When Ghana received 50,000 doses of India’s COVID-19 vaccine last month, it hit a frustrating obstacle: it had not trained enough staff to distribute them.
The country was still launching vaccines received at the end of February from the global COVAX vaccine sharing scheme and was unable to expand this operation, according to the head of Ghana’s immunization program.
Instead of going straight into the arms of health professionals, the additional doses were placed in cold stores in the capital, Accra, Kwame Amponsa-Achiano told Reuters, adding that his team had received a two-day notice of boarding.
“We were in the middle of the first campaign,” said Amponsa-Achiano. “How do you plan for 50,000 when you’re already running another campaign?”
The problems faced by Ghana, one of the most economically developed nations in sub-Saharan Africa, illustrate how a continent with experience in fighting deadly infectious diseases has found itself ill-prepared to vaccinate people against this pandemic.
Many African countries, which already face a shortage of affordable vaccines, are being surprised by the unprecedented scale of the distribution challenge when doses arrive.
Authorities do not have enough equipment, such as masks and cotton, due to a financing gap that could total billions of dollars, according to more than a dozen health experts and some internal government documents seen by Reuters.
They also lack sufficient staff and training to distribute vaccines in the short term.
Although Africa has so far been relatively unscathed by COVID-19, some experts fear that stuttering launches could prolong the outbreak in the region, potentially leading to more economically damaging deaths and restrictions on a continent that is already the poorest in the world.
Benjamin Schreiber, COVAX coordinator at the UN children’s agency, UNICEF, said that logistical problems could increase in the coming weeks and months as countries try to provide vaccines to their populations in general.
“As we start to launch large quantities, we will start to see more problems,” said Schreiber.
“The gaps in health systems will be the gaps that hinder implementation,” he added. “My concern is that we miss complete communities.”
REQUIRED: MILLION DOLLARS
Ghana, where the new coronavirus has infected more than 91,000 and killed more than 750, is considered one of the best prepared countries in Africa to carry out a mass vaccination campaign due to its political stability and economic development.
The government plans to initially inoculate 17.6 million people – about half of its population – at a cost of $ 51.7 million, according to a national plan seen by Reuters.
It expects to cover $ 7.9 million of that money with a loan from the World Bank, but lacks $ 43.8 million, described as a “financing gap” in the government’s internal document.
The immunization chief, Amponsa-Achiano, said he did not know that the situation had changed since the plan was formulated in February.
Ghana’s finance and health ministries did not respond to requests for comment.
Ghana was the first country in the world to receive a shipment from COVAX, leading to the delivery of 600,000 doses of the AstraZeneca / Oxford University vaccine, manufactured in India, on February 24.
The vaccination campaign started on March 1 and vaccinated 599,000 people by April 7.
Although this vaccination rate is better than that of many of its African peers – Côte d’Ivoire vaccinated just over 53,000 people between March 1 and April 6 – it is far behind the fastest countries in the world. Britain, for example, administered doses to about 2 million people in approximately the first month of its campaign.
REQUIRED: FRIDGES, COTTON
Ghana’s national plan shows how even relatively prosperous African nations lack vital equipment.
The money is needed by everyone, including $ 1.5 million for 11 cold stores and more than 650 refrigerators to keep vaccines between 2 and 8 degrees Celsius.
About $ 25 million is needed for supplies and waste management, including 33,600 boxes of masks, 240,000 bottles of hand sanitizer and nearly 55,000 rolls of cotton, the plan says. About $ 21 million is needed to train more than 171,000 health professionals and volunteers.
To add to Ghana’s challenge, its upcoming shipments of COVAX, expected in April and May, have been postponed until June because India has suspended major exports of vaccines manufactured there.
In its 2021 budget, outlined in mid-March, the Ghanaian government allocated 929,296,610 cedis ($ 160 million) for vaccine procurement and implantation.
Amponsa-Achiano said, however, that it is not clear how much will go towards distribution or when the funds will materialize.
It is a common problem in Africa, said UNICEF’s Schreiber.
“The question is at what point will this funding reach the ground? Will it be in time?”
CONGO EBOLA OUTBREAKS
Some African officials are familiar with deadly contagions. Since 2018, Congo has contained four outbreaks of Ebola with a vaccine that should be stored between -60 and -80 degrees Celsius.
But the scale of the COVID-19 vaccination campaign is new.
COVAX – the donor scheme co-led by the World Health Organization (WHO) – has delivered more than 18 million doses to 41 African countries, according to Reuters data.
This is the first wave of a campaign that is expected to deliver 600 million doses to Africa this year, enough to vaccinate 20% of its populations. Russia, China and India have also donated some of their vaccines.
Financing is just an issue that delays the launch of vaccines.
Another is the maintenance of irregular records in many public health systems, which, experts say, makes it difficult to identify people who should be prioritized due to age or comorbidities.
Demand for vaccines is also weak in some countries due to distrust from health officials, lack of education about vaccines and concerns about possible side effects.
Weak electricity and poor transport connections in some places add to the challenge, while medical teams will have to negotiate safe passage through parts of the Democratic Republic of Congo, Mali, Somalia and other places where the rebellions take place.
VACCINATING UNTIL THE END OF 2022?
John Nkengasong, who heads the African Centers for Disease Control and Prevention, says it may take until the end of 2022 to vaccinate 60% of the continent’s 1.3 billion people.
Take on the task facing Mali, an impoverished country fighting an Islamic insurgency. US $ 14.7 million is needed to distribute vaccines, including gasoline, storage and vaccine training, according to an internal government vaccination plan seen by Reuters.
The government will need financial support from WHO, UNICEF, the GAVI vaccine alliance and the World Bank, the plan says. All of these organizations seek to provide funding to African nations that face disabilities.
South Sudan, still plagued by violence after the end of the civil war in 2018, saw COVID-19 infect at least 10,300 people and kill more than 100.
It started delivering 132,000 doses of COVAX vaccine on April 7. However, officials will not start administering vaccines outside the capital Juba and the neighboring county until May, said Kawa Tong, a member of a COVID-19 steering committee that advises the government.
“The main reason is the lack of funds for an implantation outside of Juba. The transport of vaccines, the training of health professionals, the reach of the community – these are all linked to financing,” Tong told Reuters.
Adding to the difficulties, in May the rainy season will be well underway, cutting transport links to large parts of the country, she said. The vast majority of the population of 11 million live outside Juba County.
Atem Riek Anyom, director general of primary health at the Ministry of Health of South Sudan, said the government had requested funding from the World Bank, adding that vaccines would be distributed soon across the country.
“There is no challenge regarding the launch of the vaccine,” he added.
The World Bank, which has a $ 12 billion fund to help developing countries around the world buy and distribute vaccines, said it was looking at requests from Mali and South Sudan.
The bank said it had approved $ 2 billion for 17 countries, including seven in Africa: Ethiopia, Cape Verde, Ivory Coast, Eswatini, Tunisia, Rwanda and Gambia.
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