Wars, instability pose vaccine challenges in poor countries

A convoy of Saudi military vehicles is patrolling the city of Aden in southern Yemen, on April 26, 2020.

SALEH AL-OBEIDI | AFP via Getty Images

Arifullah Khan had just administered another polio vaccine when gunfire erupted from nearby hills.

“It happened so suddenly. There were so many gunshots that it felt like an explosion,” he said, recalling the details of the attack five years ago in the Bajaur tribal area of ​​Pakistan near the Afghan border.

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

“I could not move,” Khan said. “I saw him lying right in front of me as he took his last breath.”

In Pakistan, the delivery of vaccines can be deadly. Militant and radical religious groups are spreading allegations that the polio vaccine is a Western ploy to sterilize or repel Muslim children. More than 100 health workers, vaccinators and security officers involved in polio vaccination have died since 2012.

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

It’s not just the problem of giving vaccines or being behind the line of rich countries to receive them.

Poor infrastructure often means that the roads are treacherous and that electricity is sporadic for the refrigerators that are essential for storing vaccines. Wars and uprisings jeopardize vaccination. Corruption can take away funds, and vaccination planners sometimes have to navigate through various armed factions.

“The most challenging areas … are conflict settings, where outbreaks of violent vaccination are hampered, and areas where misinformation is circulating, which discourages community participation,” said UNICEF Deputy Chief Benjamin Benjamin Schreiber.

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

UNICEF, which manages vaccination programs worldwide, is ready to obtain and administer COVID-19 vaccines, Schreiber told The Associated Press. It has amassed half a million syringes and is aimed at providing 70,000 refrigerators, mostly on solar power, he said.

The agency plans to ship 850 tonnes of COVID-19 vaccines per month next year, doubling the normal annual 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 begin vaccinations soon. The military will handle distribution, and by the end of 2021, the government has promised free vaccines to Mexico’s nearly 130 million inhabitants.

Meanwhile, Haiti, the poorest country in the Western Hemisphere, has not yet announced any vaccination plans. Health experts are concerned that widespread vaccinations could catch up, including allegations that hospitals will give fatal injections to inflate COVID-19 mortality rates and receive more foreign aid.

Mourners attend the funeral of 43 farm workers in Zabarmari, Nigeria, on 29 November 2020 after being killed by Boko Haram fighters in rice fields near the town of Koshobe on 28 November 2020.

Audu Marte | AFP via Getty Images

The African Centers for Disease Control and Prevention is leading a continental effort to vaccinate 1.3 billion people in Africa in 54 countries. The agency coordinates efforts to obtain doses and seeks funding from the World Bank – it estimates it will take $ 10 billion to obtain, distribute and administer the vaccines.

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

“The time for action is now,” Nkengasong said. “The West cannot defeat COVID-19 alone. It must be defeated by the whole world, and that includes Africa.”

Congo highlights the obstacles facing the campaign.

The country has overcome Ebola outbreaks with vaccination campaigns. But it has struggled in eastern Congo, where Allied Democratic rebels are launching regular attacks and other armed groups are fighting for control of mineral wealth.

Rough terrain and uncertainty meant that intruders had trouble getting to all areas. Some came under attack.

Rumors are flying about the Ebola vaccines, including the idea that they are meant to kill people, Dr. Maurice Kakule, an Ebola survivor who worked on vaccination campaigns, said. Education programs have overcome much of the resistance, but similar suspicions are spreading across the COVID-19 vaccine, he said.

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

Civil wars offer perhaps the biggest obstacles.

In Yemen, the health care system collapsed during a six-year war between Houthi rebels controlling the north and government-allied factions in the south.

Yemen, for the first time in 15 years, has broken out of polio this summer in the northern province of Saada. Intenters have not been able to work there for the past two years, in part for fear of safety, UNICEF said. Agencies rushed in November and December to give new vaccinations in parts of the north and south.

Cholera and diphtheria were on the rise, and Yemen is once again facing a new famine. UN officials warned in 2021 about possible famine.

No plans for COVID-19 vaccinations have been announced yet, either by the Houthis, southern authorities or WHO and UNICEF.

Only half of Yemen’s health facilities remain functional. Roads, power grids and other infrastructure were destroyed. The Houthis have blocked some programs and are trying to settle concessions from UN agencies, including sending cholera vaccines amid an outbreak in 2017.

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

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

Pakistan, Afghanistan and Nigeria are the only countries in the world where polio is still endemic. There were only 82 new polio cases this year, mainly because vaccinations have been suspended due to the pandemic, dr. Rana Safdar, who coordinates the polio vaccination campaigns, said.

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

Khan tried to explain the deep mistrust in his region. Deeply conservative tribal elders “believe that the vaccine is the reason why the young people who received it as children are disrespectful and show little concern about Islamic traditions and values.”

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

According to Khan, he applied to administer polio vaccines because he was only paid 56 days for a few days’ work. “I had to feed my family.”

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

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