1.10 Population with at Least One Dose of the COVID-19 Vaccine

coronavirus vaccines. As of mid-February 2022, the continent had received nearly 669 million doses (nearly 6 percent of all COVID-19 vaccines) and administered 405 million. Nearly 10 percent of the population of Sub-Saharan Africa is fully vaccinated according to the Africa Centers for Disease Control and Prevention as opposed to 64 percent in the United States and 85 percent in Great Britain. Only eight countries in Sub-Saharan Africa exceeded the World Health Organization target of 40 percent of the population with a first dose of the coronavirus vaccine by end-2021 (figure 1.10). The probability of most countries in the region reaching the 70 percent target by mid-2022 is very small. If access to COVID-19 vaccines by low-income countries (and, notably, African countries) does not improve at a faster pace, the world runs the risk of prolonging the pandemic. Low-vaccination countries/regions can potentially become the epicenter of the virus, as they might facilitate the emergence of new variants that might reduce vaccine effectiveness as well as heighten disease severity and global spread.13

Vaccine insecurity in Sub-Saharan Africa reveals the excessive dependence on foreign supply and a wide gap in manufacturing vaccines in the region. The continent imports nearly 99 percent of the vaccines that it administers, while it demands more than 25 percent of the vaccines produced globally.14 Despite the challenges the region faces in vaccine manufacturing, capacity building is taking place at different stages through technological transfer partnerships at manufacturing facilities—as is the case with Aspen Pharmacare in South Africa. Scale-up efforts in already installed capacity by Biovac (South Africa) are being deployed, along with production

FIGURE 1.10: Population with at Least One Dose of the COVID-19 Vaccine (%) 100

90

80

70

Percent

60

50

40

30

20

10

0

SeychellesMauritius Comoros Rwanda Botswana Cabo Verde São Tomé and PríncipeMozambiqueUgandaMauritania AngolaLesotho Zimbabawe Ghana Côte d'Ivoire Guinea-Bissau Guinea Benin South Africa Liberia Sierre Leone EthiopiaEquatorial GuineaTogoNamibia Gabon Central African RepublicCongo, RepublicKenyaSudan Somalia Gambia, The Burkina Faso NigeriaNigerSenegalEswatini Cameroon Mali Zambia Tanzania Malawi MadagascarSouth Sudan Chad Congo, Dem. Rep.Burundi

Source: Africa Centers for Disease Control and Prevention. Note: Vaccination figures are as of March 17, 2022. The dotted lines represent the World Health Organization targets of full primary immunization against coronavirus of 40 percent by end-2021 and 70 percent by mid-2022. Many countries in the region still have low vaccination rates.

13 This is manifested by the different variants that were first detected in the countries/regions with low vaccination rates, like Beta (B.1.351) in South Africa (May 2020),

Delta (B.1.617.2) in India (October 2020), and Omicron (B1.1.529) in Southern Africa (November 2021). 14 Sibidé (2022).

initiatives by Innovative Biotech (Nigeria) in collaboration with Merck.15 In addition to these local efforts, the World Health Organization, along with a consortium of partners, has established a global messenger ribonucleic acid (mRNA) technology transfer hub in Africa.16 Moderna and BioNTech have also announced plans to build mRNA vaccine factories in Africa, although production still has a long way to go. Finally, the Institut Pasteur de Dakar and the Coalition for Epidemic Preparedness Innovations are partnering to set up a regional manufacturing hub for COVID-19 and other vaccines in Senegal. Initially, the facility will produce up to 300 million doses of COVID-19 vaccine annually for use in Africa.17

The problem with low vaccination in Sub-Saharan Africa goes beyond access to vaccines.18 Additional challenges for the continent are the inadequate logistics for getting doses into arms and vaccine hesitancy among the population. By mid-February, only 60 percent of the vaccines procured by African countries had been used. Several factors can explain the uneasy transition from vaccine supply to vaccination rollout, including the donation of vaccines with limited shelf life (which led to doses being destroyed in Nigeria and Malawi, among others), lack of components (for example, syringes), limited time to mobilize human and financial resources for the rollout, and inadequate capacity (public health infrastructure, trained personnel, and funding for vaccine program implementation, among others). Efforts to continue investing in health and reconfigure the public health system on the continent toward more self-reliance are critical.19

Vaccine hesitancy in Sub-Saharan Africa reflects lack of knowledge about the effectiveness of vaccines as public health interventions that sharply reduce the burden, morbidity, and mortality of communicable diseases.20 A recent study shows that 63 percent of Africans would be willing to receive a COVID-19 vaccine as soon as possible.21 More than 25 percent of the survey respondents did not think the vaccine was necessary, while 43 percent believed there were suitable alternatives to COVID-19 vaccination. Hesitancy among Africans is attributed to perceived risks of coronavirus infection and past experiences. For instance, most of the survey respondents were worried about side effects from the vaccine (79 percent), while others were concerned about vaccine-associated infection (39 percent).22 Therefore, policy makers need to address misinformation about COVID-19 vaccines through community engagement strategies to raise awareness and diffuse knowledge about the effectiveness of these vaccines.23

15 In collaboration with University of the Witwatersrand, South Africa’s Afrigen Biologics has manufactured its own version of the Moderna mRNA COVID-19 vaccine using the publicly available sequence of the shot. This version will be tested in humans by end-2022. 16 Nweneka and Disu (2022). 17 CEPI (2022). 18 According to the World Health Organization, deliveries to Africa under the COVID-19 Vaccines Global Access (COVAX) initiative increased more than 100 percent between November 2021 and January 2022. At the same time, the Africa Centers for Disease Control and Prevention is asking COVID-19 vaccine donors to align the distribution of shots to the country’s take-up to optimize their usage. 19 Lancet (2022). 20 Mutombo et al. (2021). 21 The study by Anjorin et al. (2021) surveyed 5,416 individuals, of which 94 percent are residents of 34 African countries, while the rest of the Africans live in the diaspora. 22 More details on the drivers of hesitancy among Africans can be found in Anjorin et al. (2021). 23 Brits (2022).

1.3 IMPLICATIONS OF THE UKRAINE-RUSSIA CONFLICT FOR SUB-SAHARAN AFRICA

The conflict in Ukraine has led to trade embargoes and financial sanctions on Russia, thus resulting in a drastic reduction of imports from Russia and Ukraine, as well as soaring global commodity prices. The magnitude of the impact on economic activity is uncertain due to high volatility in commodity prices. This subsection describes how important the economies of Russia and Ukraine are to Sub-Saharan Africa, given their roles as key players in commodity markets. It also discusses how the conflict has affected Sub-Saharan Africa through direct and indirect channels of transmission.

Russia and Ukraine: Large Players in Key Commodity Markets The economies of Russia and Ukraine are not large in terms of their gross domestic product (GDP) or their export sectors.24 However, these two countries are top producers (as well as exporters) of key commodities worldwide. Russia is a key producer of energy commodities, particularly petroleum and gas. With production of 10.5 million barrels of crude oil per day in 2020, Russia is the third largest producer of crude oil in the world. Its global market share of crude oil is sizable at 11.2 percent, trailing only the United States and Saudi Arabia. Russia is also the second largest producer of natural gas worldwide, with a global market share of 17 percent.25 In 2020, Russia produced an estimated 22.5 trillion cubic feet (Tcf) of dry natural gas, second only to the United States which produced an estimated 33.5 Tcf.

Beyond energy, Russia and Ukraine are top world exporters of food staples. Disruption in their production and exports is currently influencing the prices of wheat, maize, barley, and fertilizers. Rising prices of grain cereals, including maize, barley, and soybeans, are affecting the prices of animal feed and, hence, the international price of beef, poultry, and pork. Russia and Ukraine are among the top ten world producers of maize (6th and 10th largest producers, respectively). Russia and Ukraine are also the 4th and 7th largest producers of wheat in the world, respectively: Russia accounts for 11 percent of the world production of wheat, and Ukraine accounts for 3.3 percent. The Russian share of global barley production is about 13 percent while the Ukrainian share is approximately five percent. Production of rye in Russia and Ukraine accounts for 17 percent and 3.2 percent, respectively, of global production.

Russia and Ukraine are not only among the top ten producers of many food staples, but also among their largest exporters. Considered the world’s breadbasket, Russia and Ukraine combined are the largest exporters in the world of certain agricultural products. For example, Russia and Ukraine account for 75.8 percent of worldwide sunflower seed oil exports—with 46.9 percent coming from Ukraine and 28.9 percent from Russia (table 1.1). Disruptions in the supply of sunflower seeds and seed oil due to the conflict are exerting upward pressure on the price of palm oil—widely consumed by Sub-Saharan African households. Russia represents a significant share of the world exports of wheat (19.3 percent), rye (19.4 percent), and barley (17.6 percent).

24 As measured by gross domestic product (in current US dollars), Russia’s economy ranks 11th in the world, and it is roughly 7 and 10 percent the size of the United States and

China, respectively—the two largest economies in the world. Ukraine is a smaller economy, with a level of economic activity similar to that of Hungary, and less than one percent the size of the United States. In terms of its exporting sector, Russia is relatively small given the size of its economy. Based on the dollar value of its exports, Russia ranks within the top 20 in the world for exports of goods and services. Its export size is about 14 and 18 percent that of China and the United States, respectively. It also trails smaller European countries such as the Netherlands, Ireland, Switzerland, Belgium and Spain, as well as East Asian trade hubs like Singapore and Hong Kong SAR, China. 25 The data reported were obtained from the US Energy Information Administration (EIA).