Monthly Bulletin - COVID-19 vaccination in the African Region: Issue No. 09

DATE OF ISSUE: 10 NOVEMBER 2022 DATA AS REPORTED BY 30 OCTOBER 2022 ISSUE NO. 9 O C T O B E R 2 0 2 2 MONTHLY BULLETIN COVID-19 VACCINATION IN THE WHO AFRICAN REGION 2COVID-19 VACCINATION IN THE WHO AFRICAN REGION Author : File name : _DSC2265.jpg File Size : 59.6 kB Dimensions : 1040 x 615 Credit : WHO/Eromosele Copyright : © WHO/Eromosele Date created : 2022-06-07 19:19:42 Description : Nigeria has stepped up COVID-19 genomic surveillance to effectively track the evolution of the virus and adjust responses to pandemic waves driven by variants of concern. The country began carrying out genomic sequencing in March 2020. Currently it can carry out around 500 sequences per month. Before the pandemic, the country only had two laboratories with sequencing capacity. Genomic sequencing is currently done through a network of four laboratories coordinated by the Nigeria Centre for Disease Control’s National Reference Laboratory.https://www.afro.who.int/photo-story/scaling-genomic-sequencing-nigeria? country=979&name=Nigeria AT A GLANCE EXPIRED DOSES OF ALL DOSES RECEIVED 2.4% COUNTRIES THAT HAVE ADMINISTERED FEWER THAN 50% OF DOSES RECEIVED 14 DOSES ADMINISTERED OF ALL DOSES RECEIVED 68% COUNTRIES THAT HAVE ALREADY REPORTED EXPIRED DOSES 35 THE REGION’S POPULATION THAT HAS COMPLETED THE PRIMARY SERIES 23% INCREASE IN DOSES ADMINISTERED IN OCTOBER 2022 COMPARED TO SEPTEMBER 2022 63% VACCINE DOSES RECEIVED PER 100 POPULATION 62 DOSES RECEIVED FROM THE COVAX FACILITY 66% COUNTRIES YET TO SURPASS 10% OF THEIR POPULATION WITH THE COMPLETE PRIMARY SERIES 6 COUNTRIES THAT HAVE ACHIEVED BETWEEN 40% AND 69% COVERAGE OF THEIR POPULATION WITH THE COMPLETE PRIMARY SERIES 10 COUNTRIES THAT HAVE ACHIEVED THE TARGET OF 70% OF THEIR POPULATION HAVING COMPLETED THE PRIMARY SERIES 3 © WHO/Eromosele 3COVID-19 VACCINATION IN THE WHO AFRICAN REGION TABLE OF CONTENTS SUMMARY.........................................................................................................................................................................4 1. COVID-19 VACCINATION SITUATION UPDATE............................................................................................6 2. WHO/AFRO OPERATIONS UPDATE................................................................................................................17 3. COUNTRY FOCUS: ZAMBIA - IMPLEMENTING A SUCCESSFUL MASS VACCINATION CAMPAIGN TO MOVE TOWARDS THE GLOBAL TARGET............................................................................19 4. PARTNER FOCUS: USING HIGH VOLUME VACCINATION SITES IN A CROWDED CITY TO INCREASE ACCESS TO AND DEMAND FOR COVID-19 VACCINATION: EXPERIENCE OF VILLAGEREACH IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO........................................26 5. TECHNICAL/SCIENTIFIC UPDATE: GOOD PRACTICE STATEMENT ON THE USE OF SECOND BOOSTER DOSES FOR COVID-19 VACCINES...................................................................................................32 6. USEFUL LINKS..........................................................................................................................................................34 APPENDIX: DOSES ADMINISTERED AND VACCINATION COVERAGE BY COUNTRY IN THE WHO AFRICAN REGION (DATA AS OF 30 October 2022)............................................................................35 4COVID-19 VACCINATION IN THE WHO AFRICAN REGION As of 30 October 2022, a total of 273 million people in the African Region had completed the primary COVID-19 vaccination series, representing 23.4% of the Region’s population. Three countries have surpassed the target of 70% of their population having completed the primary series: Mauritius (86.0%), Seychelles (76.5%) and Liberia (75.5%). Ten countries have recorded a percentage of between 40% and 70% of people who have completed the primary series: United Republic of Tanzania (40.0%), Lesotho (42.0%), Eswatini (42.3%), Mozambique (42.9%), Zambia (43%), Sao Tome and Principe (47.2%), Comoros (48.4%), Botswana (55.9%), Cabo Verde (62.8%) and Rwanda (67.0%). Six countries are yet to vaccinate more than 10% of their population: Burundi (0.2%), Democratic Republic of the Congo (4.6%), Cameroon (4.7%), Madagascar (5.9%), Senegal (7.1%) and Mali (9.6%). Booster doses are being administered to fully vaccinated people (those who have completed the primary series) in 37 out of 46 countries in the African Region (80%). Thirty-six of them have submitted reports on booster shots to WHO/ AFRO. Benin is still the only country with no data on booster doses available at national level. In the 36 countries that submitted reports to WHO/AFRO, 14.2% of people who have completed the primary series have received at least one booster dose. Following a data cleaning process, data from 30 countries have shown that 40.5% of health workers and 36.9% of older adults have completed the primary series in 24 countries. A total of 722 million doses of COVID-19 vaccines have been delivered in the African Region, including 66.4% from the COVAX Facility. This represents 62 doses per 100 population. Of the doses received, 67.8% have been administered. Fourteen out of 46 countries (30%) have administered fewer than 50% of doses received. The number of doses administered increased by 63% in October 2022 compared to September 2022 (this figure decreased by 12% in September 2022 compared to August 2022). On average, 8.8 million doses were administered per week in October 2022, compared to 5.3 million per week in September 2022. The United Republic of Tanzania (7.5%), Niger (9.0) and Zambia (11.1%) recorded the highest percentage of people who completed the primary series in October 2022 among countries that have not yet achieved 70% of people who have completed the primary series. The United Republic of Tanzania continued to implement the strategy of assigning specific regions SUMMARY 5COVID-19 VACCINATION IN THE WHO AFRICAN REGION to technical and financial partners, ensuring healthy competition. This has contributed to maintaining the upward trend in COVID-19 vaccination coverage. Niger carried out a seven-day nationwide mass vaccination campaign. As a result, over 1.2 million people completed the primary series. Zambia implemented a 10-day nationwide mass vaccination campaign which contributed to an additional 1.9 million people completing the primary series (accounting for 23% of all people who have completed the primary series in Zambia as of 24 October 2022). Thirty-five out of 46 countries have reported expiry of vaccines. The number of expired doses accounts for 3.7% of doses received in these 35 countries and 2.4% of all doses received in the African Region. Senegal (25.4%), Madagascar (22.2%), Congo (21.8%), Algeria (18.8%) and Eswatini (12.6%) recorded the highest percentage of expired doses in relation to those received. WHO AFRO continued to implement the Multi-Partner Country Support Team (MP-CST) initiative in the month under review, with a focus on the 14 priority countries. In October 2022, eighteen additional consultants were recruited and deployed, bringing the total number of consultants deployed through the MP-CST initiative to 71. The response to multiple public health emergencies in the African Region continued to affect the roll-out of COVID-19 vaccines in October 2022. Notwithstanding these competing priorities, a few countries including Burkina Faso, Mozambique, South Sudan, Uganda, Zambia, Liberia, Niger, and Malawi conducted COVID-19 vaccination campaigns in October 2022. This issue of the Bulletin shares lessons from Zambia in implementing a successful mass vaccination campaign to move towards the global targets. The experience of VillageReach, a non-profit organization, in using high volume vaccination sites to increase access to and demand for COVID-19 vaccination in the Democratic Republic of the Congo is also discussed. The WHO guidance document: “Good practice statement on the use of second booster doses for COVID-19 vaccines” is summarized in this issue. 6COVID-19 VACCINATION IN THE WHO AFRICAN REGION 1.1. VACCINES RECEIVED As of 30 October 2022, a cumulative total of 722 388 729 doses of COVID-19 vaccines had been received in 46 of the 47 Member States of the WHO African Region. Eritrea is still the only country that has not started vaccinating against COVID-19. Of the doses received, 479 million (66.4%) were from COVAX, 161 million (22.3%) from bilateral cooperation arrangements, 64.8 million (9.0%) from the African Vaccine Acquisition Trust (AVAT), 7.6 million (1.1%) purchased by governments, and 9.1 million (1.3%) from unspecified sources (Figure 1). Johnson & Johnson, Pfizer/BioNtech, Sinopharm and Oxford/AstraZeneca account for 33.8%, 18.7%, 13.9% and 12.6% of vaccines received in the Region, respectively. Table 1 shows the distribution of doses received in the WHO African Region as of 30 October 2022 by type of vaccine. Figure 1. Doses of COVID-19 vaccines received in the African Region by source, as of 30 October 2022 1. COVID-19 VACCINATION SITUATION UPDATE “Of the doses received, 479 million (66.4%) were from COVAX, 161 million (22.3%) from bilateral cooperation arrangements, 64.8 million (9.0%) from the African Vaccine Acquisition Trust (AVAT), 7.6 million (1.1%) purchased by governments, and 9.1 million (1.3%) from unspecified sources” 7COVID-19 VACCINATION IN THE WHO AFRICAN REGION On average, 61.8 doses have been received per 100 population. Eight countries have received over 140 doses per 100 population (two doses for 70% of the population): Comoros, Sao Tome and Principe, Mauritius, Rwanda, Seychelles, Liberia, Mauritania and Cabo Verde. Meanwhile, Burundi (6.2 doses per 100 population), Democratic Republic of the Congo (12.1 doses per 100 population), and Cameroon (20.7 doses per 100 population) have received the lowest number of doses per 100 population. “On average, 61.8 doses have been received per 100 population” Vaccines Doses received % doses received Johnson & Johnson 244 077 485 33.8 Pfizer/BioNtech 134 943 702 18.7 Sinopharm 100 280 759 13.9 Oxford/Astrazeneca 90 868 740 12.6 Sinovac 49 947 400 6.9 Moderna 38 283 180 5.3 Unspecified 35 968 473 5 Covishield 25 746 540 3.6 Sputnik V/Light 1 907 450 0.3 Covaxin 365 000 0.1 Total 722 388 729 100.0 Table 1. Cumulative doses of vaccines received as of 30 October 2022 by type of vaccine 8COVID-19 VACCINATION IN THE WHO AFRICAN REGION 1.2. EXPIRED DOSES The cumulative number of expired doses had slightly increased from 17 576 156 by the end of September 2022 to 17 697 775 as of 30 October 2022 (0.7% increase). Of the expired doses, 13 640 875 have not yet been destroyed (77.1% of all expired doses).Thirty-five out of 46 countries have reported expiry of vaccines. The number of expired doses accounts for 3.7% of doses received in the 35 countries and 2.4% of doses received in the African Region. Senegal (25.4%), Madagascar (22.2%), Congo (21.8%), Algeria (18.8%) and Eswatini (12.6%) recorded the highest percentage of expired doses in relation to those received (Figure 2). 1.3. COVID-19 VACCINES ADMINISTERED Of the 722 million doses received, 489 558 897 have been administered, representing 67.8% of doses received. Administered doses as a percentage of all doses received ranged from 3.2% in Burundi to 93.1% in Eswatini (Figure 3). Fourteen out of 46 countries (30%) have administered fewer than 50% of doses received (15 countries at end-September 2022). Figure 2. Expired doses as a percentage of COVID-19 vaccine doses received by country in the African Region (data as of 30 October 2022) Figure 3. Administered doses as a percentage of COVID-19 vaccine doses received by country in the African Region (data as of 30 October 2022) 9COVID-19 VACCINATION IN THE WHO AFRICAN REGION Figure 4 presents the distribution of doses administered in the African Region by month of reporting as of 30 October 2022. The number of doses administered increased by 63% in October 2022, compared to September 2022 (this figure decreased by 12% in September 2022 compared to August 2022). On average, 8.8 million doses were administered per week in October 2022, compared to 5.3 million per week in September 2022. Figure 4. Number of COVID-19 vaccine doses administered by month in the African Region (data as of 30 October 2022) “On average, 8.8 million doses were administered per week in October 2022, compared to 5.3 million per week in September 2022.” Vaccine doses administered to children and adolescents Twenty-four countries in the African Region have reported doses administered to children aged 12 to 17 years. In these countries, cumulative doses administered to children and adolescents account for 8.0% of all doses administered (Table 2). 10 COVID-19 VACCINATION IN THE WHO AFRICAN REGION 1.4. GENERAL POPULATION COVERAGE As of 30 October 2022, a total of 342 million people had received at least one dose of the COVID-19 vaccine, representing 29.3% of the African Region’s population (26.5% by the end of September 2022), while 273 million people had received the required number of vaccine doses in the primary series, representing 23.4% of the Region’s population (21.1% by the end of September 2022). Globally, 62.6% of the population had completed the primary series as of 30 October 2022. Figure 5 shows the evolution over time of the percentage of people vaccinated with at least one dose of COVID-19 vaccine and people who have completed the primary series, by reporting month in the African Region. Table 2. COVID-19 vaccines doses administered to children in 24 countries in the African Region (data as of 30 October 2022) Country Doses administered to children Total doses administered % doses administered to children Lesotho 240 922 1 102 069 21.9 Botswana 568 224 2 891 400 19.7 Comoros 162 083 835 021 19.4 Eswatini 138 907 773 579 18.0 Angola 3 995 343 22 990 789 17.4 Kenya 3 523 512 22 457 583 15.7 Guinea 989 145 7 626 551 13.0 Mauritania 377 121 3 252 274 11.6 Cabo Verde 94 536 859 940 11.0 Rwanda 2 695 642 26 106 436 10.3 Côte d'Ivoire 1 561 862 20 588 390 7.6 Togo 256 762 3 381 542 7.6 South Africa 2 644 863 37 796 915 7.0 Mauritius 180 155 2 610 884 6.9 Seychelles 11 901 217 487 5.5 Sierra Leone 259 311 4 834 206 5.4 Uganda 1 328 161 25 783 131 5.2 Ethiopia 2 667 086 52 509 414 5.1 Namibia 44 553 962 898 4.6 Zambia 312 359 13 055 448 2.4 Ghana 419 331 20 359 448 2.1 Malawi 88 349 5 619 203 1.6 Mali 51 114 3 615 160 1.4 Burkina Faso 19 962 4 070 678 0.5 Total 22 631 204 284 300 446 8.0 11 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Figure 6 presents the percentage of people who have completed the primary series by country. Three countries have surpassed the target of 70% of their population having completed the primary series: Mauritius (86.0%), Seychelles (76.5%) and Liberia (75.5%). Ten countries have recorded a percentage of between 40% and 70% of people who have completed the primary series: United Republic of Tanzania (40.0%), Lesotho (42.0%), Eswatini (42.3%), Mozambique (42.9%), Zambia (43%), Sao Tome and Principe (47.2%), Comoros (48.4%), Botswana (55.9%), Cabo Verde (62.8%) and Rwanda (67.0%). Thirty-four countries have recorded percentages of between 10% and 40% of their population who have completed the primary series (29 countries in September 2022). Six countries are yet to vaccinate more than 10% of their population: Burundi (0.2%), Democratic Republic of the Congo (4.6%), Cameroon (4.7%), Madagascar (5.9%), Senegal (7.1%) and Mali (9.6%). Figure 5. Percentage of people who have received at least one vaccine dose and people who have completed the primary series against COVID-19 by reporting month in the African Region (data as of 30 October 2022) Figure 6. Proportion of people who have completed the primary vaccination series against COVID-19 by country in the African Region (data as of 30 October 2022) 12 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Figure 7. Geographical distribution and percentage of people who have completed the primary vaccination series against COVID-19 (fully vaccinated) by country in the African Region (data as of 30 October 2022) Figure 7 shows the geographical distribution and percentage of the population who have completed the primary series by country in the African Region. 13 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Figure 8 shows the percentage of people who completed the primary series (fully vaccinated) at the end of September 2022 and in October 2022 in the 28 countries that had less than 30% of people fully vaccinated at the end of September 2022. Figure 8. Percentage of people who completed the primary series (fully vaccinated) at the end of September 2022 and in October 2022 (data as of 30 October 2022) in the 28 countries that had less than 30% of people fully vaccinated at the end of September 2022 Figure 9. Percentage of people who completed the primary series (fully vaccinated) at the end of September 2022 and in October 2022 (data as of 30 October 2022) in the 18 countries that had more than 30% of people fully vaccinated at the end of September 2022 Figure 9 shows the percentage of people who completed the primary series at the end of September 2022 and in October 2022 in the 18 countries that had more than 30% of people fully vaccinated at the end of September 2022. 14 COVID-19 VACCINATION IN THE WHO AFRICAN REGION The United Republic of Tanzania (7.5%), Niger (9.0) and Zambia (11.1%) recorded the highest percentage of people who completed the primary series in October 2022 among countries that have not yet achieved 70% of people who have completed the primary series. The United Republic of Tanzania continued to implement the strategy of assigning specific regions to technical and financial partners, ensuring healthy competition. This has contributed to maintaining the upward trend in COVID-19 vaccination coverage. Niger carried out a seven-day nationwide mass vaccination campaign. As a result, over 1.2 million people completed the primary series. Zambia implemented a 10-day nationwide mass vaccination campaign which contributed to an additional 1.9 million people completing the primary series (accounting for 23% of all people who have completed the primary series in Zambia as of 24 October 2022). Booster doses are being administered to fully vaccinated people in 37 out of 46 countries in the African Region (80%), including 35 that submitted reports on booster shots to WHO/AFRO; Benin is still the only country with no data on booster doses available at national level. In the 36 countries that submitted reports to WHO/AFRO, 14.2% of people who have completed the primary series have received at least one booster dose. Figure 10 presents the distribution and proportion of people who have completed the primary series and received booster doses in the African Region as of 30 October 2022. Figure 10. Distribution and proportion of people fully vaccinated who have received booster doses in 35 countries in the African Region (data as of 30 October 2022) 15 COVID-19 VACCINATION IN THE WHO AFRICAN REGION 1.5. COVERAGE IN HIGH PRIORITY GROUPS Health workers and older adults will be used in this issue as a tracer for all high priority groups. Data on these two groups have been cleaned and countries that did not report consistently were excluded. Thirty countries have reported data on the number of health workers who have completed the primary series. In these 30 countries, considering country estimates instead of WHO health workforce estimates, 40.5% of health workers have completed the primary series, ranging from 10.3% in Burundi to 99% in Rwanda (Figure 11). Figure 11: Proportion of health workers who have completed the primary vaccination series against COVID-19 in 30 countries in the African Region (data as of 30 October 2022) Twenty-four countries have reported data on the number of older adults who have completed the primary series. In these 24 countries, considering country estimates instead of the United Nations population estimates, 36.9% of older adults have completed the primary series, ranging from 0.9% in Chad to 83% in Cabo Verde (Figure 12). 16 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Figure 12: Proportion of older adults who have completed the primary vaccination series against COVID-19 in 24 countries in the African Region (data as of 30 October 2022) Low coverage in Chad, the United Republic of Tanzania, Ghana and the DRC may result from under- reporting due to suboptimal data collection systems. 17 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Author : File name : 15.JPG File Size : 6.1 MB Dimensions : 5760 x 3840 Credit : WHO/Motherland productions Copyright : © WHO/Motherland productions Date created : 2022-06-07 18:42:33 Description : https://www.afro.who.int/photo-story/expanding-south-sudans-covid-19- vaccination-remote-regionsExpanding South Sudan’s COVID-19 vaccination to remote regions 29 April 2022 Juba - Near the banks of the White Nile in South Sudan, residents of a settlement are among the In October 2022, the WHO Regional Office for Africa (WHO AFRO), in an effort to better understand the stagnating COVID-19 coverage rates in countries, conducted more country- centred activities. In a press briefing organized on 20 October 2022, the WHO Regional Director for Africa, Dr Matshidiso Moeti, noted that “the end of the COVID-19 pandemic is within sight, but as long as Africa lags far behind the rest of the world in reaching widespread protection, there is a dangerous gap which the virus can exploit to come roaring back”. She added that “the biggest priority is to shield our most vulnerable populations from the worst effects of COVID-19. On this front, we are seeing some progress as countries step up efforts to boost coverage among health workers, the elderly and those with compromised immune systems.” The response to multiple public health emergencies in the African Region continued to affect the roll-out of COVID-19 vaccines. Ghana, Togo, Malawi, Mozambique, Benin, Democratic Republic of the Congo, Zimbabwe, Zambia and Uganda conducted subnational and national immunization days (S/NIDs) against polio in October 2022. As Africa continues to grapple with the monkeypox pandemic, two new countries, including Egypt and Mozambique, reported their first confirmed cases in the past week. Twenty-five new cases were reported from Egypt, Central African Republic, Ghana, Sudan, and Mozambique. In general, 13 2. WHO/AFRO OPERATIONS UPDATE countries have confirmed monkeypox outbreaks in Africa from January to October 2022. Uganda continues to battle its Ebola outbreak, which has become a priority for the country. There is ongoing flooding in Malawi and South Sudan as well as cholera in Malawi and parts of Ethiopia. These events negatively impacted the implementation of high-impact COVID-19 vaccination activities. Notwithstanding these competing priorities, a few countries including Burkina Faso, Mozambique, South Sudan, Uganda, Zambia, Liberia, Niger and Malawi conducted COVID-19 vaccination campaigns in October 2022. WHO AFRO continued to implement the Multi-Partner Country Support Team (MP- CST) initiative in the month under review with a focus on the 14 priority countries . Through this initiative, consultants with expertise in immunization, demand generation, data management, logistics and waste management and health financing have been recruited and deployed to countries to support COVID-19 vaccination. In October 2022, eighteen additional consultants were recruited and deployed, bringing the total number of consultants deployed through the MP-CST initiative to 71. Efforts are being made to recruit additional MP-CSTs especially as countries continue to battle multiple outbreaks. 2 Burkina Faso, the Gambia, Senegal, Niger, Nigeria, Cameroon, Chad, Democratic Republic of the Congo, Burundi, the United Republic of Tanzania, South Sudan, Malawi, Madagascar, and Mali. © WHO/Motherland productions 18 COVID-19 VACCINATION IN THE WHO AFRICAN REGION The Vaccine Pillar continued to work with countries to review plans and budgets for vaccination activities. In October 2022, the Pillar participated in funding alignment calls of the COVID-19 Vaccine Delivery Partnership (COVDP) as well as calls with Zambia, Malawi and Cameroon to review plans and budget. These countries received financial support from AFRO for campaigns in October (Zambia and Malawi) and November (Cameroon). WHO AFRO, as part of efforts to improve the quality and coverage of mass campaigns, made the maiden mission of the COVID-19 Campaign Surge Support to Zambia. The 11-member team comprising immunization officers (4), a demand generation officer (1), logisticians (2), data managers (2), a finance officer (1) and an administrative/human resource officer (1) were deployed from 26 September to 14 October 2022. The team supported planning and preparations at the national and subnational levels, assessed campaign preparedness and offered support to bridge identified gaps and provided support for the implementation of the campaign. Through this support, and with good collaboration and commitment from the Ministry of Health, the campaign was able to reach 1 925 798 people, increasing the country performance from 56% of the target population completing the primary series to 74%. The success story of the Zambian mission is presented in detail in the Country Focus section of this issue. WHO AFRO continued to support Member States in the process of strengthening COVID-19 vaccination data management and adjusting population size estimates for high priority groups. To this end, three in-country missions were conducted in the DRC (3–7 October), Niger (10–14 October) and Gambia (24–28 October). WHO AFRO has so far disbursed US$ 3.8 million to Uganda, Malawi, Burkina Faso, DRC and Côte d’Ivoire, to support the implementation of operational mechanisms for strengthening COVID-19 vaccination data management and use. Author : File name : OMS_COVID 19-11.jpg File Size : 19.3 MB Dimensions : 6000 x 4000 Credit : WHO / Booming - Carlos Cesar Copyright : © WHO / Booming - Carlos Cesar Date created : 2021-09-27 18:57:32 Description : The first fase of Angola´s roll out of COVID-19 vaccines. The Angolan Ministry of Health announced the milestone of more than 1 million doses of vaccines administered to the population, after receiving 624 000 doses of the AstraZeneca-Oxford vaccine on 2 March this year from the Serum Institute of India, as part of the COVA initiative, and subsequently, in April 2021, an additional 495 000 doses. Read more here. “Through this support, and with good collaboration and commitment from the Ministry of Health, the campaign was able to reach 1 925 798 people, increasing the country performance from 56% of the target population completing the primary series to 74%. The success story of the Zambian mission is presented in detail in the Country Focus section of this issue.” 19 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Author : File name : OMS_COVID 19-11.jpg File Size : 19.3 MB Dimensions : 6000 x 4000 Credit : WHO / Booming - Carlos Cesar Copyright : © WHO / Booming - Carlos Cesar Date created : 2021-09-27 18:57:32 Description : The first fase of Angola´s roll out of COVID-19 vaccines. The Angolan Ministry of Health announced the milestone of more than 1 million doses of vaccines administered to the population, after receiving 624 000 doses of the AstraZeneca-Oxford vaccine on 2 March this year from the Serum Institute of India, as part of the COVA initiative, and subsequently, in April 2021, an additional 495 000 doses. Read more here. In July 2022, the WHO Regional Director for Africa sent an official communication to all the ministers of health in the African Region, calling for a fresh impetus to revive COVID-19 vaccination, focusing on high priority groups. In line with this appeal, the Government of Zambia decided to conduct a 10-day mass vaccination campaign in October 2022 to surpass 70% coverage of the target population and 50% coverage of the general population with the complete primary vaccination series in each of the 10 provinces of the country. Zambia, which started rolling out COVID-19 vaccination on 14 April 2021, had implemented two mass vaccination campaigns in December 2021 and May 2022. As of 26 September 2022, the number of people that had completed the rimary series accounted for 31% of the general population and 56% of the target population in Zambia. The country targeted adolescents and adults aged 12 years and above for COVID-19 vaccination including high p iority groups (health workers, older adults, people with comorbid conditions), giving a total of 10 919 814 people, representing 61% of the general population. The October mass vaccination campaign was implemented from 3 to 12 October. The campaign goal was to vaccinate 2 million people to surpass 70% coverage of the target population with the complete primary series at national level and in each province. Such an ambitious target requires adequate planning and robust preparedness including costed microplans for each province, and timely availability of all resources including vaccines and funding. To this end, the WHO Regional Office for Africa deployed 11 experts to support 3. COUNTRY FOCUS: ZAMBIA - IMPLEMENTING A SUCCESSFUL MASS VACCINATION CAMPAIGN TO MOVE TOWARDS THE GLOBAL TARGET “The national campaign aimed to vaccinate at least 1.15 million people to reach a target of 10% completing the primary vaccination series. The targeted populations for the campaign included health workers, old people, other adults, pregnant and lactating women, and adolescents aged 12-17 years.” © WHO / Booming - Carlos Cesar 20 COVID-19 VACCINATION IN THE WHO AFRICAN REGION the preparation and implementation of the campaign from 26 September to 14 October 2022. The WHO AFRO surge team comprised Immunization officers (4), a Demand generation officer (1), Logisticians (2), Data managers (2), a Finance officer (1) and a Human resource and Administrative officer (1). The National COVID-19 vaccination Steering Committee, made up of Ministry of Health officials and partners, led the planning and coordination of the campaign. All the 116 districts in the 10 provinces of Zambia conducted the vaccination campaign. In preparation for the campaign, the National Steering Committee held daily meetings to review COVID-19 vaccination performance against targets by province and district. Fifty-one low performing districts were identified for closer monitoring and technical support during the campaign. Below are some pre-campaign activities conducted at the national level in preparation for the campaign:  COVID-19 campaign readiness and preparedness assessments were conducted, and the preparedness dashboard updated daily. Major gaps identified were addressed before the start of the campaign. These included: low stock levels of the Pfizer vaccine at the subnational level, delayed disbursement of operational funds to the districts, and updating and digitizing of the technical support supervision tool.  The national campaign budget was consolidated, and adequate funds mobilized for campaign activities in all districts. A total of US$ 10 009 795 was mobilized respectively from the Government of Zambia (US$ 1 148 650) and partners including WHO (US$ 1 572 404), USAID (US$ 5 000 000), UNICEF (US$ 700 000), the Centre for Infectious Disease Research in Zambia (CIDRZ - US$ 1 588 741) and the International Federation of Red Cross and Red Crescent Societies (US$ 18 065).  A one-day virtual training/orientation for all supervisors (national, provincial and district) was conducted and teams of national supervisors constituted. A surge team of 11 officers from WHO AFRO joined forces with national supervisor teams to supervise the 10 provinces.  Engagements were held with all provinces and districts to provide technical guidance on the final preparations for the campaign and address challenges and concerns at subnational level before the campaign kick-off.  A support supervision monitoring dashboard was developed and used to monitor supervision activities in all districts in real time (Figure 13). Part of the WHO AFRO surge team deployed in Zambia to support the mass vaccination campaign 21 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Campus Vaccination team at Komo State College of Education Figure 13: Supportive supervision dashboard for the COVID-19 Vaccination Steering Committee at the Ministry of Health Zambia, developed with support from WHO AFRO. 22 COVID-19 VACCINATION IN THE WHO AFRICAN REGION The campaign was officially launched by the Honourable Minister of Health at a Launching Ceremony in the Capital City of Lusaka on 4 October 2022. The main approaches used were fixed sites, outreach, and mobile teams. A total of 3274 health facilities (fixed sites), 6548 community outreach sites and 152 mobile vaccination teams were deployed. Door-to-door mobilization and vaccination strategy by mobile vaccination teams was one of the most effective strategies used to reach unvaccinated populations and increased coverage in the most underperforming health facilities. The door-to-door vaccination strategy was also used to reach older persons in their homes. Other effective mobilization strategies used included event-based mobilization in urban centres, use of village headmen, youth, women leaders for peer-to-peer mobilization, and influential political and church leaders. During the campaign, 1 925 798 people were vaccinated, representing 96% of the set target. Figure 14 presents the percentage of the general and target population with complete primary series as of 24 October 2022, that is, after the campaign. At the national level, 74% of the target population has completed the primary series (45% in the general population). Five provinces have surpassed 70% of the target population who have completed the primary series: Central, Copperbelt, Muchinga, Northern and Northwestern. Figure 15 compares the percentage of people fully vaccinated in the general population at the end of September (before the campaign) and during the campaign. Figure 14. Percentage of the general and target population with complete primary series at national level and in each of the 10 provinces of the country (data as of 24 October 2022). 23 COVID-19 VACCINATION IN THE WHO AFRICAN REGION The following table summarizes the strengths and weaknesses of the mass vaccination campaign as well as recommendations for future campaigns. Figure 15. Percentage of people who completed the primary series in the general population as of 26 September 2022 and in October 2022 (during the mass vaccination campaign). 24 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Strengths  High political commitment from the Government, Ministry of Health, provincial and district leadership was key to driving the campaign activities. At the subnational level, provincial and district health directors proactively led the vaccination campaign activities and conducted field visits to vaccination sites with the other supervisory teams.  Daily progress review meetings were held by each district and province to identify any bottlenecks and address them in time. Lessons and good practices were also shared across facilities, and low performing facilities quickly adjusted strategies to improve the outputs of the campaign.  Use of door-to-door mobilization and vaccination strategy by mobile vaccination teams to reach unvaccinated populations increased coverage in most underperforming health facilities. The door- to-door strategy was also leveraged to reach the elderly population in their homes.  Strong data use at all levels to inform strategies and level of support at all levels (health facility, district, provincial and national levels). Health facilities were using data to plan and adjust strategies rapidly.  Facilities had mechanisms for tracking 2nd dose defaulters and refusals for follow up, such as refusals registers.  Identifying bottlenecks and addressing them in real time or through follow up visits by the support supervision teams. These included vaccine stock- outs, health worker knowledge gaps and gaps in cold chain maintenance.  Centralized data entry at the district level for health facilities with poor network connectivity to reduce any backlog during the campaign.  Efforts were made to integrate COVID-19 vaccination into other health services such as antenatal care clinics, HIV clinics and out-patient clinics at most health facilities. 25 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Challenges/bottlenecks/weaknesses  Districts and health facilities were aiming to achieve 70% coverage of the target population instead of 70% of the total population. The remaining 30% of the target population will be missed.  Delayed disbursement of operational funds for the campaign affected the start of some campaign activities.  Relaxation of public health and social measures (PHSM) by the Minister of health a few days before the campaign kicked off reduced the motivation of the population to get vaccinated.  Limited movement of vaccination teams in some rural areas due to bad terrain and other transportation challenges.  Suboptimal cold chain management in some health facilities.  Poor internet connectivity caused delays in data entry and a backlog of data had to be entered in the reporting system in some health facilities.  There were no deliberate strategies to reach the priority groups besides door-to-door vaccination. Recommendations for COVID-19 vaccination roll-out  It is critical for Zambia to urgently develop and implement a plan for integrating COVID-19 vaccination into routine immunization, primary health services and other relevant health services.  Improve the effectiveness of the systems in place for documenting vaccination for high priority groups and tracking appointments for second doses when required.  Need for adjusting population size estimates for high priority groups to compute more accurate coverages.  There is a need to keep engaging community leaders and health workers to continue demystifying deep- rooted myths and misconceptions since most of the remaining unvaccinated population are harder to convince to get vaccinated. Implementing a successful COVID-19 mass vaccination campaign requires strong political and technical leadership and commitment, adequate preparation, adequate and timely disbursement of funds, supportive supervision, and data use to inform real-time tailored support to the vaccinating teams. Interpersonal communication by knowledgeable health workers and community health workers is important for debunking deep-rooted myths and misinformation within the communities. 26 COVID-19 VACCINATION IN THE WHO AFRICAN REGION The Democratic Republic of the Congo (DRC) began to roll out COVID-19 vaccination on 19 April 2021 in Kinshasa, a province-city with an estimated 15 million inhabitants. The province was followed by five other provinces (Lualaba, Haut-Katanga, Kongo Central, North-Kivu and South-Kivu), before the vaccination programme was extended to all the 26 provinces of the country. At the end of October 2021, six months after the beginning of COVID-19 vaccination, only 38 163 people had completed the primary vaccination series, representing 0.03% of the population. To increase vaccination coverage in Kinshasa, VillageReach, a non-profit organization, supported the Congolese Government’s efforts to roll out COVID-19 vaccines by establishing, on 29 November 2021, a high-volume vaccination site (Vaccinodrome) at Place des Evolués in Gombe, the downtown area of Kinshasa. Place des Evolués is one of the busiest and most attractive places in the city. At the request of the Expanded Programme on Immunization and the Governorate of Kinshasa Province, VillageReach established three additional vaccinodromes to cover other densely populated areas in Kinshasa: Place des Artistes (Kalamu Health Zone, launched on 26 February 2022), Marché de la Liberté 4. PARTNER FOCUS: USING HIGH VOLUME VACCINATION SITES IN A CROWDED CITY TO INCREASE ACCESS TO AND DEMAND FOR COVID-19 VACCINATION: EXPERIENCE OF VILLAGEREACH IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO (Massina 1 Health Zone, launched on 7 March 2022) and Terrain Sainte Thérèse (N’djili Health Zone, launched on 18 March 2022). The overall goal of setting up the vaccinodromes was to ensure access to and demand for COVID-19 vaccines by taking vaccination closer to where people live and work. The target for each vaccinodrome was to have 500 people vaccinated per day. The space in each vaccinodrome is large enough to safely accommodate 200 or more people an hour, providing room to queue while physically distancing, vaccinate, and post-vaccination monitoring. The vaccinodromes used a multimodal vaccine delivery strategy, which is a combination of fixed vaccination sites and outreach efforts (including mobile vaccination teams moving to different locations in the community surrounding the vaccinodrome, and occasional special vaccination events). Each vaccinodrome fixed site had a plastic tent with four areas: a waiting and registration area; a pre-vaccination consultation area; a vaccine administration area; and a post- vaccination observation area. The vaccine Demand generation activities by Community Health Workers 27 COVID-19 VACCINATION IN THE WHO AFRICAN REGION administration area had booths for each of the available vaccines (Moderna, Pfizer BioNtech, Johnson & Johnson and Sinovac). In addition to observation after vaccination, active surveillance of adverse events following immunization (AEFI) was done through phone calls to all clients, one day after receiving the jab. The cost of setting up the first two vaccinodromes was about US$ 15 000. The cost of setting up the last two vaccinodromes was less than that of the first two, as plastic tents were provided by WHO. The number of staff working at each vaccinodrome varied from 57 to 70, including four clinicians, six vaccinators, two nurses in charge of client registration, one to four data clerks, 10 to 20 community health workers (CHW), two to three cleaners, one sanitation technician, three to six security staff, three logisticians, nine supervisors (from national, provincial and health zone levels), one site manager, one administrative assistant and one to three data analysts. Demand creation activities in areas surrounding each vaccinodrome were conducted by CHWs who visited markets, bus stops, and bars, to raise awareness about COVID-19 vaccination, ensure pre-registration and refer people to the fixed site vaccinodrome. About 53% of people vaccinated in the four vaccinodromes were referred by CHWs. Clients vaccinated at the vaccinodromes were encouraged to take photos of themselves while receiving the vaccine shot and share them with relatives and friends through social media (WhatsApp, Facebook, Instagram, Tik Tok) as a way of promoting COVID-19 vaccination. Spot messages on local radio and television were broadcast to promote the vaccinodromes. Some outreach sessions were conducted by Vaccinodrome at Place des Evolués 28 COVID-19 VACCINATION IN THE WHO AFRICAN REGION View of Vaccinodrome at Place des Artistes community-based organizations to reach people with comorbidities, people with disabilities, as well as those at workplaces. Data were collected using client-specific forms and entered in both the paper- based registers and a digital platform (DHIS2 tracker). Both paper-based and digital certificates were delivered to clients who had been vaccinated. As of 16 September 2022, a total of 4 874 216 people (4% of the population) had been vaccinated in the Democratic Republic of the Congo including 696 269 in Kinshasa. Between 29 November 2021 and 16 September 2022 (8 and a half months), 229 983 people were vaccinated in the four vaccinodromes, including 118 652 who have completed the primary series (51.5% of all those vaccinated) (Table 3). The four vaccinodromes accounted for 33% of people vaccinated in Kinshasa. Famous musician Innoss’B getting vaccinated at the Place des Artistes Vaccinodrome 29 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Vaccinodrome Moderna Pfizer Sinovac Janssen Total vaccinated Complete primary series Dose 1 Dose 2 Dose 1 Dose 2 Dose 1 Dose 2 Single dose Number % Number % Place des Evolués 6 696 5 789 15 876 12 502 8 - 28 658 69 529 30.2 46 949 39.6 Place des Artistes 8 491 1 880 10 941 3 507 3 529 564 13 589 42 501 18.5 19 540 16.5 Marché de la Liberté 3 846 1 412 15 725 3 794 1 606 480 12 566 39 429 17.1 18 252 15.4 Terrain Sainte Therese 7 704 1 521 34 193 11 817 2 716 571 20 002 78 524 34.1 33 911 28.6 Total 26 737 10 602 76 735 31 620 7 859 1 615 74 815 229 983 100.0 118 652 100.0 Table 3: Cumulative number of people vaccinated against COVID-19 in four vaccinodromes in Kinshasa, Democratic Republic of the Congo (data as of 16 September 2022) Table 4: Average number of people vaccinated per day in four Vaccinodromes in Kinshasa, Democratic Republic of the Congo (Data as of 16 September 2022) The vaccinodrome of Terrain Saint Therese recorded the highest performance in terms of number of people vaccinated per day compared to the set target of 500 per day (Table 4). Figure 16 shows the distribution of people vaccinated per month and by vaccinodrome. Vaccinodrome Moderna Pfizer Sinovac Janssen Total vaccinated Complete primary series Dose 1 Dose 2 Dose 1 Dose 2 Dose 1 Dose 2 Single dose Number % Number % Place des Evolués 6 696 5 789 15 876 12 502 8 - 28 658 69 529 30.2 46 949 39.6 Place des Artistes 8 491 1 880 10 941 3 507 3 529 564 13 589 42 501 18.5 19 540 16.5 Marché de la Liberté 3 846 1 412 15 725 3 794 1 606 480 12 566 39 429 17.1 18 252 15.4 Terrain Sainte Therese 7 704 1 521 34 193 11 817 2 716 571 20 002 78 524 34.1 33 911 28.6 Total 26 737 10 602 76 735 31 620 7 859 1 615 74 815 229 983 100.0 118 652 100.0 30 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Figure 16: Number of people vaccinated per month in four vaccinodromes in Kinshasa, Democratic Republic of Congo In September 2022, three out of the four vaccinodromes (Place des Artistes, Marché de la Liberté, Terrain Sainte Therese) were closed, as part of the process to transition COVID-19 vaccination to government-owned health facilities. These facilities took over the vaccinodrome activities and integrated COVID-19 vaccination into routine immunization services. The transition was completed on 1 July 2022, 4 August 2022, and 16 September 2022 for Terrain Sainte Therese, Maché de la Liberté, and Place des Artistes respectively. The following criteria were used to select the health facilities to transition to integrated COVID-19 vaccine services: (i) the health facility is public and government-owned; (ii) staff trained in routine immunization and COVID-19 vaccination are available; (iii) routine immunization is already being carried out at the health facility; (iv) the facility has adequate capacity for integrating COVID-19 vaccination; (v) and the facility has adequate cold storage for additional vaccines. The Place des Artistes Vaccinodrome is still operational and is being managed by another non-profit organization: Global Health Systems Solution (GHSS). Stock-outs of some antigens, insecurity caused by gangs (Kuluna) especially around the Terrain Sainte Therese vaccinodrome, bad weather that damaged the roof of the vaccinodromes, are the main challenges that were experienced by VillageReach in the management of the four vaccinodromes. 31 COVID-19 VACCINATION IN THE WHO AFRICAN REGION The vaccinodromes were funded by Bill & Melinda Gates Foundation. Some of the key lessons learnt were:  Establishing high volume vaccination sites in densely populated areas contributed to improving access to COVID-19 vaccines.  The use of CHWs to raise awareness about COVID-19 vaccination in the communities contributed to demand generation.  The use of mobile teams to reach high priority groups and offer vaccination services at workplaces contributed to extending the vaccinodromes’ capacities.  Transitioning to government-owned health facilities will contribute to integrating COVID-19 vaccination into routine vaccination but may result in an absolute drop in the number of people vaccinated daily as the health facilities will not have the same capacities as the vaccinodromes. 32 COVID-19 VACCINATION IN THE WHO AFRICAN REGION 5. TECHNICAL/SCIENTIFIC UPDATE: GOOD PRACTICE STATEMENT ON THE USE OF SECOND BOOSTER DOSES FOR COVID-19 VACCINES Methods Literature reviews and the summary of available evidence served as the basis for the guidance provided in the document. The recommendations apply to all COVID-19 vaccines that had received WHO Emergency Use Listing (EUL) as of 11 August 2022. There is increasing evidence of the benefits of a second COVID-19 vaccine booster dose for restoring waning vaccine effectiveness (VE). The data exist mainly for mRNA vaccines with very limited data for other COVID-19 vaccines. Nevertheless, SAGE considered the available data from several sources as sufficient to proceed with issuing the good practice statement. Rationale for a second booster In the context of the Omicron variant, waning of VE was documented as relatively minor against severe disease, and significant and rapid against symptomatic illness. The rationale for a second booster is to restore and possibly enhance protection. While second boosters are currently being offered (that is, fourth doses to older adults and fifth doses to immunocompromised persons), data on their additional protection in terms of duration of vaccine effectiveness are currently limited. Good practice statement The objective of this good practice statement is to provide a review of the evidence and policy recommendations for a second booster dose. Achieving high and equitable vaccine coverage rates for primary series and first booster doses globally among the groups at higher risk of severe disease/death remains the greatest priority. The combination of waning vaccine- and infection-induced SARS- CoV-2 immunity against infection and mild disease, and to a lesser extent severe disease, the widespread relaxation of public health and social measures, temporal fluctuations in virus transmission, and the potential emergence of new SARS-CoV-2 variants, may lead to one or more surges in SARS-CoV-2 activity in the The “Good practice statement on the use of second booster doses for COVID-19 vaccines” guidance document, produced by the World Health Organization (WHO), was developed based on the advice issued by the Strategic Advisory Group of Experts (SAGE) at its meeting on 11 August 2022. The full document can be accessed at: https://www.who.int/publications/i/item/WHO-2019-nCoV- vaccines-SAGE-good-practice-statement-second-booster 33 COVID-19 VACCINATION IN THE WHO AFRICAN REGION coming months, with the need to introduce a second booster dose in a risk-based approach. Evolving evidence from studies suggests that additional protection of the most vulnerable populations, at least for several months, is likely to be achieved through administration of a second booster dose, although follow-up time for these studies is limited. When deciding to implement second boosters, each country needs to consider the age structure, current and potential burden of severe COVID-19 disease and hospitalizations, availability and access to vaccines, opportunity costs, coverage rates with primary series and community acceptance of second boosters. The incremental benefit of a second booster is likely lower compared to primary series and first booster doses. To reduce the risk of severe disease, deaths, and disruption to health services, WHO recommends that countries consider a second booster dose for the following population groups: i. all older persons (age specific cut-off should be defined by countries based on local COVID-19 epidemiology) ii. all persons with moderately and severely immunocompromising conditions iii. adults with comorbidities that put them at higher risk of severe disease iv. pregnant women v. health workers WHO supports a flexible approach to homologous versus heterologous vaccination schedules for both primary and secondary doses. As VE wanes, a second booster dose should be offered 4-6 months after the last dose or, if this time is missed, as soon as possible thereafter, especially for individuals at high risk for disease and/or death. Variant-containing vaccines can be considered as well, but individuals at high risk should not delay receiving a booster dose in anticipation of these. Furthermore, WHO recommends countries consider co- administration of COVID-19 vaccines with seasonal influenza or other adult vaccines whenever feasible, in line with WHO’s aim for a life course approach for the implementation of COVID-19 vaccines. The optimal interval between vaccination after natural infection is currently not known. In the context of second boosters, individuals who have had a SARS- CoV-2 infection after the first booster dose, could consider delaying the second booster dose by 4–6 months. The high incidence of mild to moderate symptomatic COVID-19 illness continues to cause significant disruptions to society. SARS-CoV-2 infections, even if not severe and not requiring hospitalization, may impact economies, the resilience of the work force due to the need for isolation, loss of productivity, and the ability to travel. The impact of currently available vaccines on reducing symptomatic illness and transmission in the context of Omicron is modest. The effects of a second booster dose on restoring VE against symptomatic illness will be transient and likely not last longer than a few months. Countries considering methods to reduce the socioeconomic impact due to mild and moderate SARS-CoV-2 infections need to consider cost–benefit, affordability, opportunity costs to other vaccination programmes, and community acceptance of a second booster dose before offering second boosters to individuals who do not fall into the high-risk categories as listed above. WHO recommends that countries consider the broader integration of COVID-19 vaccination and booster doses into primary health care through national immunization programmes. 34 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Author : File name : _NB_3150.JPG File Size : 13.6 MB Dimensions : 5184 x 3456 Credit : WHO / EPA Copyright : © WHO / EPA Date created : 2021-09-28 06:14:22 Description : Workers offload boxes of AstraZeneca/Oxford vaccines as the country receives its first batch of coronavirus disease (COVID-19) vaccines under COVA scheme, in Abidjan, Ivory Coast February 26, 2021. 504 thousand doses of the Astrazeneca / Oxford vaccine were received in Abidjan. Vaccination against COVID-19 begins March 1 in Côte d'Ivoire  AFRO COVID-19 Vaccination dashboard: https://rebrand.ly/AFROCovid-19Dashboard  AFRO microsite on lessons learnt in rolling out COVID-19 vaccination https://covid-19vaccineslessonslearned.afro.who.int/  AFRO COVID-19 dashboard: https://who.maps.arcgis.com/apps/dashboards/0c9b3a8b68d0437a8cf28581e9c063a9  AFRO Country Profile Dashboard: https://worldhealthorg.shinyapps.io/Covid19countryProfileDashboard/ 6. USEFUL LINKS © WHO / EPA APPENDIX: DOSES ADMINISTERED AND VACCINATION COVERAGE BY COUNTRY IN THE WHO AFRICAN REGION (DATA AS OF 2 October 2022) Country # Doses received # Doses administered # Vaccinated by at least one dose # Fully vaccinated % Doses administered % Vaccinated by at least one dose % Fully vaccinated Mauritius 3 915 940 2 610 884 1 123 773 1 088 142 66.7 88.8 86.0 Seychelles 612 000 217 487 85 655 81 494 35.5 80.4 76.5 Liberia 6 622 860 4 179 219 3 692 705 3 511 588 63.1 79.4 75.5 Rwanda 28 117 820 26 106 436 9 547 259 8 962 371 92.8 71.4 67.0 Cabo Verde 1 045 840 859 940 356 734 308 720 82.2 72.6 62.8 Botswana 3 148 925 2 891 400 1 589 621 1 378 230 91.8 64.5 55.9 Comoros 1 366 879 835 021 438 825 397 080 61.1 53.5 48.4 Sao Tome & Principe 431 020 227 603 127 410 103 508 52.8 58.2 47.2 Zambia 16 579 500 13 055 448 10 611 599 8 143 760 78.7 56.0 43.0 Mozambique 34 777 686 19 435 780 18 585 783 13 573 329 55.9 58.8 42.9 Eswatini 830 880 773 579 492 300 490 673 93.1 42.4 42.3 Lesotho 2 033 170 1 102 069 1 631 364 872 661 54.2 78.6 42.0 Tanzania 34 378 670 31 047 338 26 392 125 24 524 930 90.3 43.1 40.0 Sierra Leone 6 965 850 4 834 206 3 513 208 2 736 804 69.4 46.6 36.3 South Africa 41 525 237 37 796 915 23 825 968 20 898 618 91.0 40.1 35.2 Ethiopia 73 085 410 52 509 414 43 111 242 36 707 357 71.8 40.2 34.2 Cote d'Ivoire 23 624 190 20 588 390 12 681 498 9 215 656 87.1 46.2 33.5 Mauritania 7 102 490 3 252 274 2 008 576 1 426 547 45.8 45.9 32.6 Zimbabwe 22 397 800 12 622 764 6 542 794 4 902 925 56.4 40.0 30.0 Uganda 50 252 820 25 783 131 18 867 075 12 765 601 51.3 42.7 28.9 CAR 2 568 280 1 754 834 1 674 402 1 616 195 68.3 29.3 28.3 Ghana 34 047 598 20 359 448 11 837 459 8 758 799 59.8 37.3 27.6 Angola 40 602 092 22 990 789 14 220 830 7 814 121 56.6 43.0 23.6 Guinea 9 630 810 7 626 551 5 209 518 2 983 614 79.2 39.3 22.5 Nigeria 106 124 380 87 872 150 60 946 631 48 312 871 82.8 28.1 22.3 Country # Doses received # Doses administered # Vaccinated by at least one dose # Fully vaccinated % Doses administered % Vaccinated by at least one dose % Fully vaccinated Niger 8 737 660 7 042 134 5 935 299 5 176 311 80.6 24.3 21.2 Benin 6 541 590 3 693 045 3 207 889 2 691 413 56.5 24.9 20.9 Namibia 3 047 115 962 898 596 399 519 505 31.6 23.4 20.4 Kenya 33 958 650 22 457 583 13 969 231 10 564 568 66.1 26.9 20.3 Chad 8 476 860 3 879 297 3 746 216 3 619 014 45.8 20.9 20.2 Guinea-Bissau 1 443 670 673 091 640 393 404 228 46.6 31.3 19.7 Togo 6 405 510 3 381 542 2 232 792 1 451 712 52.8 28.0 18.2 South Sudan 3 050 170 2 180 708 2 143 114 2 101 283 71.5 15.7 15.4 Malawi 7 193 670 5 619 203 3 748 590 2 949 082 78.1 19.4 15.2 Algeria 33 876 400 15 267 442 7 840 131 6 481 186 45.1 17.7 14.7 Gambia 894 093 815 861 452 514 357 390 91.3 17.1 13.5 Eq. Guinea 860 000 488 738 270 109 214 032 56.8 16.5 13.1 Burkina Faso 9 650 540 4 070 678 3 079 151 2 658 480 42.2 13.9 12.0 Gabon 1 630 600 569 829 310 842 257 322 34.9 14.0 11.6 Congo 3 236 630 833 210 695 760 654 119 25.7 12.0 11.3 Mali 6 490 400 3 615 160 2 631 658 2 110 796 55.7 12.0 9.6 Senegal 6 780 898 2 469 499 1 732 282 1 263 032 36.4 9.8 7.1 Madagascar 7 382 476 2 069 585 1 793 522 1 722 381 28.0 6.2 5.9 DRC 14 394 340 6 185 534 6 577 469 5 575 771 43.0 5.5 4.7 Cameroon 5 746 910 1 924 807 1 638 561 1 286 179 33.5 5.9 4.6 Burundi 802 400 25 983 24 053 23 471 3.2 0.2 0.2 Eritrea Total 722 388 729 489 558 897 342 380 329 273 656 869 67.8 29.3 23.4 37 COVID-19 VACCINATION IN THE WHO AFRICAN REGION © WHO Regional Office for Africa This is not an official publication of the World Health Organization. Correspondence on this publication may be directed to:  Dr Phionah Atuhebwe, COVID-19 Vaccine Pillar Lead (atuhebwep@who.int)  Dr Franck Mboussou, COVID-19 Vaccine Monitoring and Evaluation Sub-Pillar Lead (mboussou@ who.int) Requests for permission to reproduce or translate this publication – whether for sale or for non- commercial distribution – should be sent to the same address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. 38 COVID-19 VACCINATION IN THE WHO AFRICAN REGION Contributors Sheillah Nsasiirwe Ajiri Atagbaza Daniel Oyaole Arish Bukhari Leacky Kamau Lisa Sthreshley Joseph Biey Charlotte Kabore Fred Osei-Sarpong Chinyere Nwonye Cyrus Kihoro Petus Amos Gilson Paluku Ado Bwaka Oniovo Efe-Aluta So Yoon SIM Carla Toko (VillageReach) Fidele Ngabo (WHO DRC) Cedric Mwanga (WHO DRC) Marcellin Nimpa (WHO DRC) Oluwole SMILE (WCO Zambia). Editorial Team Benido Impouma, UCN Director Phionah Atuhebwe, Vaccines Pillar Lead Franck Mboussou, Vaccination Information Monitoring and Evaluation Sub-pillar Lead Bridget Farham, Scientist. Acknowledgements WHO staff from the COVID-19 vaccination IMST, IST and WCOs.