What is fueling the COVID-19 crisis in Africa?

COVID-19 is surging across Africa, as a devastating spike in infections sweeps across the continent. In some African countries, the death rate has tripled compared to previous waves. Last week, new infection counts in Libya and Tunisia reached new highs. South Africa set a record with 26,000 new cases in one day, bringing its total cases to around 2 million in a country where many hospitals are at capacity.

To help understand what is fueling this crisis, experts from PATH’s Africa Region helped answer key questions about diagnostics capacity, access to vaccines, vaccine manufacturing, critical oxygen supplies, and data availability.

COVID-19 testing is a challenge in many countries in Africa, for reasons including availability, accessibility, cost, and health care systems that are stretched beyond capacity.

“During a time when there are many competing priorities for public health, it’s difficult to prioritize one thing, but testing is a critical component in responding to and controlling this rapidly changing virus,” says Douglas Waudo, PATH’s regional advocacy, communications, and media officer for Eastern and Southern Africa.

Around 54 million tests have been conducted—a small number compared to the 1.3 billion people on the continent. And though experts say the highly contagious Delta variant is helping drive this crisis—it has been detected in 16 African countries thus far—capacity to detect and sequence specific variants is still limited.

“Without knowing which variants are spreading and where, policymakers are missing important information that would be invaluable for adequately responding to the crisis,” Douglas says.

Even in those countries where testing is available, testing sites are often limited and are concentrated in urban settings.

According to the World Health Organization, only 2 percent of all Africans have received one dose of a COVID-19 vaccine.

In Uganda, around 1 million people have been vaccinated, leaving the country far from vaccinating all 21.9 million of its residents at risk for severe disease from COVID-19. Meanwhile, facilities across the country are running out of vaccines and other supplies.

“Many facilities are facing the two-dose delivery challenge,” says Emmanuel Mugisha, PhD, MPH, PATH’s country director and senior technical advisor for immunizations in Uganda. “They’ve run out of doses and are thus unable to offer second doses to those who have received their first. It’s a big problem.”

African countries need more vaccine doses. In Uganda, for instance, a government minister said that despite having funds to procure vaccines, they are simply unable to get more vaccines beyond those provided through the COVAX Facility.

Additionally, many countries are facing distribution challenges ranging from logistical problems and vaccine hesitancy to supply chain and cold chain issues.

“We do need to strengthen our overall health systems for vaccine distribution. But for any of that to matter, we need more vaccines, and we need them now,” Emmanuel says. “There is no excuse for vaccine hoarding at this moment. It’s unethical, immoral, and is exacerbating a third wave in Africa that is a threat for the whole world.”

Despite the continent’s heavy burden of disease, only 1 percent of all the vaccines administered in Africa are manufactured in the continent. But this is beginning to change.

Leaders across the continent committed to increasing vaccine manufacturing capacity from 1 percent to 60 percent by 2040, as part of the Partnerships for African Vaccine Manufacturing initiative, led by the African Union and the Africa Centres for Disease Control and Prevention.

“We currently don’t have any COVID-19 vaccine manufacturing plants in Africa. This has never been ideal, and now we’re seeing exactly what happens when we have to compete against high-income countries for vaccine doses,” says Johnpaul Omollo, PATH research and development officer based in Nairobi.

“With more manufacturing capacity at home, we can boost the availability of vaccines across the continent and be more in control of our public health.”

But Johnpaul says manufacturing locally and having more vaccines is just one part of the puzzle.

“Of course it’s a huge step in the right direction, but we also must be doing more if we want to increase vaccination rates. This means strengthening overall health systems—optimizing supply chains so we can access syringes and necessary raw materials, improving cold chain equipment, and boosting vaccine education.”

Vaccines are absolutely critical for preventing more infections and more deaths, but today, for this crisis, treatment is essential. Medical oxygen is a first-line treatment for COVID-19.

There are currently severe shortages across the continent, but scaling up oxygen supplies is not easy to do quickly, especially since oxygen systems have been historically underfunded.

For instance, last month, amid a spike in COVID-19 cases, some projected that Uganda could need 25,000 oxygen cylinders per day. But the oxygen generating plants in the country, and the available cylinders, limited production to 3,000 per day.

“Sending in oxygen concentrators is great, but these are short-term solutions that, alone, won’t reach nearly enough people,” says Sibusiso Hlatjwako, PATH’s country representative in South Africa. “We need more investment in sustainable, long-term oxygen systems in Africa.”

PATH is helping improve long-term access to safe oxygen in the Democratic Republic of the Congo (DRC), Kenya, Malawi, South Africa, Uganda, and Zambia.

“Solutions to address oxygen shortages in many sub-Saharan African countries look quite different than they did during India’s latest COVID-19 outbreak,” Sibusiso says. “India had significant reserves of oxygen production dedicated to private industry that could be temporarily reallocated for medical purposes. This is not the case across the African continent.”

In partnership with governments, PATH is analyzing the market landscape to identify what is needed and where—understanding local demand and noting technical specifications at hospitals and facilities.

With such information, governments can know where and how to start building systems that will provide medical oxygen now and after the pandemic.

Health data is a necessary tool for planning, preparing, and responding to crises. Without it, policymakers struggle to make informed decisions on how to allocate resources and how to provide care for those who need it most.

We know that the Delta variant has been reported in 16 countries in Africa and has become dominant in South Africa. According to the World Health Organization, it was found in 97 percent of samples in Uganda and 79 percent in the DRC.

But many countries don’t have much reliable data at all. In Sudan, limitations on data collection and analysis have affected COVID-19 response. Some estimate that 90 percent of COVID-19 deaths in Sudan go unreported.

“Data is one of our best tools for strengthening global health security,” says Nanthalile Mugala, PATH’s chief of the Africa Region. “And while we can guess that the Delta variant is driving this unprecedented third wave across the continent, the truth is, for many countries and many groups of people—often those at highest risk—we just don’t have any data.”

“And in this case, data is not just a number. The data tells the stories of people’s lives. It helps us figure out where to send vaccines, how much oxygen is needed, and which health facilities need support. This very often means the difference between life and death.”