Sub-Saharan Africa: We Need to Act Now

IMF Blog, June 28, 2021

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Sub-Saharan Africa is in the grips of a third wave of COVID-19 infections that "threatens to be even more brutal than the two that came before."
The growth of infections in sub-Saharan Africa is now the fastest in the world, "with an explosive trajectory that is outpacing the record set in the second wave."
The delta variant—reportedly "60 percent more transmissible than earlier variants"—has been detected in 14 countries.
In some countries, infections are already "more than double, or even triple, their January peaks." Example: in Namibia, new cases "reached the previous January peak within only two weeks, and tripled another two weeks later."

Earlier policy actions limited infections initially but strained local health systems to the breaking point.
By the second wave, most sub-Saharan African countries entered "in a more difficult economic position than the first," with:
- shrinking fiscal resources to protect the vulnerable,
- additional millions thrown into poverty,
- depleted household balance sheets.
Current wave is again "threatening to overwhelm local health systems":
- hospitals overwhelmed,
- patients dying while waiting for beds,
- non-emergency surgeries canceled,
- military hospitals opened for civilian use,
- oxygen supply failing to keep up with demand,
- scarce health workers continue to be at risk.

There is a dangerous divergence: countries with good access to vaccines are on a stronger recovery track; those without remain at risk of falling further behind.
Vaccine rollout in sub-Saharan Africa remains the slowest in the world:
- "Less than 1 adult in every hundred is fully vaccinated, compared to an average of over 30 in more advanced economies."
Without significant international assistance and an effective region-wide vaccination effort:
- repeated waves of infection are likely,
- increasing toll on lives and livelihoods,
- paralysis of investment, productivity, and growth,
- higher risk of more dangerous variants emerging.
Vaccination is framed as a global public good: the most durable vaccine effort "is one that covers everyone, in every country."

IMF staff proposal targets:
- vaccinating "at least 40 percent of the total population of all countries by end-2021,"
- and "at least 60 percent by the first half of 2022."
Africa is expected to receive:
- "30 percent vaccination coverage through COVAX"
- and "another 30 percent coverage through the African Vaccine Acquisition Task Team (AVATT)."

1. Deliver vaccines to sub‑Saharan Africa as soon as possible.

Advanced economies should share stockpiles bilaterally or through multilateral initiatives.
COVAX has received pledges for over half a billion doses; pledges must turn into actual deliveries.
Goal: "to get a quarter of a billion doses to the region by September."

2. Vaccine manufacturers should speed up supply to Africa for the rest of this year.

Advanced economies with manufacturing capabilities should encourage manufacturers to increase supply, especially when domestic demand is falling short.

3. Fully finance AVATT to ensure coverage of 30 percent of the African Union population.

This requires an estimated "$2 billion," which would allow AVATT to execute its optional contract of "180 million doses with J&J."

4. Remove cross-border export restrictions on raw materials and finished vaccines.

5. Provide financing of at least "$2.5 billion" and upfront planning to ensure health systems can deliver shots-in-arm promptly as supply ramps up.

Several countries (eSwatini, Ghana, Kenya, Namibia, and Rwanda) have effectively administered limited supplies but have had campaigns placed on hold awaiting new supplies.
The main constraint so far has been shortages of supply rather than administration capacity.
Examples of rapid scale-up once supplies arrived: Seychelles, Mongolia, Bhutan, and Maldives.

6. Accelerate acquisition of vital COVID-19 health tools alongside vaccination efforts:

therapeutics, oxygen, and personal protective equipment.
Urgent grant financing to pre-emptively procure and deliver a minimum package of critical COVID-19 Health Tools is needed now.

7. Coordinate international financing efforts:

Most international financial assistance will need to come in the form of grants or concessional loans.
The IMF, with World Bank, WHO, WTO, and others, has formed a special task force to ensure countries get resources and vaccines.

The IMF "remains deeply committed to all countries in the region."
The IMF has ramped up lending to sub‑Saharan Africa—"last year it was more than 13 times our annual average"—and support to increase access limits will allow scaling up zero-interest lending capacity.
The unprecedented "$650 billion new SDR allocation," once approved, "will make $23 billion available to member countries in sub‑Saharan Africa."

The gravity and urgency of the situation requires the global community to work together.
Collective action can help reclaim physical and economic health from the pandemic and allow sub‑Saharan Africa to resume its path toward a more prosperous future.

Source: IMF blog post "Sub-Saharan Africa: We Need to Act Now" by Kristalina Georgieva and Abebe Aemro Selassie, June 28, 2021.