Ghana, like many of its counterparts on the continent, is contending with the fallout from the rapid spread of SARS-CoV-2 variants. Of particular concern is the B.1.1.7 variant first identified in the UK. It is estimated to be up to 70% more infectious and 65% more lethal than the ancestral strain.

Scientists at the West African Centre for Cell Biology of Infectious Pathogens have confirmed that B.1.1.7 is now the dominant variant in Ghana based on nationwide genomic surveillance. And that it is responsible for 88% of cases in the capital city.

The ongoing surge in new infections, hospital admissions and deaths has refocused public attention on a situation that the Ghana Medical Association describes as “dire”. Intensive care units are operating at the limits of their staff and space constraints. And more young people appear to be developing severe forms of the illness.

This means that the rollout of COVID-19 vaccines in Ghana cannot come quickly enough. But what is the country’s COVID-19 vaccination strategy? And how well advanced are plans to execute it?

Potential pitfalls

At least 60% of Ghana’s 31 million residents will need to be vaccinated for the population to attain herd immunity. The goal of the president, Nana Akufo Addo, is that every Ghanaian will be vaccinated. But a timeline for this remains elusive as no plan has been made public.

The president has promised to procure and administer 17.6 million COVID-19 vaccine doses in the first half of 2021 as part of an initial push. But there is uncertainty even around this target.

Firstly, how the country will secure this number of doses is not yet clear.

Secondly, there are questions around how the doses will be stored and distributed, as well as the capacity of the country’s existing cold chain infrastructure.

And there will be a final major hurdle to clear – convincing many sceptical Ghanaians that the vaccines on offer are safe and effective.

Constraining factors

A number of external factors are hampering Ghana’s efforts to secure the doses it needs to reach its mid-year target.

Unlike developed nations, countries like Ghana have limited bargaining power to negotiate directly with manufacturers. As a result, it is principally relying on two multilateral initiatives to procure COVID-19 vaccines – the COVAX facility and the African Vaccine Acquisition Task Team. Combined, they have secured 1.27 billion vaccine doses for African nations.

COVAX is a global initiative co-led by the World Health Organisation, Gavi and the Coalition for Epidemic Preparedness Innovations. It aims to develop, manufacture and distribute COVID-19 vaccines to all nations on a fair and equitable basis. It operates as a funding mechanism that uses the collective purchasing power of participating nations to obtain competitive prices.

Nevertheless, participating low- and middle-income countries will only receive enough vaccines to cover up to 20% of their populations.

Ghana expects to take delivery of up to 968,000 doses of the Oxford-AstraZeneca vaccine by the end of March 2021 as part of an initial batch from COVAX. These first doses have been earmarked for the nation’s healthcare workforce of about 108,000.

COVAX aims to deliver the remainder of this initial tranche of 2.4 million doses by June 2021. This should be enough to protect about 1.2 million Ghanaians with the two-jab Oxford-AstraZeneca vaccine. But reaching the president’s target will require about four times that amount.

This means that Ghana will have to lean heavily on vaccine supplies from the African Vaccine Acquisition Task Team – an initiative being driven by the African Union. It aims to bridge the gap between the 20% population coverage promised by COVAX to participating African countries and the 60% coverage they need to attain herd immunity.

The African Export-Import Bank and the World Bank are supporting the strategy with about $7 billion in cash advancements to vaccine manufacturers on behalf of AU member states. The African Vaccine Acquisition Task Team has so far secured 270 million doses of the Pfizer, Oxford-AstraZeneca and Johnson & Johnson vaccines. Deliveries are scheduled to begin later this month.

In early February the director of the Africa Centers for Disease Control announced that 16 African nations had applied to the task team for vaccine supplies totalling 114 million doses. While the final allocations are yet to be published, Zambia, Kenya and Nigeria are set to receive 42.7 million.

It is not yet known if Ghana is one of the remaining 13, nor how many doses it intends to order from the African Vaccine Acquisition Task Team.

Ghana’s Presidential Advisor on Health, Anthony Nsiah-Asare, recently hinted that the country was also procuring vaccines through bilateral deals with some of its development partners. But these supplies are likely to be a negligible fraction of the 15.2 million additional doses required to meet the June target.

This means that Ghana’s supplies from the African Union initiative is likely to determine the nation’s ability to reach its mid-year goal of 17.6 million doses.
The groundwork

Ghana’s COVID-19 vaccination drive will face other challenges that ought to be addressed urgently.

One is a storage and distribution plan that prioritises speed and minimises waste. Public health authorities have assured Ghanaians that a comprehensive plan exists – it has not yet been made public – to make use of the country’s existing cold chain infrastructure for vaccine distribution.

This infrastructure supports Ghana’s enviable record in immunisation coverage that has helped reduce infant mortality and the incidence of vaccine-preventable diseases such as measles. In 2019, immunisation coverage for essential vaccines was in excess of 90%. Ghana has not recorded a single death from measles since 2003. In addition, it was certified as having eliminated maternal and neonatal tetanus in 2011.

But there are gaps. Ghana’s current cold storage facilities lack the capacity to house vaccines like those manufactured by Pfizer and Moderna because of the arctic temperatures required to store them. Both use a technology known as mRNA.

This limits the COVID-19 vaccine options available to Ghana. It also matters because these vaccines can be adapted to target new SARS-CoV-2 variants relatively quickly compared with other vaccine technologies. Having access to them could therefore determine how fast nations are able to respond to the emergence of new variants.

Ghana faces a potentially bigger stumbling block: public scepticism about COVID-19 vaccines.

Anxieties and uncertainties about their safety underlies considerable hesitancy in Ghana towards the COVID-19 vaccines. The proliferation of fake news and misinformation on social media and in certain quarters of the popular press are fanning those embers.

To meet this challenge public health authorities will have to be laser-focused on identifying and addressing both legitimate apprehensions and conspiracy theories. They will also have to be proactive in monitoring digital platforms because of the dynamic and viral nature of vaccine misinformation.

It will also be important to measure progress towards public acceptance of the vaccines. One route would be to conduct a series of public surveys to assess the evolving landscape of knowledge and attitudes. This would enable the government to identify specific misinformation that allows for more focused communication about vaccine safety and efficacy.

Much of that will also depend on media coverage. It is, therefore, crucial to engage the media on its role in combating misinformation.