Inadequate infrastructure and preparation could hinder Africa’s Covid-19 vaccine rollout – and delay an end to the global pandemic

Rwanda’s vaccine rollout provides blueprint for effective vaccine deployment

A new report from the Tony Blair Institute says a lack of adequate infrastructure and preparation among some African governments risks hindering mass Covid-19 vaccination programmes – and points to the early success of Rwanda’s vaccine rollout as a blueprint for effective deployment.

According to the WHO Africa Vaccine Readiness tracker, just 51 per cent of 46 countries assessed are equipped overall to deliver vaccines to their populations.

The new TBI report – Vaccinating Africa: What Governments Can Learn from Rwanda’s Effective Rollout – says that if countries are not equipped to implement mass vaccinations, the consequences will be far-reaching:

Given that the order in which COVAX ships available vaccines is based on readiness, there is a risk of further delays to arrivals of COVID-19 vaccines to countries which are not prepared.
An inadequate cold chain will lead to vaccine spoilage and unreached communities.
An inadequately trained workforce and uninformed public will lead to vaccine wastage.
Premature expiration of vaccines will result in financial loss from the investment in those doses as well as in underserved communities, lower coverage rates and, ultimately, a slower timetable to reaching population immunity.
The inability to efficiently deliver vaccines to the population means the virus will continue to spread, causing needless excess morbidity and death.
It could also mean the segmentation of lower-coverage countries from the global economy, leading to huge economic losses and exacerbating global inequities.
With every new transmission, the virus has an opportunity to mutate. The longer the virus is allowed to spread, the more probable a mutation will occur that renders existing vaccine regimens ineffective.

TBI’s Senior Africa Covid-19 Adviser Elizabeth Smith said:


“The stakes are high and there are risks at every step along the way. Governments must ensure that the enormous efforts to develop a vaccine are not undercut by insufficient efforts to deploy them.

“Although there is no ‘one-size-fits-all’ approach, Rwanda’s early success – based on leadership and collaboration across government, agile last-mile delivery, proactive communications strategies and acceleration of digital record keeping and new technology infrastructure – can provide a blueprint for governments on the co-ordination necessary for successful vaccine delivery.

“The pandemic ends with successful global vaccine deployment. No country is safe from Covid-19 until the world achieves population immunity.”

Rwanda’s early success in vaccination rollout – the four pillars of effective deployment

Whole-of-government coordination – Rwanda’s whole-of-government approach was instrumental in the successful transport of AstraZeneca vaccines from the central distribution hub in Kigali to 14 remote areas of the country within 24 hours on 4 March and with little advance notice. In Kigali, the Ministry of Health organised the allocation of vaccines, which were then transferred to hospital vehicles and Ministry of Defence helicopters. The Ministry of Defence helicopters transported the vaccines to the district hospitals. From there, with the support of the Rwanda police, the vaccines were distributed to area health centres. The effective cross-government coordination ensured that Rwanda would be ready to begin administering vaccinations across the country the next day.

A tailored delivery approach – The Rwandan government conducted a mass, rapid national screening process to calculate how many vaccines would be needed in each community, according to its prioritisation list. It also completed a cold-chain capacity assessment in late 2020, enabling it to identify areas that would be more suited to certain vaccines than others. health-care workers administering shots were recruited and trained in advance of the rollout, with a training surge and checklists ensuring that workers were on standby and ready the moment the vaccines arrived.


Digital data and technology infrastructure – As part of its rollout, Rwanda is pushing to digitise its record keeping on health countrywide. Though getting staff trained on and accustomed to a new system can create initial process lags, still, the vast majority of vaccinations were tracked in real time in a digital database that makes data available to decision-makers and citizens. In Rwanda, vaccinations were reported multiple times a day by health centres and districts to give the National Covid-19 Task Force, command post, head of state and cabinet a picture of the rollout.

Proactive communication with the public – Since the first COVAX shipment arrived on 3 March, the government of Rwanda has kept the public informed of the progress of deployment. Daily updates from the Ministry of Health and government of Rwanda on Twitter, TV and radio have allowed every citizen a window into the rollout operations. A key element included in the updates is the identification of the priority groups getting vaccinated that day with photos. Regular newspaper articles and nightly radio interviews also track updates. Trusted community leaders have also been utilised to help those invited for vaccination know where to go and to understand the benefits of vaccination on their collective community.