NAIROBI, Kenya (AP) — Africa has surpassed 2 million confirmed coronavirus cases as the continent's top public health official warned Thursday that "we are inevitably edging toward a second wave" of infections.

The Africa Centers for Disease Control and Prevention said the 54-nation continent has seen more than 48,000 deaths from COVID-19. Its infections and deaths make up less than 4% of the global total.

The African continent of 1.3 billion people is being warned against "prevention fatigue" as countries loosen pandemic restrictions to ease their economies' suffering and more people travel.

"We cannot relent. If we relent, then all the sacrifices we put into efforts over the past 10 months will be wiped away," Africa CDC director John Nkengasong told reporters. He expressed concern that "many countries are not enforcing public health measures, including masking, which is extremely important."

While the world takes hope from promising COVID-19 vaccines, African health officials also worry the continent will suffer as richer countries buy up supplies.

"Let's celebrate the good news" first, Nkengasong said. But he warned that the Pfizer vaccine requires storage at minus -70 C (-94 F), and such a requirement "already creates an imbalance in the fair distribution or access to those vaccines" as richer countries will be better equipped to move quickly.

A storage network at -70 C (-94 F) was put in place for West Africa's devastating Ebola outbreak a few years ago, but that was localized, Nkengasong said.

"If we were to deploy across the whole continent, it would be extremely challenging to scale it," he said.

The Moderna vaccine requires storage at -20 C (-4 F), which Nkengasong called promising. But the price of any COVID-19 vaccine is another factor in their fair distribution, he said. "So if a vaccine is $40 it becomes almost exclusive to parts of the world" that can afford it.

But he offered an optimistic early look at attitudes across Africa toward any COVID-19 vaccine. Early data from a vaccine perception survey in 11 countries show 81% of respondents would accept a vaccine, he said. "So that's very, very encouraging news."

In a separate briefing, the World Health Organization's Africa chief Matshidiso Moeti acknowledged "very hot competition at the global level to reserve doses" but expressed her hope that "as time goes on, other countries are willing to, if you like, concede that you don't need to try to cover all the population at once."

Salim Abdool Karim, chairman of South Africa's COVID-19 advisory committee, said there was no sign that the vaccines now showing promise won't be just as effective in Africa as in their clinical trials elsewhere in the world.

Nearly 20 countries in Africa are now seeing a more than 20% increase in cases over the past four weeks, WHO said. This time the surge is driven not by South Africa, but by North African nations as temperatures fall there.

Several African countries have confirmed virus cases in the six figures. South Africa leads with more than 750,000, while Morocco has more than 300,000, Egypt more than 110,000 and Ethiopia more than 100,000.

Kenya is the latest concern as it now sees a fresh surge in cases. At least four doctors died on Saturday alone, leading a powerful health union in the country to threaten a nationwide strike starting next month.

"Absolutely no doubt you'll see COVID spread into more rural areas" of Kenya and other countries, Nkengasong said, as more people move around.

The approaching holidays and inter-generational gatherings bring the risk of super-spreader events and new virus clusters in yet-untouched areas, WHO said.

The African continent has conducted 20 million coronavirus tests since the pandemic began, but shortages mean the true number of infections is unknown.

Moeti worried that in some of Africa's low-income countries, much of the limited testing capacity has been used on people who want to travel abroad instead of controlling the virus at home.

___

Follow AP's coverage at https://apnews.com/hub/coronavirus-pandemic and https://apnews.com/UnderstandingtheOutbreak