COVID-19 has been devastating globally, but growing evidence indicates that emerging countries are suffering and will continue to suffer the health, social and economic effects of the pandemic more acutely and longer into the future.
Massive vaccination campaigns, alongside the implementation of large-scale economic and social recovery measures, will be key to getting the virus and its effects under control. Importantly, efforts across Africa are challenged by infrastructural issues that do not always meet the eye. More specifically, electricity, which is imperative for correctly storing the vaccine at low temperatures, is still lacking for large populations across the continent, in both rural and urban areas, especially in the sub-Saharan region.
Africa’s response to COVID-19
In terms of virus containment, Africa has been relatively successful. After the first case was confirmed on the continent on 25 February 2020, the African Union promptly adopted a Joint Continental Strategy with support from Member States and the Regional Economic Communities, which provided a public health platform.
The first efforts were focused on rapidly establishing and maintaining the response capacities and capabilities required at national and sub-national levels to contain and mitigate the spread of the virus, including quarantines, contact tracing, national lockdowns, school closings, border closures and restrictions on travel, trade and in-person assemblies.
For now, the numbers of cases and deaths are relatively low as compared to the projections. The WHO had estimated that the COVID-19 pandemic could kill an estimated 83,000 to 190,000 people in 47 African countries. As at first week of January 2021, Africa has recorded 3,059,974 cases; with five countries reporting most cases, these include South Africa (1,231,597), Morocco (452,532), Egypt (149,792), Ethiopia (128,616) and Tunisia (162,350) and 72,834 deaths with five countries reporting most deaths, these include South Africa (22,747), Egypt (6854), Morocco (6492), Tunisia (3758) and Algeria (2564).
Africa’s successes in dealing with COVID-19 pandemic can also be attributed to experiences gained in handling both HIV/AIDS and Ebola, for which communities have developed best practices with innovative strategies for tracing, treatment, isolation and caring for the sick. Countries in Africa are also drawing lessons from previous epidemics to engage communities, communicate risks and adapt local and innovative approaches to craft an African approach to pushing back against the pandemic, although the magnitude of the challenges and the continent’s underlying vulnerabilities cannot be underestimated.
State of cold chains and the COVID-19 vaccine
The world is counting on effective vaccines to put a definitive stop to COVID-19, and it is here that Africa encounters obstacles in protecting its peoples.
Efficient and reliable cold chain equipment is essential for effective and equitable immunization coverage, but in Africa there are critical disruptions in the line. Existing vaccination campaigns have always focused on children, and a total of 116 million infants are vaccinated annually, requiring refrigeration between 2⁰C and 8⁰C (35-46⁰ F). This is just a fraction of the 4.7 – 5.5 billion doses estimated necessary for the COVID-19 vaccines: approximately half of the authorised and leading COVID-19 vaccines will need cold storage temperatures as low as -18⁰C.
Keeping vaccines cold enough until they can be administered is a major logistical obstacle. According to the Global Alliance for Vaccines and Immunization (GAVI), it is estimated that only 10% of health care facilities have a reliable supply of electricity in the world’s poorest countries, while less than 5% of health centres have vaccine-qualified refrigerators in some countries. The WHO estimates that due to temperature control and logistics failure, more than 25 per cent of some vaccines may be wasted globally every year.
The need for such low storage temperatures means that cold chains around the world must expand rapidly. Entirely new cold chain systems may need to be installed in developing countries, particularly in rural areas where electricity supply and cooling infrastructure is still non-existent or unreliable.
Africa’s electricity deficit
The global advance in access to electricity since 2010 masks unequal progress across regions. The world’s access deficit is increasingly concentrated in Sub-Saharan Africa: in 2018, approximately 548 million people did not have access there, more than half of the population of the region and almost 70 per cent of all people in the world without access. In 2018, Nigeria and the Democratic Republic of Congo had the world’s biggest access deficits, with 85 and 68 million people lacking access, respectively, while population growth fuels ever larger deficits.
Health centres use electricity mainly for lighting (57 per cent), refrigeration for vaccines (40 per cent), and for fans or evaporative air-cooling systems (28 per cent). In sub-Saharan Africa, the power supply is compromised by unscheduled interruptions and voltage fluctuations. According to a global survey carried out by IRENA, 25 per cent of health facilities report that unscheduled outages affect the capacity to deliver essential health services. Damage to equipment caused by poor-quality connections and frequent voltage fluctuations are also constraints for 28 per cent of health centres.
The challenge for vaccination in Africa
A large proportion of the African population lives in remote areas with geographical barriers, poor electricity supplies, lack of transportation and poor roads, and limited access to health and immunization services. Rapid COVID-19 vaccination will be an immense challenge for these populations.
Unless stable and sustainable electricity supplies are established in the near future, it is unlikely that countries can guarantee the refrigeration necessary to maintain vaccine supplies. Despite the continent’s positive efforts up to now in containing and mitigating the virus, the electricity deficiency leaves Africa losing out in the vaccination race.
Nathan Awuapila is a Policy Leaders Fellow at the School of Transnational Governance, European University Institute, Florence, Italy. A graduate in physics, he has over 10 years post graduation experience at the Energy Commission of Nigeria with practical experience in energy issues such as energy access, efficiency, energy planning and policy development.