, but the IMF figures suggest that nearly three-quarters of donated doses delivered so far have been AstraZeneca, while less than 3 per cent has been Pfizer.
A Gavi spokesperson said there had been issues with short shelf lives and unpredictable supplies, but that “these calls are now being answered”. Pfizer is the second-largest component of the Covax portfolio in terms of doses delivered, the spokesperson added.
“While Covax has funded a significant ramp-up in global ultra-cold chain capacity, different vaccines are still better-adapted for different countries and settings,” the spokesperson said. “We remain committed to offering a broad variety of vaccines through Covax.”
The key issue now, said Ruchir Agarwal, head of the IMF’s global health and pandemic response task force, is speed. “Predictability and sufficient shelf life of dose donations translate into lives saved and a quicker economic rebound.”
Additional reporting from Mehreen Khan in Brussels, Hannah Kuchler in London, Kiran Stacey in Washington DC and Neil Munshi in Lagos