The outbreak of COVID-19 (coronavirus) sent shockwaves around the world, overwhelming health systems, upending lives, disrupting globalized systems and supply chains, and undermining development gains in many of the poorest countries. Eastern and Southern Africa was not spared, with many nations imposing restrictive lockdowns and struggling to reinforce health systems that desperately needed supplies to cope with testing, treatment, and vaccination.
Eastern and Southern Africa’s COVID-19 Vaccination Journey
Unlocking Supply, Building Capacity, and Overcoming Hesitancy
The outbreak of COVID-19 (coronavirus) sent shockwaves around the world, overwhelming health systems, upending lives, disrupting globalized systems and supply chains, and undermining development gains in many of the poorest countries. Eastern and Southern Africa was not spared, with many nations imposing restrictive lockdowns and struggling to reinforce health systems that desperately needed supplies to cope with testing, treatment, and vaccination.
With only 12% of the African population fully vaccinated against COVID-19 as of April 2022, vaccination efforts have been confronted with a series of challenges that have prevented the region from reaching a continental target 70% vaccination coverage. These hurdles include limited access to supply, weak capacity and infrastructure, bottle necks in logistics, vaccines hesitancy, and indifference.
For most of 2021, the binding constraint to vaccinations in Africa was the supply of vaccines, as African countries were relying on supplies produced outside the region. Even as supplies became increasingly available, countries also needed financing support to procure them.
Humberto Lopez, World Bank Director of Strategy and Operations, visits a vaccination center in Malawi. Henry Chimbali/World Bank
Humberto Lopez, World Bank Director of Strategy and Operations, visits a vaccination center in Malawi. Henry Chimbali/World Bank
Humberto Lopez, World Bank Director of Strategy and Operations, visits a vaccination center in Malawi. Henry Chimbali/World Bank
Humberto Lopez, World Bank Director of Strategy and Operations, visits a vaccination center in Malawi. Henry Chimbali/World Bank
Humberto Lopez, World Bank Director of Strategy and Operations, visits a vaccination center in Malawi. Henry Chimbali/World Bank
Humberto Lopez, World Bank Director of Strategy and Operations, visits a vaccination center in Malawi. Henry Chimbali/World Bank
Humberto Lopez, World Bank Director of Strategy and Operations, visits a vaccination center in Malawi. Henry Chimbali/World Bank
Humberto Lopez, World Bank Director of Strategy and Operations, visits a vaccination center in Malawi. Henry Chimbali/World Bank
The World Bank has been at the forefront of helping countries in Eastern and Southern Africa to overcome these obstacles, providing $2.84 billion in approved financing to help 20 countries (an additional $180 million is currently under preparation for AFE countries – for a total of 20 countries supported under the vaccine portfolio) buy and deploy vaccines, expand storage and cold chains, develop tracking systems, train health workers, engage citizens and communities, and strengthen health systems. In partnership with COVAX and the African Union’s Africa Vaccine Acquisition Trust (AVAT), the World Bank is helping to accelerate the procurement of vaccines doses for millions in Eastern and Southern Africa. This extraordinary African-led effort complements COVAX, and as of June 2022 has so far delivered 62 million doses to the region and CARICOM countries, of which 45 million doses were financed by the World Bank.
While constraints on supply have eased, African countries continue to face a series of hurdles to getting jabs in arms, notably waning demand, low capacity in warehousing/storage, weak infrastructure and cold chain capacity, lack of trained vaccinators, lack of data systems to support vaccination campaigns, and shortages in ancillary equipment, such as syringes and safety boxes. African countries also struggle with misinformation and vaccine hesitancy requiring concerted efforts to build trust in vaccination programs, particularly among youth and non-at-risk populations that are increasingly indifferent to the threat that COVID-19 poses.
Malawi is just one of many countries in Eastern and Southern Africa that is struggling to reach its target of vaccinating 60% of the population by December 2022, mainly due to vaccine hesitancy and slow uptake by the eligible population. The World Bank is supporting Malawi to scale up communication efforts to address vaccine hesitancy by working with local structures and leadership to mobilize people to get the vaccines.
Supporting Vaccine Roll-Outs in Eastern and Southern Africa
As of June 2022, the World Bank has committed $3.6 billion to 24 COVID-19 operations that are supporting vaccine acquisition and deployment in Sub-Saharan Africa. Twenty of these operations are in Eastern and Southern Africa.
Rwanda
An All Hands on Deck Approach
At the request of the Government of Rwanda, the World Bank provided $30 million to help finance the country’s national vaccination plan and provide upfront financing to enable the acquisition of vaccines from a range of sources, including through the COVAX facility and the African Union sponsored African Vaccine Acquisition Task Team (AVATT). This rapid financing allowed Rwanda to procure 3.6 million vaccine doses to cover up to 1.8 million people, or 14% of the total population.
However, as vaccine deliveries arrived in the country, Rwanda faced a new set of challenges associated with distributing those vaccines before they expired.
"The cold chain conditions are very tight, so bringing the vaccines to the rural areas is sometimes very challenging. We were able to get support from the government to use helicopters to bring vaccines across the country in a short time."
To overcome these obstacles, Rwanda deployed youth volunteers, such as Jean-Felix Niyomugabo, a university student and youth mobilizer, and other civil servants to help plug the gaps in data entry, running vaccination centers, citizen mobilization, transportation, and vaccine communication.
"If I meet those who are scared [to get the vaccine], when I give them my testimony, they feel free to come get vaccinated. So in my village, we are all vaccinated due to this mobilization."
Rwanda also proactively took steps to address vaccine hesitancy, setting up mobile teams across the country to go house-to-house to communicate about the vaccine, and administer the vaccine in people’s homes. They conveyed accurate information about the safety, side effects, and availability of vaccines through an array of platforms (Twitter, Whatsapp, traditional media, radio, and other social media platforms), and actively engaged faith-based leaders in the campaign to mobilize their communities and other social groups.
As of May 2022, 64% of Rwanda’s population has been fully vaccinated; more than 3.7 million people (29% of the population) aged 18 years and above have received a booster dose, and close to 9 million people (from the age of 12), representing 69% of the Rwandan population, have so far received at least one dose.
Sao Tome
Solar-Powered Cold Chain Key to Achieving Last Mile Vaccination
Sao Tome and Principe (STP), a two-island nation, is a hidden gem that glistens and floats off the coast of West Africa. A Portuguese-speaking archipelago with a population of 220,000 individuals, of which 96% live on the island of Sao Tome and the other 4% on the island of Principe, STP is a small and insular state that faces challenges accessing a range of resources, particularly medical resources. This has had a direct impact on the health sector, as limited inputs affects the quality of health services available to its population. This is further compounded by sparse human resources on the island, let alone those with specialized skills.
The COVID-19 pandemic presented an unprecedented challenge and stress on Sao Tome’s health system. Thanks to World Bank support, the country rapidly purchased 72,000 Moderna doses through the COVAX facility and 80,000 Johnson and Johnson doses through the African Union's Vaccine Acquisition Trust (AU-AVAT) platform, allowing the government to vaccinate 55% of the eligible population as of June 22, 2022.
To reach some Sao Tome’s most remote and isolated population, the Ministry of Health turned to innovation. This included purchasing and installing solar direct drive solutions which consist of several vaccine refrigerators and freezers directly connected to solar panels, and do not use batteries and regulators. These solutions provided Sao Tome with a reliable cold chain for vitally important vaccines even in the most remote areas as they rely on the source of energy not lacking in Sao Tome – the sun!
More than half of the resources from the World Bank’s additional support came from the Heath Emergency Preparedness and Response Umbrella Program (HEPR Program), which provided the country with the flexibility to use the resources for not only COVID-specific investments, but just as importantly, for interventions that also have a longer-term vision of strengthening the overall health system. Thanks to their innovations, STP has been able to establish a climate-friendly vaccine storage warehouse, an integral element of a responsive health system for better preparedness for future health emergencies.
Sao Tome used the vaccination roll-out to simultaneously introduce innovations to its health sector, such as the installation of solar direct drive solutions.
Vaccine refrigerators and freezers were able to be directly connected to solar panels, without the use of batteries and regulators in order to provide Sao Tome with a reliable cold chain for vitally important vaccines even in the most remote areas.
Thanks to World Bank support, Sao Tome was able to rapidly purchase 72,000 Moderna doses through the COVAX facility and 80,000 Johnson and Johnson doses through the African Union's Vaccine Acquisition Trust (AU-AVAT) platform helping the country achieve a 55% vaccination coverage.
To further support STP in its climate-friendly approach and energy-efficient investments, the country will receive additional support of approximately $1 million from the Energy Sector Management Assistance Program (ESMAP). A feasibility study is currently underway to assess the country’s capacity to introduce small, electric vehicles as part of the logistics supply chain to distribute vaccines and essential medicines. In addition to the electric vehicles, ESMAP’s support will also finance the installation of solar panels and energy efficiency retrofitting of warehouses which provide immunization services. To complement this, the Green Climate Fund has selected STP as one of only nine countries to receive support for the purchase of cold storage equipment such as refrigerators and freezers to enhance the country’s cold chain capacity.
Angola
Harnessing Digital Technology to Accelerate COVID-19 Vaccination
As Angola began to receive shipments of the COVID-19 vaccine through global and regional initiatives such as COVAX and AVATT, the country was quickly confronted with another challenge; a sub-optimal immunization system. The process could not provide the data or transparency needed to ensure compliance with the national COVID-19 vaccination population prioritization process, and that vaccines were getting into the intended arms.
As part of Angola’s desire to embrace a digital health transformation, the government rapidly rolled out an identity digital database known as the ReDIV system. ReDIV provides a digital platform for nominal pre-registration for COVID-19 vaccines in Angola, issuing a unique identifier to each registered individual, and facilitating their monitoring in real-time throughout the vaccination process. The dashboards and reports of the ReDIV system help decision-makers take informed, tailored, and immediate actions to address bottlenecks. Associated with the ReDIV platform, an app (KuKula) has been developed that allows citizens to access and download their digital COVID-19 vaccine certificate and report adverse events.
Benjamim Muti shows his proof of vaccination using the Kukula app, which connects to the ReDIV platforms and allows citizens to access and download their digital COVID-19 vaccine certificate.
Benjamim Muti shows his proof of vaccination using the Kukula app, which connects to the ReDIV platforms and allows citizens to access and download their digital COVID-19 vaccine certificate.
Using the ReDIV platform, Angola has tracked the administration of nearly 17 million vaccine doses for people 12 years and older, leading to a 54% national coverage for the 1st dose and 27% for both vaccine doses. Angola turned the COVID-19 challenge into a development opportunity, by embarking on a digital transformation that positions the individual at the center of the value chain. This approach tackles vaccine hesitancy through individual and community social responsibility, gives citizens ownership, and empowers communities to mobilize without the need for monetary and other incentives.
Using the ReDIV platform, Angola has tracked the administration of nearly 17 million vaccine doses for people 12 years and older, leading to a 54% national coverage for the first dose and 27% for both vaccine doses.
Using the ReDIV platform, Angola has tracked the administration of nearly 17 million vaccine doses for people 12 years and older, leading to a 54% national coverage for the first dose and 27% for both vaccine doses.
Developed by Equilibrium, a company based in Angola working directly with the Ministry of Health, the ReDIV platform was made possible thanks to financial and technical support from the World Bank, as well as the technical expertise of the World Health Organization (WHO) and the Global Alliance for Vaccines and Immunizations (GAVI). ReDIV has become the single largest identification database in the country - surpassing the national identification platform.
The World Bank, through the International Bank for Reconstruction and Development (IBRD), approved a loan in the amount of $150 million to finance the Angola COVID-19 Strategic Preparedness and Response Project (SPRP). Nearly $5 million of this amount has been dedicated exclusively to the ReDIV platform component.
Voices on Vaccines
How do people in Eastern and Southern Africa feel about COVID-19 vaccination? We went to countries from around the region to capture the voices of a wide range of people—from young to old, different backgrounds and genders—to share their thoughts about COVID-19 vaccination and their experience with getting the vaccine.