Reconsidering the COVID-19 vaccine strategy in West and Central Africa

Seroprevalence studies have now clearly established that the SARS-CoV-2 virus has spread widely in Africa, with a low severity that is probably under-reported in West and Central Africa.1Soumah AA Diallo MSK Guichet E et al.High and rapid increase in seroprevalence for SARS-CoV-2 in Conakry, Guinea: results from 3 successive cross-sectional surveys (ANRS COV16-ARIACOV).Open Forum Infect Dis. 2022; 9ofac152Crossref PubMed Scopus (1) Google Scholar, 2Sagara I Woodford J Kone M et al.Rapidly increasing SARS-CoV-2 seroprevalence and limited clinical disease in three Malian communities: a prospective cohort study.medRxiv. 2022; (published online April 29.) (preprint).https://doi.org/10.1101/2021.04.26.21256016Google Scholar, 3Bobrovitz N Arora RK Cao C et al.Global seroprevalence of SARS-CoV-2 antibodies: a systematic review and meta-analysis.PLoS One. 2021; 16e0252617Crossref PubMed Scopus (59) Google ScholarIn September, 2022, data on WHO's COVID-19 dashboard suggested that 62% of the world's population had received at least two doses of the COVID-19 vaccine. Only 22% of the population in Africa have received two doses. Coverage falls far from the announced global target of 70% by the end of 2022.There are many reasons for this gap.4Maxmen A The radical plan for vaccine equity.https://www.nature.com/immersive/d41586-022-01898-3/index.htmlDate: July 13, 2022Date accessed: September 9, 2022Google Scholar Despite implementation of the COVAX initiative, it was difficult to roll out the SARS-CoV-2 vaccine in Africa because of supply and access problems and a short shelf life. Vaccine demand was low because the pandemic had little effect on the general population. Thus, health authorities provided little incentive after the first waves because COVID-19 vaccination campaigns are costly and pose logistical problems. Additionally, acceptance has been low due to people's reluctance to get a new vaccine for a discrete disease, echoing reluctance from other continents.Consequently, we consider the application of so-called universal vaccination as currently inappropriate for our region in the present context, given the demographic and epidemiological specificities of the population (median age is <20 years in West and Central Africa), the cost of vaccination for health systems (even though the vaccine is provided for free), the low level of risk compared with other disease burdens, and the poor effectiveness of vaccines to contribute to herd immunity.We also believe that the vaccination strategy should: target priority populations (older people [ie, people aged >60 years], health workers, and people with identified comorbidities) rather than focus on campaigns for the general population—these target populations need to be identified and linked to health services and their vaccination status must be known to ensure they return for future boosters; establish an effective mechanism to launch a rapid vaccination campaign in the event of severe variants, on the basis of comprehensive and accessible databases; redefine research priorities and funding to quantify the current rate of COVID-19-related mortality and better investigate immunity in Africa; coordinate with vaccination and treatment efforts for other diseases to overcome the low numbers of COVID-19 vaccination and reduce costs; and support capacity building for vaccine production in Africa.In conclusion, there is an urgent need to reconsider COVID-19 immunisation strategies in West and Central Africa on the basis of discussions and collaborations between researchers and stakeholders that take into consideration multiple disciplines of vaccinology including the social sciences, information sciences, and public health.For the WHO COVID-19 dashboard see https://covid19.who.int/We declare no competing interests. The opinions of the authors do not reflect the opinions of their institutions. Seroprevalence studies have now clearly established that the SARS-CoV-2 virus has spread widely in Africa, with a low severity that is probably under-reported in West and Central Africa.1Soumah AA Diallo MSK Guichet E et al.High and rapid increase in seroprevalence for SARS-CoV-2 in Conakry, Guinea: results from 3 successive cross-sectional surveys (ANRS COV16-ARIACOV).Open Forum Infect Dis. 2022; 9ofac152Crossref PubMed Scopus (1) Google Scholar, 2Sagara I Woodford J Kone M et al.Rapidly increasing SARS-CoV-2 seroprevalence and limited clinical disease in three Malian communities: a prospective cohort study.medRxiv. 2022; (published online April 29.) (preprint).https://doi.org/10.1101/2021.04.26.21256016Google Scholar, 3Bobrovitz N Arora RK Cao C et al.Global seroprevalence of SARS-CoV-2 antibodies: a systematic review and meta-analysis.PLoS One. 2021; 16e0252617Crossref PubMed Scopus (59) Google Scholar In September, 2022, data on WHO's COVID-19 dashboard suggested that 62% of the world's population had received at least two doses of the COVID-19 vaccine. Only 22% of the population in Africa have received two doses. Coverage falls far from the announced global target of 70% by the end of 2022. There are many reasons for this gap.4Maxmen A The radical plan for vaccine equity.https://www.nature.com/immersive/d41586-022-01898-3/index.htmlDate: July 13, 2022Date accessed: September 9, 2022Google Scholar Despite implementation of the COVAX initiative, it was difficult to roll out the SARS-CoV-2 vaccine in Africa because of supply and access problems and a short shelf life. Vaccine demand was low because the pandemic had little effect on the general population. Thus, health authorities provided little incentive after the first waves because COVID-19 vaccination campaigns are costly and pose logistical problems. Additionally, acceptance has been low due to people's reluctance to get a new vaccine for a discrete disease, echoing reluctance from other continents. Consequently, we consider the application of so-called universal vaccination as currently inappropriate for our region in the present context, given the demographic and epidemiological specificities of the population (median age is <20 years in West and Central Africa), the cost of vaccination for health systems (even though the vaccine is provided for free), the low level of risk compared with other disease burdens, and the poor effectiveness of vaccines to contribute to herd immunity. We also believe that the vaccination strategy should: target priority populations (older people [ie, people aged >60 years], health workers, and people with identified comorbidities) rather than focus on campaigns for the general population—these target populations need to be identified and linked to health services and their vaccination status must be known to ensure they return for future boosters; establish an effective mechanism to launch a rapid vaccination campaign in the event of severe variants, on the basis of comprehensive and accessible databases; redefine research priorities and funding to quantify the current rate of COVID-19-related mortality and better investigate immunity in Africa; coordinate with vaccination and treatment efforts for other diseases to overcome the low numbers of COVID-19 vaccination and reduce costs; and support capacity building for vaccine production in Africa. In conclusion, there is an urgent need to reconsider COVID-19 immunisation strategies in West and Central Africa on the basis of discussions and collaborations between researchers and stakeholders that take into consideration multiple disciplines of vaccinology including the social sciences, information sciences, and public health. For the WHO COVID-19 dashboard see https://covid19.who.int/ For the WHO COVID-19 dashboard see https://covid19.who.int/ For the WHO COVID-19 dashboard see https://covid19.who.int/ We declare no competing interests. The opinions of the authors do not reflect the opinions of their institutions.