By Maggie Fick and Edward McAllister
SEKENANI, Kenya (Reuters) – When a group recently arrived at the Sekenani health clinic in rural Kenya for their COVID-19 vaccines, staff told them there were no more doses left and they should come back soon.
For some it meant a long trek and a day away from their herds of cattle.
Yet Narok County, where the clinic is located, had no shortage of vaccines; nearly 14,000 doses were stored in a refrigerator in the nearest town, 115 km away. Confusion with county officials meant Sekenani didn’t have enough, two health workers said.
“We had to apologize. It’s not a good feeling when someone comes and wants the vaccine and we don’t have it, ”clinician Mike Nalakiti, 27, told Reuters.
The small setback in a village 270 km southwest of the capital Nairobi is an illustration of the challenges African nations now face in their fight against COVID-19: Even if vaccine supplies are finally increasing, putting needles in weapons proves the hardest part.
Successful vaccination campaigns in Africa are essential to end the pandemic on a global scale, according to health experts. The continent’s low inoculation rates are encouraging viral mutations like the new Omicron variant which is spreading across South Africa, which has sparked a new wave of overseas travel bans.
Only 102 million people, or 7.5% of the continent’s population, are fully vaccinated, according to the World Health Organization, which has warned that vaccine inequality will prolong the pandemic.
African governments have called for increased vaccine deliveries this year, but production constraints and hoarding from rich countries have severely constrained supplies until recently.
Lack of funds, medical personnel and equipment, as well as reluctance to vaccinate, were already hampering vaccination campaigns in parts of Africa. The expected surge, including millions of jabs in the coming weeks, could further expose these weaknesses, experts warn.
About 40% of the vaccines that have arrived on the continent so far have not been used, according to data from the Tony Blair Institute for Global Change, a policy think tank.
The rate of vaccine use will have to be quadrupled to keep up with the supply expected in the coming months, according to the institute.
“We are all, like you, very concerned that countries are not collecting vaccines. The adoption is not as we would have liked to see it, ”said the head of the African Centers for Disease Control and Prevention, John Nkengasong.
FRIDGE AND MOTORCYCLE
Immunization rates vary widely across Africa, a continent of over one billion people, and some health systems in relatively small countries and North Africa are more successful.
Cape Verde, an archipelago off West Africa with a population of around 600,000, has vaccinated nearly 65% of adults, rivaling some European countries.
In the Democratic Republic of the Congo, a restless country in Central Africa with a population of nearly 90 million, the number is 0.1%.
In some ways Kenya is doing relatively well. East Africa’s largest economy has received nearly 5 million doses in the past two weeks after months of slow supplies.
On December 1, it vaccinated a record 110,000 people and aims to maintain that rate for the next 30 days, said Willis Akhwale, head of the government COVID-19 vaccine task force. This would bring the total number of vaccinated to 10 million out of a population of 47 million, he said.
However, in the rural clinic of Sekenani, on the edge of the famous game reserve of the Maasai Mara, where elephants and lions roam, the challenges are not lacking.
The clinic started offering COVID-19 vaccines four weeks ago. He continues to run out of doses and only has one reliable refrigerator, which is also used for routine vaccinations, said clinical manager Gerald Yiaile.
Staff need motorcycles to bring vaccines to the community, semi-nomadic herders of the Maasai ethnic group who are struggling to afford transportation for health care, he said.
He asked local authorities for funds for mobile vaccination and had no response.
“We were forced to ask the community to come to us instead of us going to them,” Yiaile said.
NOT ENOUGH MONEY
African countries rushed to prepare their health systems earlier this year as the global COVAX vaccine-sharing program began distributing doses in small amounts months after rich countries began inoculations.
Cash-strapped countries lacked cotton, refrigerators, face masks and trucks.
COVAX deliveries were subsequently halted after exports of vaccines from COVAX’s main supplier to India. The hiatus gave countries time to improve immunization deployment without being inundated. They have done so to varying degrees.
The COVAX co-leader GAVI vaccine alliance did not initially prioritize investing in ultra-cold chain equipment needed for mRNA injections like Pfizer’s because it expected most doses to be the cheapest and easiest to administer AstraZeneca injections. in India, Reuters reported in September.
As vaccine shipments to Africa skyrocket, uptake of large volumes is expected to pose a major challenge for many poor countries, especially as a substantial volume will come from Pfizer, GAVI said in internal documents prepared for its board meeting last week and viewed by Reuters.
Even Kenya, which has the ultra-cold chain capacity to store 3 million doses of Pfizer, fears its cold chain will be limited by the influx, threatening its routine immunization program, Akhwale said.
Cameroon in central Africa had 244 vaccination centers when its vaccine rollout began in April, and now has 1,000, said Njoh Andreas Ateke, deputy head of the vaccination program.
But health workers and officials say power outages and understaffing have compromised vaccines.
The country has a refrigerated truck suitable for transporting vaccines, said Leonard Kouadio, head of the health section of UNICEF in Cameroon. It needs at least 2,500 additional refrigerator temperature gauges and more trucks to increase distribution, he added.
Mali, one of the largest and poorest countries in Africa, has two refrigerated trucks to transport vaccines over long distances. Some health workers have fled their posts in the north due to insecurity caused by an Islamist insurgency, said UNICEF Mali health program manager Abdoul Gadiry Fadiga.
The country expects to receive around 3.5 million doses by the end of March, more than double the number it has received since inoculations began, Fadiga said.
Mali has enough cold chain capacity to cope with the first wave of doses until March, Fadiga added, but it still needs 288 refrigerators and freezers for its full deployment, of which only 10 freezers had arrived.
The funds have been slow to materialize. The World Bank has approved $ 9.8 billion for emergency health responses, including vaccine deployment, in developing countries around the world, but so far only $ 4.4 billion has been disbursed.
Mali and Cameroon are waiting for support.
A World Bank official said disbursements were happening “very quickly”.
Even when help arrives, they can turn on them. Donors have sometimes sent batches of vaccine nearing expiration to African countries, rendering them unusable in some cases.
Countries desperate for vaccines, including South Sudan and Congo, had to return vaccines because they could not distribute them on time. Namibia warned last month that it may have to destroy thousands of expired doses.
South Africa has asked Johnson & Johnson and Pfizer to delay vaccine delivery because it has too much stock.
A key difficulty in administering vaccines is community skepticism, sometimes driven by religious beliefs and mistrust of Western drug companies and their own governments. Insufficient education about COVID-19 vaccines allows rumors to spread.
This may be the result of shortages of local staff and budgets, health workers from across the continent told Reuters.
Ethiopia is concerned that vaccines will expire before use due to low demand and is trying to overcome vaccine reluctance by educating communities through local religious and civil society groups, said Muluken Yohannes, senior advisor to Ethiopia’s health ministry.
“Currently, developed countries… have met their vaccine needs. As a result, they are pushing the remaining vaccines… to developing countries. However, the golden period for absorbing these vaccines has already passed, ”he said.
Kenya has stepped up its vaccine rollout with social media and TV and radio ads promoting the vaccines. Posts on the Ministry of Health’s Twitter feed urging pregnant and breastfeeding mothers to get vaccinated.
Not everyone gets the message. Nicky Theron, 20, who works in a clothing store in the town of Talek, is five months pregnant and afraid of the jab. She does not follow any government Twitter accounts.
“I have never heard of anyone who is pregnant receiving the vaccine,” she said.
Some people think they might be persuaded if someone came to explain themselves in person.
Julius Tuyioto, who raises cattle in the arid plains of southern Kenya, hears the government warning of the dangers of COVID-19 on the radio. But the disease has not affected his community; he says it doesn’t seem real.
“There is no civic education on why we should be vaccinated. No one is telling us, ”Tuyioto told Reuters outside his mud brick house in Narok County, to the sound of goat bells.
Last month, the government sent vaccines by motorbike to the nearest primary school, three miles away, he said. But he only heard about it on the third and last day, when it was too late for him to go.
(Reporting by Maggie Fick and Edward McAllister; Additional reporting by Francesco Guarascio in Brussels, Josiane Kouagheu in Douala, Cameroon and Giulia Paravicini in Addis Ababa; Editing by Mike Collett-White and Alexandra Zavis)