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IHS Markit's COVID-19 vulnerability index shows economic
disruption to be the most acute impact of the pandemic across
sub-Saharan Africa (SSA), with the region recording its first
recession in over two decades. Although the number of cases and
deaths is highly likely to be under-reported, the region has been
spared the heaviest burden of COVID-19 infections and deaths.
Excess mortality is very low across the region, likely owing in
part to its young population, demonstrated in the index as
demographic risk. While several countries across the region such as
Ghana, Rwanda, and South Africa have experienced another wave of
infections since late 2020, the resultant containment measures
have, in most cases, been eased by governments to avoid highly
unpopular restrictions on movement and business activity. More
important for most governments is mitigating the impact on
livelihoods. A 2020 World Bank report forecasted that the COVID-19
pandemic could reverse years of progress in poverty alleviation,
placing up to 40 million more Africans at risk of extreme poverty
(living on less than USD1.90 per day). This, coupled with a vaccine
rollout expected by the World Health Organization (WHO) to take
around three years to achieve herd immunity in the region, means
that the resumption of economic activity in the region is unlikely
to depend on a successful COVID-19 vaccination program.
Fiscal capacity constraints are likely to create gaps in
available funding for vaccine supply, driving dependence on donor
support. The African Center for Disease Control (CDC) estimates
that it will cost up to USD15 billion to achieve the WHO's herd
immunity target of at least 60% of the population. However, many
regional countries lack the fiscal capacity to self-finance a full
or assisted vaccine rollout due to deep budget deficits and high
debt burdens for the next several years. Recognizing the fiscal
constraints on many SSA countries, the World Bank aims to have
disbursed up USD40 billion in grants and concessional lending
between March 2020 and June 2021 to support economic recovery as
well as COVID-19 responses - which includes testing, treatment, and
vaccinations.
Sub-Saharan Africa's reliance on external vaccine supply
to delay rollouts
SSA will be reliant in 2021 on external vaccine supply,
particularly pooled procurement schemes, raising delays to rollout
expectations. Even if completed on schedule, the sub-Saharan
African region's vaccination rollout plans will lag behind rollouts
globally, with the WHO estimating that, at best, 30-35% of Africa's
1.3 billion population could be vaccinated in 2021. In addition,
the WHO's threshold for herd immunity (at least 60% of the
population) is only likely to be achieved at the end of 2023. For
vaccine supply, the region will rely most heavily on the COVID-19
Global Vaccine Access Facility (COVAX Facility), led by the
Coalition for Epidemic Preparedness Innovations (CEPI), the Vaccine
Alliance (Gavi), and the WHO. COVAX has pledged to provide
participating countries with vaccines to cover 20% of their
populations in 2021, which in Africa will predominantly be used for
frontline workers. Vaccine supplies to meet this target have not
been secured (see graph), with COVAX basing its supply forecast on
existing and expected advanced procurement agreements with
manufacturers. Although the supplies will be subsidized,
participating countries will be expected to pay upfront costs of
between USD1.60 and USD10 per dose, depending on the vaccine.
Concerned with delays for the regional vaccine rollout, the
African Union's (AU) African Vaccine Acquisition Task Team (AVATT)
launched another pooled procurement scheme, having currently agreed
to purchase 670 million doses of the AstraZeneca, Pfizer, and
Johnson & Johnson vaccines, with the option to procure 300
million doses of the Sputnik V vaccine.
Infrastructural weakness likely to mean vaccine
distribution insufficient for timely rollout
With existing infrastructural weakness across many SSA
countries, vaccine distribution is likely to be insufficient for a
timely rollout and unevenly focused on densely populated, urban
areas. WHO analysis published at the end of November 2020 found
that only 49% of African countries had identified priority
populations for vaccination and had plans in place to reach them;
only 44% had co-ordination structures in place; and only 24% had
adequate plans for resources and funding. Additionally, only 17%
had data collection and monitoring tools in place and just 12% had
"plans to communicate with communities to build trust and drive
demand for immunization". Although some countries such as Ghana and
Rwanda have deployed drones for wider coverage of COVID-19 testing,
and the DRC has piloted high-tech solutions for Ebola vaccine
delivery, securing sufficient cold-chain supply and storage
infrastructure for vaccine distribution at scale will require more
time and considerable financial resources. Limited capacity at
medical facilities, including staff, will further impair vaccine
rollout efforts, especially to more remote areas across the
continent. Even within urban areas, prior to the outbreak, medical
staff in several countries, such as Kenya and Zimbabwe, had ongoing
strikes over mostly working conditions and pay.
Posted 23 March 2021 by Langelihle Malimela, Senior analyst, Country Risk – Africa, IHS Markit and
Natznet Tesfay, Executive Director, Africa, Economics and Country Risk, IHS Markit and
Sacha Baggili, Senior Analyst, Middle East, Africa and Indian subcontinent, Life Sciences, IHS Markit and
Theo Acheampong, Ph.D., Senior Analyst Country Risk – Sub-Saharan Africa, IHS Markit and
William Farmer, Analyst, Sub-Saharan Africa, Country Risk, IHS Markit