West African countries must increase COVID-19 vaccination rates to achieve population-level immunity

West African nations need to drastically ramp up their COVID-19 vaccination programmes by 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 the open access journal BMJ Global Health.

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, say the researchers.

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

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 roll-out, 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 researchers looked at coverage after 3 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 roll-out, estimate the researchers.

And to achieve coverage of 50%, 60%, and 70% after 9, 12, and 18 months of roll-out, 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.

"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," they add.

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."