Africa's bumpy trail to its dose of hope
As of May 5th this year, WHO has cited that 1.095 billion additional doses are needed for Africa to fully vaccinate 70% of its population. Currently, only 23% of Africa's population has received one dose of the vaccine. With Africa unlikely to reach its target of 70% vaccination by mid-2022, LUA does a deep dive into some logistical roadblocks hindering the vaccine rollout in the continent
With more than a billion people living in 54 countries, across a continent that is larger than the USA, China, India, and Europe combined, Africa faces huge challenges to make its presence felt in world trade. Experts agree that its logistics and transportation sector especially needs a rehaul. There also remains a lot to be desired when it comes to Africa's infrastructure which lags well behind the rest of the world, with large differences between the regions in the continent.
As per The World Bank's 2018 Logistics Performance Index from among 160 nations, Africa had a score of 2.5 on average, with 5 being the highest and an indicator of a better performance. While the index aided countries to identify the challenges and opportunities they face in trade logistics, African nations trailed in metrics of logistics performance, timeliness, and tracking.
The many problems surrounding logistics and transportation in the continent came to an inflection point during the outbreak of the Coronavirus pandemic when the procurement, supply, delivery, and administration of Covid-19 vaccines had to be done in a time-bound and safe manner.
With more than 700 million people in Africa staying in remote locations, delivering vaccines is still tough, owing to lack of electricity in certain areas, lack of adequate temperature-controlled infrastructure, cold chain facilities, and means of transportation that can reach these areas.
The Covid-19 vaccines, in particular, required an unbroken cold chain, special treatment, and handling in transit, while being administered and needed a refrigerated condition for storage and to maintain vaccine efficacy.
Added to this is the fact that intra trade in Africa is still low compared to its global counterparts because of lack of infrastructure, the high cost of crossing borders, and trading because of poor logistics and transport infrastructure. Several big-ticket infrastructure projects that have been in the works for years require huge investments and there aren't enough seaports to handle existing traffic in Africa.
THE TASK AHEAD
As per the UN website, since the first case on the continent was identified nearly two years ago, Africa has faced four waves of Covid-19, each with higher peaks or more total cases than the previous one.
As per figures shared by WHO (World Health Organisation) on its Africa Covid-19 vaccination dashboard, 53 of the 54 countries commenced Covid-19 vaccination. As of May 5th, 2022, around 772 million cumulative doses have been received and 494 million doses have been administered, which is 64% of the doses received.
WHO cites that 1.095 billion additional doses are needed for Africa to fully vaccinate 70% of its population. As per WHO, 23% of the population in Africa has received one dose of vaccine which is around 305.38 million while only 17% of its population has been fully vaccinated (recommended doses) which is around 230.7 million people.
As Africa began the huge task of inoculating millions, several collaborations between humanitarian aid agencies, countries, private players, freight forwarders, and vaccine manufacturers soon ensued. As per WHO's Global Covid-19 Vaccination strategy, the plan was to inoculate 40 percent of people globally by the end of 2021, and 70 percent by the middle of 2022.
As per a WHO release dated March 1, 2021, the first Covid-19 vaccination campaigns began in Africa, in Ghana and Cote d'Ivoire under the COVAX campaign. Both nations had received the AstraZeneca/Oxford vaccine licensed and manufactured by the Serum Institute of India (SII) called COVISHIELD.
COVAX is an initiative for equitable access to Covid-19 vaccines globally and is co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI), the WHO, and key delivery partner UNICEF (United Nations Children's Fund).
With a strong uptake in the supply of vaccines in the last quarter of 2021 and the first quarter of 2022, WHO cites that COVAX has shipped more than 1 billion doses to 144 participants (nations) which is a total of 1.06 billion doses globally.
Another key initiative that took off during the pandemic was the Gavi COVAX AMC (Advance Market Commitment). It is a financing instrument that supports the participation of 92 low and middle-income economies in the COVAX Facility, thereby enabling access to donor-funded doses of safe and effective Covid-19 vaccines. Under these key initiatives, the WHO reported that close to 3.1 billion vaccine doses have been administered across AMC participants alone.
One of the supporters of COVAX, Emirates SkyCargo announced recently in April 2022, that it had transported more than 1 billion Covid-19 vaccine doses in a span of 18 months in which two-thirds were transported to developing countries including to African nations.
Julian Sutch, Head of Global Sales Pharma, Emirates SkyCargo told LUA, "Emirates SkyCargo has placed a high priority on facilitating distribution of Covid-19 vaccines to developing nations. With our hub and extensive infrastructure in Dubai along with the reach of our network and frequency of flights, we are very well placed to distribute vaccines to markets across the Middle East, Africa, and Asia. Covid-19 vaccines are normally transported in specially prepared packaging by vaccine manufacturers that are able to sustain the low temperatures required to protect the integrity of the vaccines. Carriers such as Emirates SkyCargo then transport the packages under normal temperature-controlled ranges (2-8 or 15-25 degrees Celsius)."
Sutch added, "In Dubai, we had set up a dedicated GDP-certified handling facility for pharmaceuticals in 2016. In 2021, we expanded our pharma cool chain infrastructure with a temperature-controlled environment (2-25 degrees Celsius) for the storage and handling of vaccines and other pharmaceuticals at Emirates SkyCargo's purpose-built GDP-certified facility at Dubai International Airport. The new extension can hold an estimated 60-90 million doses of Covid-19 vaccines at one time."
With air cargo leading the way in the supply of vaccines while maintaining the required temperatures meant for vaccines, another collaboration namely The HOPE Consortium spearheaded by The Department of Health-Abu Dhabi was also formed.
It brought together leading brands to deliver end-to-end solutions to distribute Covid-19 vaccines globally. It later also launched in-country support services by combining vaccine delivery with the deployment of medical and logistics personnel and equipment to eliminate vaccine wastage and bridge the global immunization divide for Covid-19 vaccines.
Today the initiative provides first and last-mile solutions delivered by 16 leading freight forwarders including Aramex, FedEx, UPS, DHL, Agility, Hellmann, Bollore, Expeditors, CEVA Logistics, DSV, MICCO, RSA Global, Kuehne+Nagel, DB Schenker, Via Medica, and Astral Aviation.
Despite the global push for Covid-19 vaccines for Africa, its intralogistics proved to be a hindrance with nine out of 10 African nations missing the first target of vaccinating 10 percent of their population against Covid-19 set by the WHO, by June 2021.
Later in September 2021, the WHO announced that Africa needed around another 470 million doses to accomplish the global goal of fully vaccinating 40 percent of its population by the end of the year.
VACCINES DESTROYED OR RETURNED
Even as Africa needed more and more vaccines, many vaccines ended up being scrapped and even returned as they were out of date or due to expire before they could be administered. In April 2021, the Democratic Republic of Congo returned 1.3 million shots donated under COVAX while May saw Malawi incinerating close to 20,000 doses of the AstraZeneca vaccine. At least seven other African countries have destroyed some 450,000 doses in all.
In Malawi, for instance, health authorities reportedly cited the short time between delivery and expiration of vaccines and the need to reduce hesitancy for destroying vaccines.
"The Covid-19 pandemic tested global health supply chains and logistics systems unlike anything in our lifetime. Not only were countries trying to obtain an adequate supply of the vaccine, but they were also immediately faced with the equally formidable challenge of distributing those highly-sensitive doses in a safe, rapid, and equitable manner. This meant that many health logistics systems – particularly those in low to middle-income countries – were unable to effectively deliver the doses they did receive. This lack of infrastructure, combined with the short shelf-life of the vaccine, is why some countries were forced to destroy more than a million doses, unable to deliver them before their expiration dates," said Israel Bimpe, Director, Africa Go-To-Market at Zipline.
SUB SAHARAN AFRICA's LAST MILE CONUNDRUM
The situation was particularly dismal in sub-Saharan Africa where poor trade and transport infrastructure meant that the vaccination drive slowed down. The latest figures by the UNDP (United Nations Development Programme) show that most of the vulnerable countries are found in Sub-Saharan Africa, including Burundi, the Democratic Republic of the Congo, and Chad, where less than one percent of the population is fully vaccinated.
The studies show that, if low-income countries had the same vaccination rate as high-income countries in September last year (around 54 percent) they would have increased their GDP by US$16.27 billion in 2021. Improving the sub-Saharan logistics landscape could be the crucial marker in the success of vaccine delivery.
PRESSURE MOUNTS ON AIR TRANSPORTATION
As per data shared by the African Airlines Association (AFRAA), transport constraints have been compounded by Covid-19 and African airlines have been severely hit by the pandemic and Africa's aviation industry is in need of financial support.
The full-year revenue loss for African airlines in 2021 is estimated at $8.2 billion which is approximately 47.2% of the full-year 2019 airline revenue. Further restarting the operations on the intercontinental routes by African airlines reached 77.8% in August 2021 compared to 2019. Egyptair, Ethiopian Airlines, Royal Air Maroc, and RwandAir now operate to about 90% of their pre-Covid intercontinental destinations.
The global air cargo demand was up 2.9% y-o-y in February this year while the capacity was 12.5 % above February 2021 (8.9% for international operations) as per a recent IATA release. While this is in positive territory, compared to pre-Covid-19 levels, the capacity remains constrained, 5.6% below February 2019 levels.
HIGH TRANSPORTATION COSTS
Speaking at a media briefing in April on the cost of transportation in Africa, Robert Lisinge, Chief of the Energy, Infrastructure, and Services section of the Private Sector Development and Finance Division of the United Nations Economic Commission for Africa (ECA) said, "I think that if you go to different African countries, you find some have vaccinations that are free and in somewhere they are not free. Of course, we are not producing vaccines in Africa in relation to Covid-19. This will imply that because the cost of air transport to Africa is high, that means that the cost of transporting cargo including vaccines would be high and that may also impact on the cost."
He added, "The African Union has been working with ECA in acquiring vaccines and transporting them at a cheaper rate. This is the African Medical Supply Platform through which African countries could pool together their purchases of protection equipment and vaccines and I understand that this has resulted in a reduction in costs of testing and protection equipment for Covid-19. Yes, high transport costs would generally increase the cost of medical services, and equipment transported but I however cannot say without a doubt that this has contributed to low levels of vaccination in Africa."
ROAD TRANSPORTATION - A LONG ROAD AHEAD
Africa's terrain spans from deserts to rainforests and hilly areas and this terrain plays a big role in the play of its critical transport infrastructure. Even as most of the freight is transported via roadways in Africa, apart from international highways, many of Africa's roads are unpaved and in poor condition.
The terrain also makes it difficult to build critical road and rail networks especially seen in countries like Algeria, Angola, and the Democratic Republic of Congo. The road quality also suffers in places like Kenya, South Africa, and even in Kenya along with other issues like congestion and road maintenance.
CONFLICT AREAS REMAIN HARD TO ACCESS
Despite the availability of Covid-19 vaccines in a raging pandemic, several African countries that are witnessing conflict or political strife remain at the risk of being left out of the inoculation process. Last month saw ambassadors of several African countries review peace and security measures in the region and the implementation of two resolutions including one of a global ceasefire following the UN Secretary-General António Guterres's appeal during the pandemic and on cooperation to facilitate vaccine access.
ALTERNATIVES FOR A RESPONSIVE SUPPLY CHAIN
The African Continental Free Trade Area (AfCFTA) aims to accelerate intra-African trade and its position in the global market with a common voice and policy in global trade negotiations and has seen 36 African countries ratify the agreement till now.
As per the latest estimates by the Economic Commission for Africa (ECA), AfCFTA is expected to increase intra-trade in transport services by 50 percent. In absolute terms, over 25 percent of intra-African trade gains in services would go to transport alone and nearly 40 percent of the increase in Africa's services production would be in transport. AfCFTA, therefore, is expected to significantly increase traffic flows on all transport modes.
Speaking to the press about AfCFTA's benefits in April, Lisinge added, "AfCFTA provides an opportunity to build Africa's railway network. It would increase intra-Africa freight demand by 28 percent; while the demand for maritime freight will increase the most."
He shared that the estimated cost of equipment required by transport mode as a result of AfCFTA is around $291.77 billion for trucks, $26.57 billion for rail wagons, and $4.24 billion for vessels, and close to $25.76 billion USD for airplanes. He said that upgrading of infrastructure is also required to attract investment in transport equipment.
Single African Air Transport Market (SAATM)
SAATM is a project of the African Union to create a single market for air transport in Africa. Once completely in force, the single market is supposed to allow significant freedom of air transport in Africa, advancing the African Union's Agenda 2063 which proposes Africa's development in different spheres.
Speaking to LUA on the liberalisation of air transport in Africa under the aegis of the AfCFTA, Lisinge said, "35 African countries have signed the solemn commitment to the SAATM, so in principle, they are in favour of liberalising air transport. I do think there is an issue in clearly defining what liberalisation of air transport means and that is why ECA is working closely with the African Civil Aviation Commission to develop key performance indicators. That has already been done and we have worked with them and the African Union to develop a dashboard to assess gaps in the implementation of the liberalisation of air transport."
"The discussions on liberalising air transport in Africa have been very subjective, it has not been scientific. This is why the key performance indicators that were developed are based on regulatory texts. We have regulations on competition - this is where we are talking about freight freedom wherein any airlines would be able to go to any country, for any frequency they choose, with any kind or size of aircraft which is a signatory to this. Most importantly they will be able to pick passengers from any country and dispatch and drop them in any country they so wish. Many (countries) are not aware of the benefits of SAATAM and so aggressive awareness campaigns need to be done. Some countries also do not want to give freight freedom and are trying to protect their national space and tend to go with their national airlines even though some of these have not necessarily been very efficient and are losing money all the time and need to be bailed out," Lisinge added.
DRONES - THE ULTIMATE 'LAST MILE'
The work done by several drone companies in the African landscape in various vaccination, and immunisation campaigns and in providing humanitarian aid during a crisis and during the pandemic has shown that when it comes to serving the 'ultimate last mile' (for instance, from off-loading a boat towards the final destination village), drone technology is well worth considering in terms of time, cost and risk especially when it comes to humanitarian logistics.
Since 2021, VillageReach has designed and operated 11 Covid-19 vaccination sites. With the blueprint of its work in Washington, USA, it worked in Abidjan, Cote d'Ivoire where almost 10,000 people were vaccinated from January 1, 2022, through April 12, 2022. And then four vaccinodromes or vaccination sites in Kinshasa, DRC with the first one launched at the end of 2021, and the most recent three over March - leading to more than 35,000 people vaccinated from December 1, 2021, through May 1, 2022.
"In 2021, beginning May to December 31 when we joined work in partnership with Swoop Aero has an existing on-demand drone transport programme in Malawi, the drones transported 12,231 Covid-19 vaccine doses. By the end of March 2022, in Malawi, we transported 15,001 doses. Our radical collaboration with partners becomes even more critical as we continue to expand our work through outreach strategies in Cote d'Ivoire and the implementation of vaccinodromes in DRC. We continue to deliver Covid-19 vaccine doses through our drones programme in Malawi, DRC, and in our Phase-2 of drones flights in Mozambique, where we continue lab sample Covid-19 testing because we recognize that disease surveillance can help manage the spread," said Olivier Defawe, Director, Health Systems and Drone for Health Lead at VillageReach to LUA.
Giving an example of Malawi and the delivery of Covid-19 vaccines, Defawe said, "In Malawi, drones transport Covid-19 vaccine doses, where the drone transport system is 'on-demand'. This means that either the remote health facilities or their District Health Offices request the products they need – and the drones deliver them within 24 hours. This continues until today. At VillageReach, we look at drones as an integrated solution to the strategies and approaches we are taking, to address health care delivery challenges and to support governments as they face them."
Speaking about Zipline's work in helping Covid-19 vaccines reach African nations during the pandemic and outcomes achieved, Israel Bimpe, the Director, Africa Go-to-Market at Zipline told LUA, "Beginning in March of 2021, Zipline helped Ghana demonstrate one of the strongest vaccine distribution readiness programmes in the world. When Ghana was granted the first allocation of Covid-19 vaccines by the WHO, Zipline immediately began delivering Covid-19 vaccines to hospitals and doctors in rural communities across Ghana in partnership with GAVI and UPS, ensuring that those in rural areas and not just cities had access to the vaccines. Now, more than a year later, we have delivered over a million Covid-19 vaccines to more than 250 health facilities across the country, with plans to distribute millions more."
Citing some challenges that Zipline encountered along the way and how these also paved the way for a vaccine-on-demand delivery by the company, Bimpe added, "Distribution is complicated due to ultracold storage requirements of several of the leading vaccines. Zipline partnered with Pfizer to develop and validate an end-to-end distribution solution for Covid-19 vaccines. These protocols provide a framework for all countries to improve vaccine access and distribution. What's more, Zipline delivers vaccine doses on-demand, meaning a doctor can order a dose from Zipline and it can be delivered in as little as 15 minutes. This helps not only to combat waste, but also allows health professionals to administer doses as soon as a patient comes in, and prevents missed vaccination opportunities. Since 2020, Zipline has signed new partnerships in Nigeria, Cote d'Ivoire and Kenya, expanding its footprint across the continent. Zipline is capable of delivering Covid-19 vaccines and other vaccines and medications in all the countries that it operates in."
Speaking about how drones managed to solve some of these logistics challenges in African nations based on their work during the pandemic, Bimpe added, "Our model works by centralising the storage of vaccines and distributing vials to hundreds of healthcare facilities on-demand, in the precise quantities needed for that day. So far, we've delivered more than one million Covid-19 vaccine doses and counting across Ghana (including more than 150,000 in one week alone) and helped promote more equitable distribution outside of urban areas."
Unfortunately, due to several interconnected factors, Africa is not expected to reach the global target of 70 percent vaccination set for mid-2022 until the end of 2024, according to the World Health Organization (WHO).
However as the African Union and the Africa CDC move forward in their goal of producing 60 percent of their vaccines locally by 2040, it can harness the gains from initiatives like the drone technology, SAATM, and AfCFTA to build on its transport and road infrastructure to reach the critical last mile and inoculate its population in a speedy manner.