More international efforts needed to improve Covid-19 vaccinations across Africa

The African Vaccine Acquisition Trust (AVAT), the Africa Centres for Disease Control and Prevention (Africa CDC) and Covax have issued a joint statement calling for improved Covid-19 vaccine donation efforts.

The statement comes after quality issues of Covid-19 vaccine donations, which have made it difficult for the organisations to achieve higher coverage rates throughout Africa.

Throughout the Covid-19 pandemic, AVAT has acted as a centralised purchasing agent on behalf of the African Union (AU) Member States, to secure the necessary vaccines and blended financing resources to achieve the 70% vaccination target for Africa’s population.

The groups state that whilst donations of vaccine doses have been an important source of supply, the quality of these donations needs to improve. Through Covax and AVAT, over 90 million doses have been delivered to Africa, with more coming from bilateral agreements.

However, the organisations highlight that the majority of donations have been provided with little notice and short shelf lives, making it difficult for countries to plan vaccination campaigns and increase absorptive capacity.

“Having to plan at short notice and ensure uptake of doses with short shelf lives exponentially magnifies the logistical burden on health systems that are already stretched. Furthermore, ad hoc supply of this kind utilises capacity – human resources, infrastructure, cold chain – that could be directed towards long-term successful and sustainable rollout. It also dramatically increases the risks of expiry once doses with already short shelf-lives arrive in country, which may have long-term repercussions for vaccine confidence,” the statement reads.

To achieve higher coverage rates across the continent, and for donations to be a sustainable source of supply that can complement supply from AVAT and Covax purchase agreements, this trend must change. Countries within the continent now need predictable and reliable supply, the groups state.

In particular, donations must be made in a way that allows countries to effectively mobilise domestic resources in support of rollout and enables long-term planning to increase coverage rates.

The organisations are calling on the international community to commit to new standards for vaccine donations from 1 January 2022. This includes:

• Quantity and predictability: Donor countries should endeavour to release donated doses in large volumes and in a predictable manner, to reduce transaction costs. We acknowledge and welcome the progress being made in this area, but note that the frequency of exceptions to this approach places increased burden on countries, AVAT and Covax.
• Earmarking: These doses should be unearmarked for greatest effectiveness and to support long-term planning. Earmarking makes it far more difficult to allocate supply based on equity, and to account for specific countries’ absorptive capacity. It also increases the risk that short shelf-life donations utilise countries’ cold chain capacity – capacity that is then unavailable when AVAT or Covax are allocating doses with longer shelf lives under their own purchase agreements.
• Shelf life: As a default, donated doses should have a minimum of 10 weeks shelf life when they arrive in-country, with limited exceptions only where recipient countries indicate willingness and ability to absorb doses with shorter shelf lives.
• Early notice: Recipient countries need to be made aware of the availability of donated doses not less than 4 weeks before their tentative arrival in-country.
• Response times: All stakeholders should seek to provide rapid response on essential information. This includes essential supply information from manufacturers (total volumes available for donation, shelf life, manufacturing site), confirmation of donation offer from donors, and acceptance/refusal of allocations from countries. Last minute information can further complicate processes, increasing transaction costs, reducing available shelf life and increasing risk of expiry.
• Ancillaries: The majority of donations to-date do not include the necessary vaccination supplies such as syringes and diluent, nor do they cover freight costs -  meaning these have to be sourced separately – leading to additional costs, complexity and delay. Donated doses should be accompanied with all essential ancillaries to ensure rapid allocation and absorption.