When Ghana received 50,000 COVID-19 vaccine doses from India last month, it hit a frustrating roadblock: it had not trained enough staff to distribute them.
According to the head of Ghana’s immunization program, the country was still rolling out injections it had received from the global COVAX vaccination schedule at the end of February, and did not have the capacity to expand that operation.
Rather than falling directly into the arms of health workers, the extra doses were stored refrigerated in the capital, Accra, Kwame Amponsa-Achiano told Reuters, adding that his team had received two days notice about the shipment.
“We were in the middle of the first campaign,” said Amponsa-Achiano. “How do you plan for 50,000 if you’re already running another campaign?”
The problems facing Ghana, one of the more economically developed sub-Saharan countries, illustrate how a continent with experience fighting deadly infectious diseases is ill-prepared to vaccinate people against this pandemic.
Many African countries, already struggling with a shortage of affordable vaccines, are amazed at the unprecedented magnitude of the distribution challenge when doses arrive.
According to more than a dozen health experts and some internal government documents seen by Reuters, the authorities do not have enough equipment, such as masks and cotton wool, due to funding shortages that could reach billions of dollars.
They also lack sufficient staff and training to distribute vaccines in the short term.
While Africa has so far been relatively unharmed by COVID-19, some experts fear a stuttering rollout could trigger the outbreak in the region, potentially leading to more deaths and economically damaging constraints in a continent already the poorest in the world. is.
Benjamin Schreiber, COVAX coordinator at the UN children’s agency UNICEF, said the logistical problems could increase in the coming weeks and months as countries tried to get vaccines for their general populations.
“As we start to roll out larger quantities, we will see more problems,” said Schreiber.
“The gaps in health care systems will be the gaps that hinder deployment,” he added. “I’m concerned that we are missing entire communities.”
NEEDED: MILLIONS OF DOLLARS
Ghana, where the novel coronavirus has infected more than 91,000 and killed more than 750, is considered one of the more prepared countries in Africa to launch a mass vaccination campaign due to its political stability and economic development.
According to a national Reuters plan, the government plans to initially vaccinate 17.6 million people – about half the population – at a cost of $ 51.7 million.
It hopes to cover $ 7.9 million of that money with a World Bank loan, but comes in at $ 43.8 million, described as a “funding gap” in the internal government document.
Vaccination chief Amponsa-Achiano said he was unaware the situation had changed since the plan was formulated in February.
Ghana’s Ministries of Finance and Health have not responded to requests for comment.
Ghana was the first country in the world to receive a shipment of COVAX, receiving 600,000 doses of the AstraZeneca / Oxford University vaccine, manufactured in India, on February 24.
It began its vaccination program on March 1 and had vaccinated 599,000 people by April 7.
While that vaccination rate is better than many of its African peers – Ivory Coast vaccinated just over 53,000 people between March 1 and April 6 – it lags far behind the fastest countries in the world. Britain, for example, administered doses to about 2 million people in about the first month of its ride.
NEEDED: REFRIGERATORS, COTTON WOOL
The Ghanaian National Plan shows that even relatively prosperous African countries lack essential equipment.
Money is needed across the board, including $ 1.5 million for 11 walk-in refrigerators and more than 650 refrigerators to keep vaccines between 2 and 8 degrees Celsius.
The plan requires approximately $ 25 million for supplies and waste management, including 33,600 boxes of face masks, 240,000 bottles of hand sanitizer, and nearly 55,000 rolls of cotton wool. About $ 21 million is needed to train more than 171,000 health workers and volunteers.
In addition to Ghana’s challenge, the next COVAX shipments, expected in April and May, have been delayed to June as India has suspended major exports of vaccines produced there.
In its 2021 budget, drawn up in mid-March, the Ghanaian government allocated 929,296,610 cedis ($ 160 million) to acquire and deploy vaccines.
However, Amponsa-Achiano said it was not clear how much would go to distribution, or when the funds would be realized.
It’s a common problem in Africa, UNICEF’s Schreiber said.
“The question is, at what point will this funding hit the ground? Will it be on time?”
BREAKING OUT OF CONGO EBOLA
Some African authorities are aware of deadly infections. Since 2018, Congo has known four Ebola outbreaks with a vaccine that must be stored between -60 and -80 degrees Celsius.
But the scope of the COVID-19 vaccination program is new.
COVAX – the donor program co-led by the World Health Organization (WHO) – has delivered more than 18 million doses to 41 African countries, according to Reuters data.
That’s the first wave in a drive expected to deliver 600 million doses to Africa this year, enough to vaccinate 20% of their population. Russia, China and India have also donated some of their vaccines.
Funding is just one problem delaying the introduction of vaccines.
Another is the patchy record-keeping in many public health systems, which experts say make it difficult to identify people who should be prioritized because of their age or co-morbidity.
Demand for injections is also weak in some countries due to mistrust of health authorities, lack of education about the vaccines and concerns about possible side effects.
Poor electricity and poor transport connections in places add to the challenge, while medical teams will have to negotiate safe passage through parts of the Democratic Republic of the Congo, Mali, Somalia and other places where uprisings are raging.
VACCINE UNTIL THE END of 2022?
John Nkengasong, head of the Africa Centers for Disease Control and Prevention, says it could take until the end of 2022 to vaccinate 60% of the continent’s 1.3 billion people.
Take on the task of Mali, a poor country fighting an Islamic uprising. It needs $ 14.7 million to deploy vaccines, including gasoline, vaccine storage and training, according to a government internal vaccination plan seen by Reuters.
Under the plan, the government needs financial support from WHO, UNICEF, the GAVI Vaccine Alliance and the World Bank. These organizations are all looking for funding to African countries that are struggling with shortages.
South Sudan, still ravaged by violence after a civil war ended in 2018, has seen COVID-19 infect at least 10,300 people and kill more than 100.
It began distributing 132,000 vaccine doses of COVAX on April 7. However, authorities won’t start firing shots outside the capital Juba and the surrounding province until May, said Kawa Tong, a member of a COVID-19 steering group advising. government.
“The main reason is the lack of money for a rollout outside of Juba. The transportation of vaccines, the training of health workers, the reach of the community – all this is linked to funding,” Tong told Reuters.
In addition to the difficulties, the rainy season will be in full swing in May, cutting transport links to large parts of the country, she said. The vast majority of the 11 million inhabitants live outside the province of Juba.
Atem Riek Anyom, director general for primary health care at South Sudan’s Ministry of Health, said the government had asked for funding from the World Bank, adding that vaccines would soon be deployed across the country.
“There is no challenge with regard to vaccine rollout,” he added.
The World Bank, which has a $ 12 billion fund to help developing countries around the world buy and distribute vaccines, said it is reviewing requests from Mali and South Sudan.
The bank said it has approved $ 2 billion to 17 countries, including seven in Africa: Ethiopia, Cape Verde, Ivory Coast, Eswatini, Tunisia, Rwanda and The Gambia.
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