The Impact of COVID-19 Vaccine Coverage on Deaths Outcome in Africa, Subregional Differences and the need for a Renewed Multi-level Effort

IBEROAMERICAN JOURNAL OF MEDICINE 02 (2022) 83-91

Original article

IBEROAMERICAN
JOURNAL OF
MEDICINE

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The Impact of COVID-19 Vaccine Coverage on Deaths Outcome in
Africa, Subregional Differences and the need for a Renewed

Multi-level Effort

Armel F. Setubi %*\, Esther Nakoya », Annie-Flore K. Tchougene ‘, Xavier-Gabriel

Fopokam 4

“Department of Infectious Disease, Georgetown University Medical Center, Washington DC, USA
’ Department of International Relations, Catholic University of Eastern Africa, Nairobi, Kenya

© Department of Pediatrics, Yaoundé University Health Center, Yaoundé, Cameroon

4 Department of Biochemistry, University of Yaoundé |, Yaoundé, Cameroon

ARTICLE INFO

ABSTRACT

Article history:

Received 05 February 2022
Received in revised form 03
March 2022

Accepted 16 March 2022

Keywords:
SARS-CoV-2
Africa
COVID-19
Vaccine
Immunology
New strains

International relations

Introduction: SARS-CoV-2 continues to raise health and socio-economical concerns globally.
The recent discovery of the B.1.1.529 (Omicron) variant with its critical mutations has
heightened the debate about the need for a better global vaccination rollout to prevent the
emergence of new SARS-CoV-2 strains. Optimizing vaccine rollout in Africa is crucial for the
management of the pandemic and preventing the rise of new strains. To better direct efforts
and interventions it is important to know what parts of the continent necessitate more
attention.

Material and Methods: 30 African countries were grouped in five geographical subregions, six
countries for each subregion. Data on confirmed cases, doses administered, fully vaccinated,
and deaths were extracted from the Johns Hopkins Coronavirus Resource Center database. The
ANOVA test evaluated differences in means for these variables classified by subregions. The
correlation test and the linear regression examined the relationship between these
independent variables and total deaths.

Results: There was a significant regional difference in confirmed cases (P<0.0001), and in fully
vaccinated (P=0.01) across the five subregions. The overall model showed that there is a
significant regional difference in the three variables’ effect on total deaths (P<0.0001). The
linear regression indicated an association between the total number of deaths in relation to the
confirmed cases, doses administered, and fully vaccinated (P<0.0001).

Discussion: This study indicates that a relation exists between total deaths and the variables
confirmed cases, doses administered, and fully vaccinated. More importantly, African countries
grouped in geographical subregions perform differently in terms of vaccine rollout, and that
offers insights for better and oriented interventions.

© 2022 The Authors. Published by Iberoamerican Journal of Medicine. This is an open access article under
the CC BY license (http://creativecommons. org/licenses/by/4.0/).

* Corresponding author.
E-mail address: mf1329 @georgetown.edu

ISSN: 2695-5075 / © 2022 The Authors. Published by Iberoamerican Journal of Medicine. This is an open access article under the CC BY license
(http://creativecommons. org/licenses/by/4.0/).

https://doi.org/10.53986/ibjm.2022.0015

84

IBEROAMERICAN JOURNAL OF MEDICINE 02 (2022) 83-91

El impacto de la cobertura de la vacuna COVID-19 en el resultado de muertes en
Africa, las diferencias subregionales y la necesidad de un esfuerzo renovado de varios

niveles

INFO. ARTICULO

RESUMEN

Historia del articulo:

Recibido 05 Febrero 2022
Recibido en forma revisada 03
Marzo 2022

Aceptado 16 Marzo 2022

Palabras clave:
SARS-CoV-2
Africa
COVID-19
Vacuna
Immunologia
Nuevas cepas

Relaciones internacionales

Introduccién: E] SARS-CoV-2 sigue generando preocupaciones sanitarias y socioeconémicas a
nivel mundial. El reciente descubrimiento de la variante B.1.1.529 (Omicron), con sus
mutaciones criticas, ha aumentado el debate sobre la necesidad de un mejor despliegue
mundial de vacunacién para prevenir la aparicidn de nuevas cepas de SARS-CoV-2. La
optimizacion del despliegue de vacunas en Africa es crucial para la gestion de la pandemia y la
prevencion del surgimiento de nuevas cepas. Para dirigir mejor los esfuerzos y las
intervenciones, es importante saber qué partes del continente necesitan mas atencion.
Material y Métodos: 30 paises africanos fueron agrupados en cinco subregiones geograficas,
seis paises para cada subregion. Los datos sobre casos confirmados, dosis administradas,
vacunacion completa y muertes se extrajeron de la base de datos del Centro de Recursos de
Coronavirus de Johns Hopkins. La prueba ANOVA evaluo diferencias de medias para estas
variables clasificadas por subregiones. La prueba de correlacion y la regresién lineal
examinaron la relacion entre estas variables independientes y el total de muertes.

Resultados: Hubo una diferencia regional significativa en casos confirmados (P<0,0001) y en
vacunados completos (P=0,01) en las cinco subregiones. E] modelo general mostré que existe
una diferencia regional significativa en el efecto de las tres variables sobre el total de muertes
(P<0,0001). La regresi6n lineal indicé una asociaci6n entre el numero total de muertes con
relacidn a los casos confirmados, las dosis administradas y los vacunados completos
(P<0,0001).

Discusion: Este estudio indica que existe una relaci6n entre el total de muertes y las variables
casos confirmados, dosis administradas y vacunados completos. Mas importante atin, los
paises africanos agrupados en subregiones geograficas se desempefian de manera diferente en
términos de implementacién de vacunas, y eso ofrece informacién para intervenciones
mejores y mas orientadas.

© 2022 Los Autores. Publicado por Iberoamerican Journal of Medicine. Este es un articulo en acceso abierto
bajo licencia CC BY (http://creativecommons. org/licenses/by/4.0/).

HOWTO CITE THIS ARTICLE: Setubi AF, Nakoya E, Tchougene AFK, Fopokam XG. The Impact of COVID-19 Vaccine Coverage on
Deaths Outcome in Africa, Subregional Differences and the need for a Renewed Multi-level Effort. Iberoam J Med.
2022;4(2):83-91. doi: 10.53986/ibjm.2022.0015.

1. INTRODUCTION

COVID-19 pandemic has caused heavy burden on countries
around the world, forcing governments to take radical
measures including lockdown, trade limitations, health
emergency measures, and fiscal changes [1]. On January 17
2022, there were about 326,279,424 confirmed cases of
COVID-19 globally with an estimated 5,536,609 deaths [2].
The WHO weekly epidemiological update of the 19" to the
25 January 2022 indicated that COVID-19 cases had
increased by 5% globally, and that about 21 million new
cases were reported across the six WHO regions with the
largest increase in new cases in the Eastern Mediterranean
Region (39%) [3]. Africa, with its limited resources,
continues to depend on international intervention for
vaccine and drug development as well as procurement. On
January 12, 2022, the African continent had registered

10,201,488 cases of COVID-19, with a total death of
232,770 [4]. At the same date, the rate of vaccination on the
continent was 60.50% of the supplied doses, with 14.92% of
the population partially vaccinated and 10.09% of the
African population fully vaccinated not counting booster
shots [4]. Just like many other viruses, SARS-CoV-2
consists of a microscopic infectious agent in which the
genetic code is enclosed by a coat essentially made of
proteins, which cannot live outside the host cells that assure
its survival and replication [5]. One of the best ways to
prevent SARS-CoV-2 is through vaccination. Immunization
helps the body to produce memory cells, which remember
the infectious agent and how to fight it [6]. Hence, when the
body is infected by the pathogenic agent, the immune system
acts faster and vigorously, producing a secondary immune
response instead of a primary response [7]. SARS-CoV-2
has on its surface a glycoprotein, which forms the spike
protein essential for the virus’ entry into living cells. So, the

IBEROAMERICAN JOURNAL OF MEDICINE 02 (2022) 83-91 85

entry of the virus in human cells is made possible through
the interaction between the virus receptor-binding motif
(RBM) and the angiotensin converting enzyme 2 (ACE2) of
human cells [8].

New vaccines including mRNA vaccine have revolutionized
the field of vaccinology and has shown tremendous results
in the fight against SARS-CoV-2. When infection by SARS-
CoV-2 occurs, the immune system uses antibodies to block
the virus’ spike protein. The mRNA vaccine in this case
contains the message to produce the spike protein, which in
turn triggers the body to produce antibodies against the spike
protein of SARS-CoV-2 [9]. Therefore, after immunization
with the vaccine, a contact with the virus will cause naive B-
cells to quickly proliferate, differentiate, and produce a class
of antibody that will block the spike protein of the SARS-
CoV-2 and so prevent entry of the virus into host cells. This
process is crucial in stopping the virus, reducing disease
severity as well as viral mutation.

The abovementioned process puts into perspective the
advantages procured by vaccines from the point of view of
infection and disease prevention. Nevertheless, this
advantage remains futile when vaccine efforts fail to cover
a critical number of people in the population. For a vaccine
to be effective against a pandemic such as COVID-19,
vaccine rollout should be optimized globally and cover
enough people to prevent the virus from breaking through
the immunologic barrier built at the ecologic level [10]. In
case of failure, the risk of facing new variants of SARS-Cov-
2 resulting from viral mutation grows. This mutation
undermines the energy put in vaccine development as well
as the capacity of the vaccine to contain the pandemic. Such
a situation explains the emergence of new variants of SARS-
CoV-2 including the Delta variant, and the Omicron variant,
the headlines in past
Unfortunately, many regions of the world fall through the
cracks and fail to deploy an effective and large-scale
vaccination program capable of stopping viral mutations.
Africa is particularly faced with the challenge of low vaccine
uptake, which feeds on several limitations ranging from
inadequate capacities and resources, poor health systems,

which have made months.

and more importantly the growing impact of vaccine
hesitancy across the continent [11, 12]. As countries and
subregions on the continent have different outcomes, it is
important to evaluate those differences to improve orient
vaccination program efforts, to increase setting-appropriate
strategies for vaccine uptake, and to foster interregional and
countries’ collaboration. In this paper, we seek to fill this
gap by providing an analysis of regional variations in
COVID-19 death outcomes and vaccine status across Africa.

2. MATERIAL AND METHODS
2.1. DATA SOURCE AND VARIABLES

The data were extracted from the Johns Hopkins
Coronavirus Resource Center (CRC) database, which is
supported by Bloomberg Philanthropies and the Stavros
Niarchos Foundation [13]. The data used in this analysis
were collected between the periods of December 30, 2021,
to January 2, 2022. The downloaded data included all
relevant, accumulated data collected since the beginning of
the pandemic. The variables collected were confirmed cases
(the total number of confirmed cases since the beginning of
the pandemic); doses administered (the total doses of
vaccines administered); fully vaccinated (the total number
of fully vaccinated people; fully vaccination being the
number of doses required depending on the vaccine type),
and total deaths (the total number of deaths attributed to
COVID-19). Since we are interested in regional differences,
these data are based on geographical location; hence
countries are grouped by region (North, Central, West, East,
and Southern) instead of population size or per capita. With
50 countries in Africa, a sample of 30 countries is enough to
provide a trend regarding vaccine status on the continent and
six countries per region is sufficient to make a comparison,
especially given that some regions have just about six
countries.

2.2. STUDY DESIGN

Given that the data present a snapshot of different variables
at a certain point in time, a cross-sectional ecological study
design was selected. Five regional groups were examined in
the analysis: West Africa, Central Africa, East Africa,
Southern Africa, and North Africa. Six countries were
randomly chosen from each of these five regions. The data
are grouped according to these five regions (Figure 1). All
data (confirmed cases, doses administered, fully vaccinated,
and total deaths) are sums of continuous variables. They are
therefore treated in the analysis as continuous variables
classified in five groups.

2.3. STUDY SETTING

The CRC is a repository of global data on COVID-19
pandemic. Its focus on cases, deaths, tests, hospitalizations,
and vaccines offers an opportunity to evaluate how different
parts of the world are faring, to provide the best response.
This study examines the effect of the pandemic on the
regarding cases, death toll, and
vaccination status. These data provide an opportunity to

African continent

evaluate and compare the geographical regions that often

86 IBEROAMERICAN JOURNAL OF MEDICINE 02 (2022) 83-91

form political entities. Such a study provides information
about the pandemic in Africa, casting light on which regions
of the continent need more attention. It also provides some
directions in terms of regional collaboration to curb the
pandemic.

A

Confirmed cases

3,424,534

5,703

wt

captured in Table 4. The multiple regression formula is
specified as follow:
Y= Bot BiXir + Boxi2 + B3xig + &
Where Y is the outcome of death, 6) the model intercept,
X;, the total doses of vaccines administered, x;, the total
B Fully vaccinated

22,994,609

3,533

we

Figure 1: A: Geographical distribution of total number of confirmed cases across the African countries randomly selected. B:
Geographical distribution of the total number of fully vaccinated people across the African countries randomly selected. The maps
were generated using Microsoft Excel Workbook (.xlsx).

2.4. STATISTICAL ANALYSIS

Data on confirmed cases, doses administered, number of
fully vaccinated individuals, and total deaths were extracted
from the CRC website [13]. Each variable represented an
accumulation of data grouped by country. To visualize the
distribution of total doses administered, and the total of fully
vaccinated people by country grouped in subregions, we
generated a histogram (Figure 2) using Microsoft Excel
Workbook (.xlsx). For the total sample of 30 countries, we
calculated the total for each of the four variables and
grouped them by geographical regions (Table 1). We carried
out ANOVA tests to evaluate the effects of subregion and
confirmed cases on deaths, subregion and fully vaccinated
on deaths, and subregion and doses administered on deaths.
The Bonferroni correction helped evaluate the means
difference between subregions with the three variables
combined in the model. The results a represented in Table 2.
We assessed the relationship between total deaths and
confirmed cases, doses administered, and the number of
fully vaccinated individuals. This was done through a
correlation test with the results summarized in Table 3. A
multiple linear regression further estimated this relation

number of fully vaccinated people, x;3 the total number of
confirmed cases, and ¢; the model deviation. We used
SAS® OnDemand for Academics to perform all statistical
tests.

3. RESULTS

North African countries tended to do better in terms of doses
of vaccines administered and fully vaccinated people
(49.3% and 51.1% respectively) (Figure 1). They are
followed by Southern Africa (24% and 28.8%) and East
Africa (13% and 7.8%). West Africa (8% and 7.5%) and
Central Africa (5.7% and 5.6%) have the lowest proportions
of doses administered and fully vaccinated people.
However, the highest death toll was in Southern Africa
(51%) and the lowest in Central Africa (1%).

IBEROAMERICAN JOURNAL OF MEDICINE 02 (2022) 83-91 87

60,000,000
50,000,000
40,000,000
30,000,000
20,000,000 |
10,000,000 | |
0 i - i St. 8. s ~ ts Fs. I 1. !
SEewmEGZEBVBERSAEBBERBESCBEBUVCBsaeUeaeassaeees
= = @ > Vv 5 >
SSPSSCSSESSZESSSEeEsSsSsEZaSsess22qs
=~ 6 & Seat ~ ExeseeteanaLecta ges 2wete5- 22
ed & S 2 = Qa Nw =
~ 5 $ Ee 8 N ° =
aes vw =
< §$
ed
§
Uv
W. Africa C. Africa E. Africa S. Africa N. Africa

Doses administered «@ Fully vaccinated

Figure 2: A: Distribution of total doses administered and total number of fully vaccinated persons across the five regions. From left
to right each group of six countries correspond to a region, West Africa, Central Africa, East Africa, Southern Africa, and North
Africa, respectively.

To determine regional differences and the vaccination There is no significant means difference in fully vaccinated
effects on deaths, we used Student test and ANOVA test among the five regions. Southern Africa and North Africa
with Bonferroni correction. The effect of the number of | do not have significant difference in means of doses
confirmed cases on deaths across regions is a statistically administered. Likewise, Central Africa, West Africa, and
significant (P<.0001). There was a regional difference inthe East Africa do not have significant difference in doses
effect of confirmed cases on deaths. The same was true for administered, but there is a difference between Southern
fully vaccinated (P=0.01). The effect of doses administered Africa and North Africa when compared to Central Africa,
and subregion on deaths was not significant, but the overall | West Africa, and East Africa. The overall model evaluating
model (with the three variables and subregions effect on the effect of the three variables and subregions on deaths is
deaths) was significant (P<.0001) (Table 2). significant as shown in table 2. Southern Africa and North

Table 1: Proportions of total confirmed cases, total doses of vaccine administered, total number of fully vaccinated people, and
total number of deaths by region

Variables West Africa Central Africa East Africa eee North Africa Total
Confirmed 485,756 212,434 882,874 4,359,214 2,712,908 8,653,186
cases (5.6%) (2.5%) (10.2%) (50.4%) (31.2%) (100%)
Doses 21,289,921 15,322,702 34,912,203 64,886,584 132,855,600 269,267,010
administered (8%) (5.7%) (13%) (24%) (49.3%) (100%)
Fully 8,293,289 6209745 8,610,314 30,946,291 56,645,437 110,705,076
vaccinated (7.5%) (5.6%) (7.8%) (28%) (51.1%) (100%)
Total deaths 7,905 2,138 16,618 105,729 74,891 207,281
(3.9%) (1%) (8%) (51%) (36.1%) (100%)

Southern Africa and North Africa do not have significant Africa do not have a significant difference, but they have
difference in means of confirmed cases. Likewise, Central worse outcomes in terms of death toll with higher means
Africa, West Africa, and East Africa do not have significant deaths. Central Africa, West Africa, and East Africa are not
difference in means of confirmed cases, but there is a significantly different, but there is a difference when
difference between Southern Africa and North Africa when comparing Southern Africa and North Africa with Central
compared to Central Africa, West Africa, and East Africa. Africa, West Africa, and East Africa.

88 IBEROAMERICAN JOURNAL OF MEDICINE 02 (2022) 83-91

Table 2: Student and ANOVA tests to evaluate the effects of subregion and confirmed cases on deaths, subregion and fully
vaccinated on deaths, subregion and doses administered on deaths. ANOVA evaluates the effects of subregions and the three
other variables combined on deaths

Countries (n)

Variables
Student test
Confirmed cases
Fully vaccinated
Doses administered

ANOVA
Overall model

The effects of the three variables on deaths were further
evaluated through correlation tests (Table 3). The results
showed that we could not be confident in saying that a
relationship exists between confirmed cases and deaths,
number of fully vaccinated individuals and deaths, or doses
administered and deaths in the North African group. In the
Southern African group, a strong positive relation exists
between confirmed cases and deaths (P<.0001, r=0.99),
fully vaccinated and deaths (P=0.005, r=0.93), and doses
administered and deaths (P=0.03, r=0.84).

F-value P value

relationship between deaths and the three variables. The
simple regression models showed that a linear relationship
exists between deaths and confirmed cases (P<.0001) in the
30 countries taken together (Table 4), as would be expected.
Similarly, in the simple regression models, there is a positive
linear relationship between the number of fully vaccinated
individuals and deaths (P=0.0004), and between doses of
vaccines administered and deaths (P=0.004). The multiple
regression overall model is statistically significant for all the
30 countries combined (P<.0001). However, when looking

Table 3: Correlation test to evaluate the existence of a relationship between the total number of deaths and total number of
confirmed cases, total number of fully vaccinated individuals, and total doses of vaccine administered in the five regions (r =
correlation coefficient)

Varaibles West Africa
Confirmed cases and deaths

Tr

P
Fully vaccinated and deaths

Tr

Doses administered and deaths

r 0.98
P 0.0002

In East Africa there was a strong positive relationship
between confirmed cases and deaths (P=0.0002, r=0.98),
and doses administered and deaths (P=0.01, 7=0.89). In
Central Africa a strong positive relationship was also found
between confirmed cases and deaths (P=0.002, r=0.95),
fully vaccinated individuals and deaths (P=0.0003, 7=0.98),
and doses administered and deaths (P=0.0002, r=0.98). The
same was not true in West Africa where a strong positive
relationship only exists between confirmed cases and deaths
(P=0.006, 7=0.93).

The multiple linear regression helped estimate the

Central Africa

East Africa Southern Africa North Africa

at specific variables in the full model, only confirmed cases
had a significant linear relationship with deaths (P<.0001).

4. DISCUSSION

Many obstacles in Africa have hampered COVID-19
vaccine campaigns. Many African countries have been
unable to procure vaccines in a timely fashion. The failures
of COVAX, and vaccine procurement arrangements by
high-income countries, which gobbled up existing supply,

Table 4: Simple and multiple linear regression to estimate the relation of deaths to confirmed cases, fully vaccinated, and
doses administered in all groups.

Variables Countries (n)
Simple model

Confirmed cases

Fully vaccinated

Doses administered

Final model
Confirmed cases

Fully vaccinated
Doses administered

Slope P value
0.0263
0.0017

0.00064485

0.02654
-0.00041734
0.00020784

IBEROAMERICAN JOURNAL OF MEDICINE 02 (2022) 83-91 89

are the main reasons [14, 15]. There are also significant
country-specific variations in terms of government interest
in acquiring vaccines, and in terms of fiscal capacity to do
so [16]. Vaccine hesitancy has also slowed down vaccine
uptake in Africa. Although the movement has been more
explicit in developed countries, a similar tendency has been
seen in including
miscommunication, lack of trust, past experiences with
health services, family histories, and rumours, might have
nurtured the current trend [17]. The continent continues to

African countries and _ factors

lag in terms of vaccine rollout [18], and that remains a
concern because areas with low vaccination rollout
represent the bedrock for new viral mutations leading to the
rise of new COVID-19 strains. The differences in vaccine
rollout performances observed among African regions
provides an idea about where the continent struggles the
most. North African countries and Southern Africa countries
have better performances in terms of doses of vaccines
administered as well as number of fully vaccinated people
[13]. Western and Central African countries have the
poorest performances. This suggests that continental and
global efforts for vaccine uptake should focused more on
these latter regions.

As shown in Table 2, the effect of total doses of vaccine
administered, total fully vaccinated people, total confirmed
cases, and total deaths show that there is a difference in
means among regions. This indicates that some regions do
better than others do. North Africa and Southern Africa are
particularly different from Central, West, and East Africa.
With higher means deaths, North Africa and Southern
Africa have worse outcomes when compared to West
Africa, Central Africa, and East Africa. This indicates that,
despite their higher vaccine rollout, North and Sothern
Africa have not made a significant difference in preventing
deaths when compared to the other regions. This might be
an indication that more efforts should be put in prevention
measures in the hot spots of these two regions. This is crucial
in the context of the B.1.1.529 variant, which has several
mutations capable of conferring high infectivity on it as well
as immune evasion capacity [19]. The difference in death
outcomes increases the need for better surveillance and
testing across regions since these factors can confound the
Difference in population demography,
comorbidities, and preventive measures can also explain the
differences. As indicated in Table 3, the positive relationship
and the lack of negative relationship found between deaths
and confirmed cases, deaths and doses administered, and
deaths and the fully vaccinated implies that the vaccine
effort is not yet sufficient to curb the death toll. This might
suggest that all the regions on the continent still need

results.

renewed vaccination efforts to reduce COVID-19-related
morbidity and mortality. This is consistent with the positive
linear trend found between total deaths and the three
variables under consideration in Table 4. Vaccine rollout is
a time sensitive race. Vaccination significantly reduces the
risk of hospitalization, disease progression, and infectivity
[20]. However, these benefits are only meaningful when
enough people are immunized within the appropriate
timeframe. That is why more programs geared at scaling up
vaccine rollout in Africa should be considered.

The fact that some countries on the continent do better than
others in terms of COVID-19 management opens doors for
international especially with
programs, social media handling and communication,
physicians, and other health professionals and their input. It
is well known that countries are always geared to seeking
their own interests by putting their people first; and without
an international government, the world is in a constant state
of chaos particularly in times of crisis [21, 22]. Furthermore,
states always tend to increase their power, relative to other

collaboration vaccine

states [23]. Nevertheless, in the context of a pandemic such
as COVID-19, there is a need for better collaboration and
exchange. The fact that some countries on the continent do
better than others opens the door for international
collaboration, especially with vaccine programs, public
communication, health professionals, and
stakeholders’ inputs. The South African government has
used several tactics in their communication campaign that
helped vaccine rollout a great deal. South Africa’s
incorporation of partners that are not part of the
pharmaceutical and health sector, including
businesspersons, labour and civil society contributed to the
success of the vaccine campaign [24]. By December 13,
2021, South Africa had administered 82% of vaccine doses
that they had procured; a rate substantially higher than Egypt
(52%), Nigeria (48%), Cameroon (23%) and DR Congo
(5%) at the same date [25]. Those experiences can be shared
at the regional and continental level to help poor performing
countries while taking into consideration the socio-cultural
setting of each country. Collaboration among African

other

countries, as well as sharing of resources, information and
technology can represent a decisive element in scaling up
vaccine uptake. There is also a need to have a global rhetoric
on vaccines, which is context sensitive, innovative in terms
of technology, and driven by the socio-ecologic model [26].
The African experience of vaccination is sharply different
from the European’s, North American’s, and even Asian’s.
Hence, a global rhetoric that seriously considers the African
lived experience can win the battle over mistrust,
misinformation, myths, conspiracy theories, and vaccine

90 IBEROAMERICAN JOURNAL OF MEDICINE 02 (2022) 83-91

hesitancy [27]. COVID-19 vaccines received an
unprecedented opposition among many populations. The
rapidity with which COVID-19 vaccines were developed is
one of the causes of mistrust even among qualified health
professionals [28]. The recent findings showing evidence of
intracellular reverse transcription of Pfizer BioNTech
COVID-19 mRNA vaccine BNT162b2 in vitro in human
liver cell line [29] is an indication that more and better
biotech and

pharmaceutical companies. The effort to scale up vaccine

communication is needed from the
rollout must be multi-sectorial. The input of international
organizations and a country’s government should be
coupled with the contribution of health professionals, civil
society, the business community, scholars, researchers, and
community leaders, to mention the most obvious.

The study has some limitations as the data used may include
mistakes through the process by which they were collected.
In the context of a pandemic, many cases go unreported and
unaccounted for; hence, these data can only provide an
approximation about the ongoing trends and cannot infer a
causal relationship. The data on deaths were considered
from around the beginning of the pandemic and not after the
beginning of vaccine rollout. This might affect the degree of
relationship between deaths and vaccination status, given
the effects of preventive measures including face masking,
hand hygiene, and physical distancing. However, since most
of these measures continued even after the beginning of
vaccine rollout, we considered that these effects are most
likely levelled up. Moreover, many African countries did not
particularly succeed with these measures especially physical
distancing, masking, and contact tracing [30]. The effects of
these measures are accounted for by the standard error in the
regression model. The social context, including unrest,
political strife, variations in infrastructures can affect
vaccine rollout from one country to another. This study is
also limited in the sense that it does not take into
consideration the ratio of each variable to each country
general population and total subregional populations.
Nevertheless, the study provides an insight into the
difference in vaccine status, confirmed cases, and their
relation to death outcome due to COVID-19 in the African
subregions investigated. This study focused on regional and
geographical based differences. Next steps can evaluate
differences through grouping countries by factors including
per capita income, population size, and similarities in health
systems.

5. CONCLUSIONS

Vaccination offers one of the best ways to battle infectious

diseases and remains efficient in the context of a pandemic
such as COVID-19. Widespread vaccination coverage is
also pivotal in suppressing the emergence of new strains of
the pathogen. Hence, vaccination is crucial in the fight
against COVID-19, especially in the African context, which
is characterized by weak health systems and limited
resources that make treating large numbers of individuals in
pandemic surges challenging. This study indicates that
African regions have performed differently in terms of
vaccine rollout, with the best performances observed in
North and Southern Africa. West and Central Africa present
the lowest performances. The study also indicates a
relationship between total doses of vaccine administered and
the total number of deaths, the number of total fully
vaccinated people and the total number of deaths. However,
vaccination is not yet adequate to reduce total deaths to the
point of producing a significant negative linear relationship.
These suggest that increasing vaccination coverage can
positively change the trend of the pandemic in Africa, by
reducing deaths as well as severe forms of the disease.

6. CONFLICT OF INTERESTS

The authors declare no conflict of interest.

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