West African nations need to ramp up COVID-19 vaccination 10-fold

Researchers highlight the risks of vaccine inequity and need for concerted action to provide practical solutions.
Muhammed Afolabi: Our study highlights how quickly COVID-19 vaccination rates need to ramp up to save lives sooner rather than later

West African nations need to drastically ramp up their COVID-19 vaccination programmes by a factor of 10 if they are to reach at least 60% coverage by 2022 and achieve the population level immunity needed to bring the pandemic under control in Africa and elsewhere, indicates an analysis published in BMJ Global Health.

The study was carried out by researchers from the London School of Hygiene & Tropical Medicine (LSHTM), with the MRC Unit The Gambia at LSHTM and partners.

In August 2020 the African Union Bureau of Heads of State and Government endorsed the COVID-19 Vaccine Development and Access Strategy to vaccinate at least 60% of each country’s population with a safe and effective vaccine by 2022. 

But despite the recent sharing of surplus vaccines by wealthy countries, as of mid September 2021, just 3% of people in Africa had had at least one dose of a COVID-19 vaccine compared with around 60% of people in high income countries. 

Such glaring inequity risks the emergence of mutant strains that could undermine the effectiveness of the existing vaccines, warn the researchers.

The relatively low numbers of confirmed COVID-19 cases and deaths in West Africa, compared with other parts of the continent, seems to have created a false sense of security, resulting in widespread vaccine hesitancy and low uptake of the COVID-19 jab.

Limited storage and delivery capacity, insufficient staffing, and poor health infrastructure have also likely played their part in hindering more widespread uptake.

Dr Muhammed Afolabi, study co-first author and Clinical Associate Professor at LSHTM, said: “Inequity in COVID-19 vaccination access and uptake is a shocking scandal. Our study highlights how few people in West Africa have been vaccinated and how quickly rates need to ramp up to save lives sooner rather than later.

“Governments in the 15 countries we analysed have faced many challenges and barriers to the vaccine supply and uptake process. These include getting hold of sufficient supplies of COVID-19 vaccines, having appropriate storage facilities, infrastructure and staff to administer and roll out vaccination programmes, and vaccine hesitancy.

“Practical solutions must be offered, and urgent action taken to enable governments to deploy culturally acceptable strategies to obtain and distribute COVID-19 vaccines to improve the meagre vaccination rates and achieve reasonable coverage.”

To forecast the likely levels of coverage by 2022 in the 15 countries that comprise the Economic Community of West Africa States (ECOWAS), the researchers analysed COVID-19 vaccine uptake 3 months after the start of vaccination rollout, drawing on publicly available, country-level population estimates and vaccination data.

ECOWAS comprises Benin, Burkina Faso, Cape Verde, Côte d'Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo. It accounts for 410 million people, or about 5% of the world’s population.

When the team looked at coverage after three months of the vaccination programme roll-out in the 15-member bloc, they found that only 0.27% of its total population had been double jabbed. 

On the basis of these trends, less than 1.6% of the total population across ECOWAS will have been fully (double) vaccinated after 18 months of the COVID-19 vaccination rollout, estimate the researchers.

And to achieve coverage of 60% after 9, 12, and 18 months of rollout, respectively, the pace of vaccination would need to increase by 10, 7, and 4 times the current speeds, they calculate. 

The researchers outline what might need to be done to tackle the existing vaccine hesitancy and shorten the time lag between vaccine arrival and deployment, so as to save lives, sooner rather than later.

The time from arrival of the vaccines (February to May 2021) to deployment was as short as two days in Nigeria and Togo but as long as 25 and 27 days in Liberia and Sierra Leone, respectively.

National governments and partners need to adopt culturally acceptable, community-led strategies to implement effective messaging that highlights the pros and cons of vaccination, and dispels the myths and misconceptions surrounding the jab, they suggest.

Dr Oghenebrume Wariri, study co-first author and Clinical Research Fellow at MRC Unit The Gambia at LSHTM, said: “Our findings show the stark reality of COVID-19 vaccination coverage rates in West Africa.

“More worrying is the fact that if significant shifts in access to, and uptake of, COVID-19 vaccines do not occur, West Africa could be left behind in the global fight against COVID-19.

“The emergence of the Omicron variant - and how it's changing our lives globally - shows vaccine equity is not just important for low- and middle-income countries alone, as COVID-19 will not be over until it’s over everywhere. But there are many issues to overcome, as our paper identified.

“All stakeholders must pull together now to ensure the current trajectory is halted and improve access and uptake of COVID-19 vaccination.”

The study authors wrote: “Given that public trust, confidence, and acceptance of vaccinations can be enhanced if clinical trials that demonstrate a vaccine’s efficacy and safety are undertaken locally, the calls for the conduct of more clinical trials and local manufacturing of COVID-19 vaccines in the West African sub-region remain strident and critically germane.”

This might also have other knock-on effects, they suggest. “Beyond the advantage of access to life-saving vaccines, there are potential secondary benefits of vaccine research and development and local manufacturing capacities, such as reduced or no cost of importation, less cold chain requirements and economic benefits to the host country.

“Establishment of this platform would also be useful for research and development for other vaccines targeted at diseases of public health importance in the region—Ebola, Lassa, cholera, meningococcal meningitis, and recently, Marburg.”

The authors acknowledge limitations in their analysis, including the fact it focused on the first 90 days after deployment of COVID-19 vaccines. There was a gap in the shipment of subsequent supplies following the first batches, which meant vaccination rates declined dramatically. However, the authors note that even after vaccine deliveries re-started in July 2021, vaccine rollout and uptake across West African countries has not significantly changed so the analysis still reflects the prevailing situation.


M Afolabi, O Wariri, Y Saidu et al. Tracking the uptake and trajectory of COVID-19 vaccination coverage in 15 West African countries: an interim analysis. BMJ Global Health. doi:10.1136/bmjgh-2021-007518

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