A drive to get Africans vaccinated against the coronavirus is being hamstrung by governments’ reluctance to sign indemnity clauses, a preference for Pfizer Inc. vaccines over other more readily available shots and a lack of preparedness to distribute the inoculations.

Delays in vaccinating the continent’s more than 1.3 billion people will likely lead to additional resurgences of the virus, may result in mutations that will potentially be more transmissible and could lead to economic damage associated with strict lockdowns.

Less than 20 million people have been inoculated in Africa, with almost half of those living in Morocco, according to Bloomberg’s COVID-19 Vaccine Tracker.

So far, seven African countries have yet to start vaccinating their populations, said Phionah Atuhebwe, the New Vaccines Introduction Medical Officer for Africa for the World Health Organization.

Eritrea, Burundi and Tanzania have as yet declined to join Covax, the global initiative that most African countries are relying on to secure the shots, while Burkina Faso hasn’t signed the indemnity and liability agreements needed to allow shipments of the vaccines to the country, Atuhebwe said in an April 30 interview. Burkinabe officials say they’ve signed all agreements they were asked to.

Vaccine Preference

Madagascar has only recently expressed interest in securing vaccines and joined Covax and the Central African Republic has just put together a vaccine deployment plan, according to Atuhebwe. Chad has meanwhile rejected shots developed by AstraZeneca Plc that Covax has to offer and said it will wait for Pfizer shots to become available, she said.

“Madagascar is a priority, Central African Republic is a priority” for inoculations, she said. “Burkina Faso said they are not ready now for deployment.”

Already the Democratic Republic of Congo has ceded 1.3 million of the 1.7 million vaccine doses it received because it said it didn’t have the capability to distribute them. Burkina Faso would have received a portion of 1 million AstraZeneca vaccines sold by South Africa to the African Union but wasn’t ready to receive them, she said.

The delay in starting vaccinations in Chad is purely due to its vaccine preference, a government official said.

“We prefer Pfizer over the other vaccines, so we decided to wait,” Ouchemi Choua, the National Health Response Coordinator for Chad’s vaccination program, said from N’Djamena, the capital, adding that Pfizer doses are expected to start arriving in June. “The delay won’t have any major impact on the response, as long as distribution starts as scheduled.”

AstraZeneca’s shot appears to be less effective against a variant of the virus first identified in South Africa late last year, and concerns it may cause blood clots have seen delays in its rollout in Europe and elsewhere.

Signatures Needed

Still, Chad is yet to sign a number of agreements including some needed by Pfizer to allow it to receive vaccines, according to a person with knowledge of the situation, who asked not to be identified as they aren’t allowed to speak to the press. Burkina Faso is finalizing the documentation to receive its first doses, but as of April 28 had not signed indemnity agreements, the person said.

“Vaccines are a delicate matter,” Emmanuel Seni, public health director at Burkina Faso’s health ministry, said by phone. “We didn’t want to sign anything before we knew exactly what we were agreeing to.”

Seychelles, which has fully vaccinated more of its population against the coronavirus than any other country, has closed schools and canceled sporting activities for two weeks as infections surge.

The measures, which include bans on the intermingling of households and the early closure of bars, come even as the country has fully vaccinated more than 60% of its adult population with two doses of Covid-19 vaccines. The curbs are similar to those last imposed at the end of 2020.

“Despite of all the exceptional efforts we are making, the Covid-19 situation in our country is critical right now, with many daily cases reported last week,” Peggy Vidot, the nation’s health minister, said at a press conference Tuesday.

The Indian Ocean archipelago, which has a population of about 98,000, is dependent on tourism for much of its foreign exchange and acted quickly to begin vaccinations in January using a donation of Chinese vaccines from the United Arab Emirates. It has procured other vaccines since.

By April 12, 59% of the doses administered were Sinopharm vaccines and the rest were Covishield, a version of AstraZeneca Plc’s shot made under license in India.

To date 62.2% of its population is fully vaccinated, according to the Bloomberg Vaccine Tracker. That compares with 55.9% for Israel, the next most vaccinated nation.

‘Global Implications’

The number of active cases in the nation rose to 1,068 on May 3 from 612 on April 28, according to the health ministry.

Of those cases, 84% are Seychellois and the rest are foreigners, Daniel Lucey, Clinical Professor of Medicine at Dartmouth Geisel School of Medicine, said in a blog post. Just under two thirds of those are either unvaccinated or have only had one dose, and the rest have had two doses, he said.

While data on genetic sequencing are not yet available for infections in April, the B.1.351 variant, first identified in South Africa late last year, was found in Seychelles in February, he said. AstraZeneca’s vaccine appeared to be less effective against that variant in a study, and South Africa halted plans to use it.

A comparison between Sinopharm, Covishield, and unvaccinated infected persons” could be done using genetic sequencing and data on the severity of their infections, Lucey said. “Given the widespread international use of these two vaccines there are global implications to what is happening now in the Seychelles.”

Officials at the press conference gave little detail on what could be behind the infection surge other than to say people were taking fewer precautions against the virus than before and the surge may be due to celebrations after Easter.

Jude Gedeon, Seychelles’ public health commissioner, didn’t answer calls made to his mobile phone or immediately answer a text message.

Other nations that have vaccinated large portions of their populations have seen Covid cases plunge. In the U.K., where 52% of people have a first dose, cases are down 96% from a recent high in January. In Israel, where 60% have had at least one dose, new cases are down 99%.