Urgent, strategic action needed in light of limited vaccine and mounting threat of new variants
As the world battles new COVID-19 variants and supply and rollout of vaccines remains critically low in Africa, new research from the Partnership for Evidence-Based Response to COVID-19 (PERC) indicates that burdens experienced by people in African Union Member States remain grave: 81% of survey respondents reported challenges in accessing food, 77% reported experiencing income loss and 42% reported missing medical visits since the start of the pandemic. The report calls for targeted public health measures for high-risk populations, increased surveillance in light of new variants, and scaled-up vaccine supply from the global community to control the pandemic in Africa.
“As case counts surge across the world, new variants emerge and vaccine rollout remains slow, it will be crucial for African Union Member States to use evidence-based strategies to manage COVID-19,” said Dr. John Nkengasong, Director of the Africa Centres for Disease Control and Prevention. “The PERC report provides valuable insights to countries to strategically tailor their ongoing responses.”
Limitations in testing capacity and surveillance—as well as uneven demand for testing—are likely masking the true severity of COVID-19 on the African continent, fueling the dangerous myth that much of Africa has been unscathed by COVID-19. Test positivity rates were above 10% across many Member States during the second wave—substantially higher than the 5% maximum warning level suggested by the World Health Organization and suggesting that many cases have gone undetected.
Vaccine acceptance was high among survey respondents—67% of people said they would get the vaccine when it’s available—with several important caveats. Acceptance varied widely among countries, from 91% in Morocco to 35% in Tunisia and Cameroon. At the time of the survey, most respondents did not yet have access to vaccines or much information about specific vaccines rolling out in the region. In fact, among those who expressed hesitancy about vaccination, lack of information was a leading reason.
“Vaccine hesitancy is driven by high levels of disinformation, misinformation, and lack of information, which erodes trust in the safety and efficacy of vaccines,” said Dr. Richard Mihigo, Program Coordinator, Immunization and Vaccine Development, WHO’s Regional Office for Africa. “Going forward, we must prioritize sustained and targeted campaigns which address the growing infodemic around vaccines while providing evidence-based information to dispel myths and build confidence in vaccines. Communication and engagement is key to building trust and creating a positive discourse around vaccines from the ground up.”
Nearly nine in 10 respondents reported using masks when near others in February 2021—almost identical to findings six months before. However, in some of the populous and hard-hit countries, such as South Africa and Ethiopia, self-reported mask use trended downward in February, suggesting the need to redouble efforts to promote this low-cost and effective intervention in some areas. Overall, self-reported adherence to measures restricting social gathering and movement declined significantly between August 2020 and February 2021.
Given the delayed rollout of vaccines and the threat posed by new variants, all AU Member States will need to scale up effective testing strategies to detect early indications of potential surges and sustain the strategic use of public health measures to prevent subsequent waves while ensuring social protection. The researchers conclude that clear, transparent communications from leaders and public health officials will be vital in building trust and influencing people to follow any further measures; respondents who expressed high satisfaction with their government, community leaders or Ministry of Health were more likely to report adherence to public health measures than those who expressed dissatisfaction.
“Countries are most effective controlling the pandemic when they consider what measures people will actually follow at this stage in the pandemic and take steps to inform, partner with, and support communities,” said Dr. Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies. “Analysis of PERC data can help governments predict adherence to preventive measures, craft effective communications and mount a stronger response to COVID-19.”
The PERC survey—the third in its “Using Data to Find a Balance” series— was fielded in February, when Africa was emerging from a second, substantially larger wave of COVID-19. PERC polled more than 24,000 adults across 19 African Union (AU) Member States, compiled social, economic and epidemiological data from a range of sources and compared results from the previous survey conducted in August 2020.
Other key findings in the report include:
Three primary factors influenced people’s adherence to PHSMs: belief that such measures are necessary, perception of personal risk and satisfaction with the government’s handling of COVID-19.
- Little more than half (53%) of respondents supported measures restricting social gathering, such as limits on visiting places of worship, public gatherings and entertainment venues, compared to 65% in August; 54% supported measures restricting movement (stay-at-home orders, reducing trips to the market or store), down from 64% in August.
- Fear of contracting COVID-19 continued to be the most common reason for missing care in the previous six months (26%). 51% of respondents believed that health care workers should be avoided because they might transmit COVID-19.
- Affordability of care was a further barrier for missing care (20%), likely related to secondary burdens such as income loss.
- Income loss and food insecurity have worsened since the beginning of the pandemic. Food insecurity is a grave concern, with 81% of respondents reporting issues in accessing food, and 48% reported having to reduce the number or size of meals in the past week.
- Households in lower income groups are the most affected and least reached by social protection programs (where such programs exist at all).
Recommendations include that governments and the global community invest in:
- Increasing capacity to detect, test, sequence and trace cases and new COVID-19 variants;
- Prioritizing targeted, individual PHSMs to high-risk areas to maximize adherence for the long run and minimize secondary burdens;
- Using an evidence-based approach to identify and offer relief to high-risk populations;
- Protecting health care workers via adequate personal protective equipment, fair compensation, paid sick leave and access to mental health care;
- Prioritizing vaccination of health care workers and strategically communicating to the public to reduce stigma against them and to reinforce that seeking health care is safe;
- Maintaining and strengthening vaccination information campaigns to bolster confidence, and supporting regional efforts to combat misinformation and build trust, in preparation for when vaccines become more available; and
- Stepping up action from the global community to increase vaccine production, ensure equitable allocation and share technological expertise to facilitate local vaccine manufacturing with Member States.
To read the full report, please visit click here.
About Resolve to Save Lives
Resolve to Save Lives, an initiative of the global health organization Vital Strategies, focuses on preventing deaths from cardiovascular disease and by preventing epidemics. It is led by Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention.
About Vital Strategies
Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. We work with governments and civil society in 73 countries to design and implement evidence-based strategies that tackle their most pressing public health problems. Our goal is to see governments adopt promising interventions at scale as rapidly as possible.
The National Academies of Sciences, Engineering, and Medicine (NASEM) are private, nonprofit institutions that provide expert advice on some of the most pressing challenges facing the nation and the world. Our work helps shape sound policies, inform public opinion, and advance the pursuit of science, engineering, and medicine. The National Academies do not receive direct appropriations from the federal government, although many of their activities are mandated and funded by Congress and federal agencies. NASEM also works with Foundations, state governments, the private sector, and philanthropy from individuals to enable them to address critical issues on behalf of the nation.
About the UK Public Health Rapid Support Team
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About the Word Health Organization
WHO is working with UNICEF, Gavi and partners to support all aspects of COVID-19 immunization in Africa, including capacity assessments, planning, advising on delivery strategies, regulatory mechanisms, ensuring adequate cold chain, training and supervision, data monitoring and surveillance, and communication including raising public awareness and promoting demand for vaccination. The WHO-founded Africa Infodemic Response Alliance (AIRA), a joint platform of 12 partner organisations is working to counter misinformation and disinformation and share science-based facts on health, including vaccines.