Making the Most of Africa's Pandemic Dividend

By Ebere Okereke and Adam Bradshaw

LONDON – Vaccinating African populations against COVID-19 has proved a difficult feat. Whereas the continent once grappled with vaccine shortages, it is now facing a shortage of attention. The COVID-19 pandemic is widely perceived to be over, and some commentators now argue that African countries should lower their COVID-19 vaccination targets and direct their resources toward more urgent priorities, including other disease outbreaks (such as Marburg virus disease and Ebola) and routine immunization. This would be a mistake.

While current COVID-19 vaccines have done less to reduce transmission than one would have hoped, they significantly reduce the severity of the illness, resulting in lower hospitalization rates. This is particularly important in Africa, where those who are hospitalized with COVID-19 are significantly more likely to die than those hospitalized with the disease elsewhere. Yet only three African countries have reached the World Health Organization’s vaccination target of 70% of the population, with the average across the continent standing at just 24%.

But mass vaccination is bigger than COVID-19. The pandemic brought a significant increase in government and multilateral investment in public health. The World Bank provided $39 billion in new financing, the Mastercard Foundation another $1.5 billion, and the European Union about $113 million. These sums have been accompanied by global contributions through the Financial Intermediary Fund for Pandemic Prevention, Preparedness, and Response, which has allocated $1.3 billion. African governments have also made large contributions.

If leveraged appropriately, these investments could substantially boost Africa’s capacity not only to end the COVID-19 crisis, but also to respond to future health emergencies, endemic diseases, and pandemics. But this “pandemic dividend” can be realized only if the continent remains committed to vaccination. If governments begin to roll back or redirect funding, the returns on pandemic investments could prove temporary.

One such return has been the rapid establishment and strengthening of systems for procuring, storing, and delivering vaccines. Africa has developed regional pooled procurement mechanisms for vaccines and other medical products, expanded and strengthened its cold-chain systems, and streamlined logistics.

A continued commitment to reaching vaccination targets for COVID-19 will help to accelerate and entrench this progress, translating into greater support for vaccination against influenza, human papillomavirus (HPV), and hepatitis B, for which there are currently limited programs. It will also enable the delivery of emerging vaccines against deadly endemic and emerging infectious diseases – such as malaria, tuberculosis, and Lassa fever – at scale. And it will help to safeguard the WHO’s Essential Program on Immunization initiatives for children, by enhancing routine vaccination systems and facilitating the adoption of integrated approaches.

But the COVID-19 pandemic may support future vaccination in an even more fundamental way. The crisis highlighted the need to foster vaccine demand in a way that is evidence-based, people-centered, guided by a tailored strategy, and integrated into a country’s long-term immunization plans. The Africa Centers for Disease Control and Prevention’s Saving Lives and Livelihoods initiative, together with many African governments, have been investing in the development of such systems.

Continued efforts on mass COVID-19 vaccination will spur progress in refining these systems. It will also help to foster public trust in vaccines, thereby boosting demand for other vaccines in the future.

Pandemic investments have also catalyzed progress in the adoption of health technologies, which have facilitated major improvements in data collection. Until recently, most African countries did not gather data on priority health groups or have systems in place to record data digitally. But many, such as the Gambia and Uganda, have now implemented vaccine-recording and health-registration systems. The accurate and real-time data these systems provide can inform vaccination strategies, improving countries’ ability to reach priority groups.

Finally, mass COVID-19 vaccination campaigns have required the training of huge numbers of vaccinators, data analysts, and logistics and storage experts. This expanded capacity will go a long way toward strengthening responses to future health emergencies and closing gaps in routine health services.

It already is. In Botswana, the United States Agency for International Development strengthened the pandemic response by taking advantage of community-health platforms that were created to help deal with HIV/AIDS. Similarly, in Nigeria, a contact-tracing workforce established for polio was used to help manage the Ebola outbreak.

COVID-19 poses a serious enough threat to merit a continued commitment to vaccination. But the short-term benefits are just the beginning. Mass COVID-19 vaccination campaigns can also catalyze progress in a wide range of crucial areas, from vaccine procurement to health-care delivery, thereby boosting the continent’s ability to prevent and respond to future health emergencies. This is the pandemic dividend, and Africa must not squander it.

Ebere Okereke, Senior Technical Adviser at the Tony Blair Institute for Global Change, is an honorary senior public health adviser at the Africa Centers for Disease Control and Prevention and an associate fellow at Chatham House. Adam Bradshaw is Senior COVID-19 Policy Adviser at the Tony Blair Institute for Global Change.