As countries across Africa struggle to vaccinate 1.3 billion people, the continent faces another obstacle besides a lagging supply of doses: the looming likelihood of a shortage of syringes.
“Early next year, Covid-19 vaccines will start pouring into Africa, but a scarcity of syringes could paralyze progress.” Dr. Matshidiso Moeti, the W.H.O.’s regional director for Africa, said at a news briefing. “Drastic measures must be taken to boost syringe production, fast. Countless African lives depend on it.”
Rwanda, South Africa and Kenya have already reported delays in receiving supplies of syringes, according to the W.H.O.
Covax, a global vaccine-sharing initiative that is working to supply many African countries with doses, is now seeking agreements with syringe manufacturers and trying to plan to keep vaccine deliveries from outpacing the availability of needles.
Africa has the lowest vaccination rate of any continent, and the W.H.O. estimates that about 59 million of continent’s population have been infected with the coronavirus since the beginning of the pandemic, though only somewhat more than eight million cases have been officially recorded.
Unless “drastic measures” are taken to accelerate vaccinations, the organization said, only five African countries are projected to meet the target set by the W.H.O.: fully vaccinating 40 percent of their populations by the end of the year. Most of Africa’s more than 50 countries already missed the W.H.O.’s target of vaccinating 10 percent of their populations by the end of September.
Wealthier countries have monopolized vaccine supplies, creating global inequities in distribution. Those inequities are only likely to be deepened as those same wealthier nations, including the United States, roll out booster campaigns.
By contrast, vaccine deliveries via Covax ground to a halt after India imposed export restrictions on doses as it dealt with its own resurgence this year. In September, regional health experts said that the unpredictability of the limited supply of doses reaching African nations added more obstacles. Some shipments, they said, were within two or three months of expiring — a shelf life too short for some health systems to reliably deploy, and one that many ordinary people interpreted as a signal of poor quality, contributing to vaccine hesitancy.
As global warming continues to worsen, the effects of climate change will force people worldwide to migrate to new areas to survive. Africa is expected to be among the hardest hit by climate change, and if actions aren't taken quickly, by 2050 the situation will be so dire that up to 86 million people will have to leave their homes, a new World Bank report found.
Climate change fueling migration from Central America
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For this report, the World Bank, an international development organization that lends money to nations to help improve their standard of living, specifically looked in the West African and Lake Victoria Basin regions of the continent, which are home to millions of people.
The regions, according to the report, have contributed the least to global warming, yet are set to experience "the most devastating impacts of climate change."
Based on how climate change is being handled and the socioeconomic statuses of the regions, the World Bank predicts that climate migration "hot spots" in the areas could begin in the next nine years.
"Without concrete climate and development action, West Africa could see as many as 32 million people forced to move within their own countries by 2050," a press release about the report states. "In Lake Victoria Basin countries, the number could reach a high of 38.5 million."
Out of the five countries that make up the Lake Victoria Basin — Kenya, Tanzania, Uganda, Rwanda and Burundi — Tanzania will be most impacted by forced migration, the report says, with up to 16.6 million people being impacted. And in West Africa, Niger and Nigeria will see the largest numbers of internal climate migrants.
Along with the more widely-discussed impacts of climate change, such as droughts and sea level rise, there are more subtle effects that will force people from their regions. Many areas will see spikes in temperature, more extreme weather events and land loss, while others will also see water and food scarcity, reduced agriculture, lower ecosystem productivity and higher storm surges, the report says.
All of these factors will make many regions unlivable, and will push people to other areas that are more survivable. But as people migrate to escape these fragile environments, other issues already being experienced — poverty, conflict and violence — will only get worse, the report says.
It's not just these regions in Africa facing this issue — millions of others around the world will be forced to migrate at the same time. In September, another report by the World Bank warned that about 216 million people from these regions, as well as North Africa, Latin America, Eastern Europe, Central Asia, South Asia, East Asia and the Pacific, will also be on the move.
World Bank published its newest findings ahead of the COP26 United Nations climate summit, which is set to begin on October 31. There, nearly every nation in the world will discuss how well they have upheld their promises to mitigate climate change.
As part of the Paris Climate Agreement, global leaders are supposed to be implementing policies and developing strategies to limit global warming to less than 2° Celsius compared to pre-industrial levels. If current policies do not change, however, it will lead to 2.9° Celsius, scientists say.
To prevent the soon-to-come mass migration, the World Bank said that the world must take "bold, transformative" actions, and quickly. If nations are able to do so, they could reduce the scale of climate migration by 30% in the Lake Victoria region and as much as 60% in West Africa, the report says.
The World Bank said at the forefront of these efforts should be cutting down on greenhouse gas emissions to limit global warming, a promise of the Paris Climate Agreement. Governments are also urged to develop resilient and inclusive climate migrations plans and invest in research and tools to better prepare for the future. Lastly, the World Bank said that investments must be made to help and encourage people get sustainable "climate smart" jobs.
But for some areas, the effects are already pushing people to leave.
Around 10,000 people have left Central America in an attempt to escape the effects of climate change. The region was blasted by two catastrophic category 4 hurricanes, Eta and Iota, just two weeks and 15 miles apart. Nearly 600,000 people had been displaced by the storms, and thousands of homes were completed destroyed.
Their migration to Mexico and the U.S. for help and opportunities offered a dire warning about what the future may look like without immediate governmental climate action.
Kayly Ober, senior advocate and program manager of the Climate Displacement Program at Refugees International, previously told CBS News that these kinds of devastating events and the impending migrations thereafter will only increase.
"We need to realize that climate change impacts are already influencing decisions to migrate today, and ensure that people moving are able to access safe and dignified pathways in their own country and abroad," Ober said in February. "...I am concerned that climate change impacts will only increase in frequency and intensity, and that without proper support or policy intervention, people will have to make the difficult to decision to move."
Africa is experiencing the world’s worst vaccine deficit. Only a minority of countries—mostly those where vaccines are manufactured—are approaching adequate levels of vaccination. But Africa is averaging even lower rates than other less affluent continents—less than one-tenth the percentage of South America and one-eighth that of Asia. Most African countries missed a recent goal of vaccinating ten percent of their populations. Overall, less than five percent of Africans are fully vaccinated.
This is a colossal global health failure. Considering the vaccine surplus found in developed economies, especially the United States, it is also a moral crisis. The United States has purchased 1.2 billion vaccine doses, enough to inoculate its entire population twice over, and may have as many as 500 million excess doses by the end of October and possibly one billion by December. Extra vaccines are beginning to accumulate so rapidly that growing numbers of doses are being destroyed.
COVAX—the global COVID vaccination partnership established by the World Health Organization (WHO), the Coalition for Epidemic Preparedness Innovations, and the GAVI Vaccine Alliance—was supposed to prevent such gross vaccine inequities. High- and low-income countries were encouraged to join, and each was supposed to receive dose shares based on population size, not wealth. But the world’s richest states sidestepped COVAX to secure priority access to more vaccines than they can use, putting themselves ahead of other countries in the manufacturing pipeline. India, the planet’s largest producer of vaccines and COVAX’s primary supplier, banned vaccine exports for five months as it weathered a devastating third wave of infections. China has largely shared its vaccines directly with other nations, sending very few through COVAX.
COVAX has still managed to ensure that no state got left entirely behind, and the United States and other high-income countries should continue to work with the initiative. But COVAX has struggled mightily, falling far short of its goals. Solving vaccine inequality and successfully inoculating the entire world is essential to ending the pandemic, and that means taking a new and different approach, with more targeted and impactful partnerships. In Africa, that means working with one organization in particular: the Africa Centres for Disease Control and Prevention.
Founded in the wake of the 2014 Ebola epidemic, the Africa CDC has a strong record of combating diseases. During the 2018–20 Ebola outbreak, for example, the organization supported contact tracing and laboratories that tested tens of thousands of samples, and it trained thousands of health-care workers. It has established effective new systems to share resources, such as the Africa Medical Supplies Platform; amplified best practices, including testing regimens; and responded to regional disease dynamics through Regional Collaborating Centers.
Until recently, vaccines bottled in Africa were going to Europe.
There are many reasons to partner with the Africa CDC in addition to COVAX. The smaller domain of the Africa CDC makes the organization more effective logistically than COVAX, which has struggled to keep up with the communications and mechanics of working with so many countries around the world. The Africa CDC directly engages heads of state, whereas COVAX deals primarily with health ministries, which often lack the staff and support needed to get vaccines distributed. And vaccine donations to COVAX are spread across the entire globe, whereas doses distributed by the Africa CDC target the countries with the most acute need. To promote global health equity, prevent the rise of dangerous new variants, and stop more of its doses from going to waste, the United States should give large shares of its surplus vaccines to this powerful institution. It is the organization best able to help Africa reach and, it is hoped, accelerate its ambitious goal of vaccinating 25 to 30 percent of residents by the end of 2021 and 60 percent as soon as possible.THE RIGHT PARTNER
Africa was never well positioned to inoculate its population without strong partners. Home to 17.8 percent of the world’s population, the continent houses less than 0.1 percent of global vaccine manufacturing, according to a WHO estimate. It is working to develop new capacity, but it will be many months before more factories come online. Reports indicate that a new facility in Senegal, for example, will likely not produce doses until the second half of 2022. As a result, the continent has been forced to rely almost entirely on overseas manufacturing. In fact, until recently, the relatively few doses bottled in Africa were being purchased by and exported to Europe, a misallocation of resources that is both unconscionable and epidemiologically unsound.
But despite these challenges, the Africa CDC has taken major steps to procure vaccines for the continent. The organization’s African Vaccine Acquisition Trust has contracted 400 million Johnson & Johnson doses, enough to partially inoculate roughly a third of the continent’s population. Yet the delivery of these doses to the trust has ramped up slowly and is expected to reach only 20 million per month in January. It is time for the United States and other wealthy nations to get out of the way. Rather than demanding that vaccine manufacturers complete their outstanding orders first, rich countries should heed the Africa CDC director John Nkengasong’s request to deprioritize their own contracts in favor of the Africa CDC’s purchases—an approach favored by the White House in leaked documents. States would still receive their doses, but the delay in delivery would fall on countries already benefiting from substantial vaccine coverage.
Vaccine-rich nations should also share their stockpiles and future commitments with Africa, and contributing through the Africa CDC has many advantages. Pandemics are driven by regional dynamics, and the Africa CDC has a strong understanding of the continent’s needs. Cross-border travel, seasonality, socioeconomic characteristics, and other factors mean that viruses have no respect for borders, and the intensive logistical investments required to vaccinate less populated areas would benefit from a regional approach that allows doses to be safely stored until they can be delivered. With its ongoing, direct engagement with heads of state, the Africa CDC has excellent visibility into epidemiologic trends and into national public health resources, making it well positioned to quarterback distribution. (In contrast, many national leaders have struggled to communicate with COVAX.) Gifting vaccines through the Africa CDC will also help limit the diplomatic fallout and national political clashes over vaccine allocation and management that would likely bedevil U.S. bilateral donations.
The Africa CDC has taken major steps to get vaccines for the continent.
As a trusted and authoritative health entity, the Africa CDC can help resolve thorny questions for the continent’s countries around such issues as delaying second doses or mixing different types of vaccines. In countries where national leaders have downplayed the pandemic or propagated vaccine misinformation, the Africa CDC can play a crucial certification role, confirming the vaccines’ safety and efficacy. The organization can address concerns from pharmaceutical companies around liability for vaccine-related injuries by helping draft a no-fault compensation agreement modeled after the one already used by COVAX, indemnifying manufacturers and administering a compensation fund that the United States should help endow.
Asking strained national public health systems to administer millions of vaccine doses will present extraordinary challenges, but African countries have demonstrated their ability to meet them. Rwanda administered nearly 350,000 doses of the Oxford-AstraZeneca vaccine in three weeks, and Ethiopia vaccinated 15 million children against measles despite the pandemic and a brutal civil war. The Africa CDC can help by using its granular data on the logistical capacity of the continent’s countries and its demonstrated ability to support supply chains during the pandemic through vehicles such as the Africa Medical Supplies Platform.AN ALLIANCE FOR THE FUTURE
The Biden administration appears to understand the need to share vaccines with Africa, recently committing to delivering 17 million more Johnson & Johnson doses to the African Union (although this is not nearly enough). It is also beginning to understand how valuable the Africa CDC can be. In addition to backing the Africa CDC’s call for manufacturers to move the organization’s contracts to the front of the line, Biden recently announced plans to nominate Nkengasong to lead the President’s Emergency Plan for AIDS Relief (PEPFAR). Biden clearly has faith in the group’s management.
Nkengasong’s appointment has been met with somewhat mixed feelings by those who worry that his departure could undermine the work of a critical organization at a key moment in the pandemic. But in addition to being an excellent choice to lead the flagship U.S. global health intervention, the move may ultimately make the Africa CDC even more effective. PEPFAR is itself a pandemic response body, with expertise and experience in disease surveillance, public health communications, and clinical interventions, and one whose work has been primarily in Africa. PEPFAR could use its infrastructure—including its existing relationships with governments, nongovernmental organizations, and community organizations, as well as with clinics and public health staff—to support the Africa CDC in its fight against COVID-19. PEPFAR is already immensely successful and has been well received on the continent. Helping the Africa CDC fight the pandemic would build on its political legacy.
This could also be just the start of an even bigger partnership between the United States and the Africa CDC. The United States could and should help the organization become more self-sufficient by increasing vaccine manufacturing in Africa as quickly as possible. This is the only way that the continent will be able to fully fight not just COVID-19 but also the next pandemic. Vaccine manufacturing capacity on the continent would also be a game changer in Africa’s fight against diseases that have plagued the world for generations, such as malaria, for which the WHO just approved a vaccine.
Strengthening the Africa CDC won’t just benefit Africans. Multiple analyses indicate that effective global vaccination campaigns, both for COVID-19 and other illnesses, have immense economic returns that rebound across the planet. In the years to come, the strength of the Africa CDC will also be essential to responding to future pandemics and managing the effects of climate change by tracking alterations in disease prevalence and geography, coordinating regional responses, and mitigating the health impacts of displacement. In doing so, the organization will be critical to keeping the entire world safe. But building the Africa CDC’s capacity must start right now by helping it vaccinate the continent and end the pandemic, and that depends on a timely and robust partnership with the United States.Loading...