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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 history: 

Received 05 February 2022 
Received in revised form 03 
March 2022 

Accepted 16 March 2022 

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 

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 

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/). 



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 




Historia del articulo: 

Recibido 05 Febrero 2022 
Recibido en forma revisada 03 
Marzo 2022 

Aceptado 16 Marzo 2022 

Palabras clave: 
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 

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. 


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 


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. 


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 


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. 


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 


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 


Confirmed cases 




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 




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). 


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 


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%). 


20,000,000 | 
10,000,000 | | 
0 i - i St. 8. s ~ ts Fs. I 1. ! 
= = @ > Vv 5 > 
=~ 6 & Seat ~ ExeseeteanaLecta ges 2wete5- 22 
ed & S 2 = Qa Nw = 
~ 5 $ Ee 8 N ° = 
aes vw = 
< §$ 
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. 


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) 

Student test 
Confirmed cases 
Fully vaccinated 
Doses administered 

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 


Fully vaccinated and deaths 


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). 


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 




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 


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 


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 


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 


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. 


The authors declare no conflict of interest. 


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