Millions of healthcare workers in sub-Saharan Africa continue to risk their lives to fight Covid-19 as authorities across the continent struggle to obtain and distribute vaccines to frontline medical staff.
Though hundreds of millions of people in western nations are now protected from the virus, doctors, nurses and others on the frontline of the fight against Covid in Africa will have to wait months, or even years, for a vaccine.
Last Thursday the World Health Organization (WHO) said less than 2% of the 690m Covid-19 vaccine doses administered globally to date were given in Africa, where most countries received vaccines only five weeks ago and in small quantities.
Supplies were dwindling on the continent with almost half of the 31.6m doses delivered to Africa already administered, the WHO said. Fewer than 13m doses have been given to the continents 1.3 billion people so far.
Africa is already playing Covid-19 vaccination catch-up, and the gap is widening, said Dr Matshidiso Moeti, the WHO Africa regional director. While we acknowledge the immense burden placed by the global demand for vaccines, inequity can only worsen scarcity, she added.
Cyril Ramaphosa, the South African president, said on Monday that Africa must expand its medical manufacturing capacity to combat the pandemic and be better equipped to face future health emergencies.
African health facilities struggled to cope with a second wave of infections that spread across much of the continent earlier this year, fuelled by new variants of the virus. Of 21 countries surveyed by the WHO, two-thirds reported inadequate critical care capacity and more reported a shortage of oxygen in recent months.
Only a handful of African countries believe they will be able to immunise their frontline healthcare workers over coming months, and the vaccination of general populations may not be completed for several years, leaving hundreds of millions of people vulnerable. There are now fears of a third wave.
The slow pace of the rollout also means there is a greater risk of new, more transmissible or severe variants emerging.
A major blow has been the decision of India, hit by surging infections in recent weeks, to suspend the export of large shipments of Oxford/AstraZeneca Covid-19 shots made in its territory by the Serum Institute of India, the biggest global producer.
The AstraZeneca vaccine is the cheapest and easiest to store and transport, making it well suited to the needs of African countries. Last week Dr John Nkengasong, the director of the Africa Centres for Disease Control and Prevention, said the ban could have a catastrophic impact if extended.
The AstraZeneca vaccine accounts for the vast majority of doses that African nations expect to receive through the WHO-backed Covax programme, which aims to deliver 600m shots to 40 African countries this year, enough to vaccinate 20% of their populations.
In Rwanda, about 350,000people, mainly healthcare workers, were vaccinated before supplies ran out. Half a million AstraZeneca shots have since arrived, allowing the campaign to restart.
Nigeria recently told local authorities to stop administering first doses of the AstraZeneca vaccine once they had used up half of their stock in order to safeguard supply for the second dose.
Officials in Kenya, which received a million doses of AstraZeneca vaccine in March, wanted to vaccinate every healthcare worker by June, but have so far reached only 99,000, among 300,000 people in total who have received the jab.
In South Africa, fewer than 300,000 healthcare workers have been vaccinated with the Johnson & Johnson vaccine, out of a total of more than 1 million. In February, South Africa put use of the AstraZeneca vaccine on hold after data showed that it gave minimal protection against mild-to-moderate infection caused by the countrys dominant and more-infectious variant.
Even before a second wave more than doubled the official Covid-19 death toll, the disease killed nearly 350 workers in South Africas stretched public healthcare system. The ruling ANC party has been criticised for a lack of planning, transparency and consultation as well as a failure to crack down on corruption. Only 19,000 vaccine jabs were distributed last week. No reason has been given for the slowdown.
Nkengasong said the African Union had also shifted its efforts to secure doses from Johnson & Johnson, with a deal announced last month to supply the continent with up to 400m doses. They will be manufactured in South Africa, which could simplify delivery, but are unlikely to be available before June. But Nkengasong said the continent would struggle to bridge that gap in the meantime.
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The main reason for the switch was to avoid duplicating efforts by agencies in Africa working to obtain vaccines, he added.
Moeti confirmed that the WHO and the African Union wanted to ensure that they were not competing and stepping over each other looking for the same vaccines for African nations.
According to the latest figures from Johns Hopkins University, there have been 4.3 million confirmed cases of Covid-19 in Africa and more than 115,000 deaths. This could be a significant underestimation, however. For example, the official death toll in South Africa is 53,000, but excess mortality data suggests that the true total is at least twice that figure. South Africa, the worst-hit country on the continent and one of the wealthiest, has some of Africas most reliable statistics.