Wars, instability pose vaccination problems in poor countries

Arifullah Khan had just been given another polio vaccine when gunfire shot from nearby hills.

“It happened so suddenly. There was so much gunfire that it felt like an explosion,” he said, recalling details of the attack five years ago in Pakistan’s Bajaur tribal region near the Afghan border.

A bullet shattered his thigh and he fell to the floor. His childhood friend and partner in the vaccination campaign, Ruhollah, lay bleeding on the ground in front of him.

“I couldn’t move,” Khan said. “I saw him right in front of me as he took his last breath.”

In Pakistan, delivering vaccines can be deadly. Militants and radical religious groups are spreading claims that the polio vaccine is a Western ploy to sterilize Muslim children or expel them from religion. Since 2012, more than 100 health professionals, vaccinators and safety officers involved in polio vaccination have been killed.

The violence is an extreme example of the difficulties faced by many poor and developing countries in Asia, Africa, the Middle East and Latin America in addressing the monumental task of vaccinating their populations against COVID-19.

It’s not just the problem of providing vaccines or falling behind rich countries to receive them.

Poor infrastructure often means roads are treacherous and electricity is sporadic for the refrigerators vital to vaccine preservation. Wars and uprisings endanger vaccinators. Corruption can carry money and vaccination campaign planners sometimes have to navigate multiple armed factions.

“The most challenging areas … are conflict situations, where outbreaks of violence hinder vaccinations, and areas where misinformation is circulating, discouraging community participation,” said Benjamin Schreiber, UNICEF deputy chief of global immunization.

Many countries rely on COVAX, an international system aimed at ensuring fair access to vaccines, even though it is already short on money.

UNICEF, which runs immunization programs worldwide, is gearing up to purchase and administer COVID-19 vaccines, Schreiber told The Associated Press. It has stockpiled half a billion syringes and is aiming for 70,000 refrigerators, mostly solar-powered, he said.

The agency aims to ship 850 tons of COVID-19 vaccines per month next year, double the usual annual monthly rate for other vaccines, UNICEF Executive Director Henrietta Fore said in a statement.

The situation can vary greatly from country to country.

Mexico is expected to start vaccinations soon. The military will provide the distribution, and the government has promised free vaccines for Mexico’s nearly 130 million residents by the end of 2021.

Meanwhile, Haiti, the poorest country in the Western Hemisphere, has not yet announced any vaccination plans. Health experts are concerned that widespread rumors could delay vaccinations – including claims that hospitals will give lethal injections to increase COVID-19 death rates and receive more foreign aid.

The African Centers for Disease Control and Prevention is leading a continental effort to vaccinate Africa’s 1.3 billion people in 54 countries. The agency is coordinating efforts to obtain doses and is seeking assistance from the World Bank with funding – it is estimated to cost $ 10 billion to acquire, distribute, and administer the vaccines.

The goal is to vaccinate 60% of the African population – some 700 million people – more within two years than the continent has done in the past, said John Nkengasong, director of the African CDC.

“Now is the time for action,” said Nkengasong. “The West cannot defeat COVID-19 alone. It has to be defeated all over the world, including Africa.”

Congo underlines the obstacles facing the campaign.

The country has overcome Ebola outbreaks with vaccination campaigns. But it has struggled in Eastern Congo, where Allied Democratic Forces rebels regularly attack and other armed groups compete for control of mineral resources.

Rough terrain and uncertainty made vaccinators struggling to reach all areas. Some were attacked.

Rumors circulated about the Ebola vaccines, including the idea that they were intended to kill people, said Dr. Maurice Kakule, an Ebola survivor who has been involved in vaccination campaigns. Education programs overcame much of the resistance, but similar suspicions are spreading about the COVID-19 vaccine, he said.

In Beni, the area’s main town, Danny Momoti, a trader, said he would take the vaccine because of his job. “I need this COVID-19 vaccination card to be accepted in Dubai and elsewhere where I am going to buy the goods for Beni,” he said.

Civil wars are perhaps the biggest obstacles.

In Yemen, the health system has collapsed after six years of war between Houthi rebels controlling the north and government-allied factions in the south.

This summer, polio broke out in Yemen for the first time in 15 years, in the middle of the northern province of Saada. According to UNICEF, vaccinators have been unable to work there for the past two years, in part due to safety concerns. Agencies rushed to issue new vaccinations in parts of the north and south in November and December.

Cholera and diphtheria are widespread, and once again Yemen is facing a new surge in hunger. UN officials have warned of possible famine in 2021.

There are no plans yet for vaccinations against COVID-19, neither by the Houthis, nor by the Southern authorities, nor by WHO and UNICEF.

Only half of the health facilities in Yemen remain functional. Roads, power grids and other infrastructure have been destroyed. The Houthis have hampered a number of programs by making concessions to UN agencies, including blocking a shipment of cholera vaccines during an outbreak in 2017.

“Even the mildest and normally preventable diseases can be fatal due to a lack of access to health care in a conflict situation,” said Wasim Bahja, Yemen’s country director for the International Medical Corps.

In Pakistan, public mistrust was sparked when the CIA used a vaccination program scam in 2011 to identify the hideout of al-Qaeda leader Osama bin Laden, which led to the special forces raid that killed him.

Pakistan, Afghanistan and Nigeria are the only countries in the world where polio is still endemic. There are 82 new cases of polio this year alone, largely because vaccinations were suspended due to the pandemic, said Dr. Rana Safdar, who is coordinating polio vaccination campaigns.

The Bajaur region, where Khan was shot, remains one of the more dangerous areas, Safdar said.

Khan tried to explain the deep distrust in his region. Very conservative tribal elders “believe that the vaccine is the reason that the young people who had it as children are disrespectful and little concerned about Islamic traditions and values.”

“Everyone is afraid” of COVID-19, he said. “But they are suspicious of Western affairs.”

Khan said he signed up to administer polio vaccines because he was paid the equivalent of $ 56 for just a few days of work. “I had to feed my family.”

He will also likely sign up to deliver COVID-19 vaccines.

“But first I would see if there is any danger,” he said.