Wars, instability are vaccine challenges in poor countries

Arifullah Khan had just received another polio vaccine when gunfire exploded from nearby hills.

“It happened so suddenly. There were so many wildfires 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 ground. His childhood friend and vaccination campaign partner, Ruhollah, was lying bleeding on the ground in front of him.

“I couldn’t move,” Khan said. “I watched him stretch out right in front of me the last time he breathed.”

In Pakistan, vaccine administration can be fatal. Activists and radical religious groups have spread claims that the polio vaccine is a Western trick to sterilize Muslim children or remove them from religion. More than 100 health workers, vaccinators and security officials involved in polio vaccination have been killed since 2012.

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

It is not just a matter of offering vaccines or being behind the line behind rich countries in receiving them.

Poor infrastructure often means that roads are treacherous and electricity is sporadic for refrigerators vital for vaccine storage. Wars and insurgencies endanger vaccinators. Corruption can destroy funds, and vaccination campaign planners sometimes have to navigate through several armed factions.

“The most challenging areas … are the conflict settings, where outbreaks of violence prevent vaccinations and areas where misinformation is circulating, which discourages community participation,” said UNICEF Deputy Chief of Global Immunization Benjamin Schreiber.

Many nations rely on COVAX, an international system that aims to ensure equitable access to vaccines, although it is already underfunded.

UNICEF, which runs global immunization programs, is preparing to help procure and administer COVID-19 vaccines, Schreiber told the Associated Press. He has stockpiled half a billion syringes and aims to supply 70,000 refrigerators, most of them solar-powered, he said.

The agency aims to transport 850 tonnes of COVID-19 vaccines per month next year, doubling 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 begin immunizations soon. The military will handle distribution, and the government has promised free vaccines to nearly 130 million people in Mexico by the end of 2021.

Meanwhile, Haiti, the poorest country in the Western Hemisphere, has not yet announced any vaccination plans. Health experts worry that widespread rumors could prevent vaccinations – including claims that hospitals will inject fatal injections to inflate COVID-19 death rates and receive more external help.

African Centers for Disease Control and Prevention is leading an effort across the continent to vaccinate the 1.3 billion people in Africa in 54 countries. The agency is coordinating efforts to obtain doses and is seeking help from the World Bank in funding – estimating that $ 10 billion will be needed to purchase, distribute and administer vaccines.

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

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

Congo highlights the obstacles facing the campaign.

The country has overcome Ebola outbreaks with vaccination campaigns. But it has been fought in eastern Congo, where rebels from the Allied Democratic Forces are organizing frequent attacks and other armed groups are fighting for control of mineral wealth.

The rugged terrain and insecurity meant that vaccinators had trouble reaching all areas. Some were attacked.

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

In Beni, the main town in the area, Danny Momoti, a trader, said he would get the vaccine because of his work. “I need this COVID-19 vaccination card to be accepted in Dubai and other places where I go to buy goods for Beni,” he said.

Civil wars are probably the biggest obstacle.

In Yemen, the health system collapsed under six years of war between Houthi rebels who control the north and factions allied with the southern government.

This summer, Yemen experienced the first outbreak of polio in 15 years in the northern province of Saada. Vaccinators have been unable to work there for the past two years, in part because of security concerns, UNICEF said. The agencies rushed to make new vaccinations in northern and southern parts in November and December.

Cholera and diphtheria have increased, and once again, Yemen is facing a new rise in hunger. UN officials have warned of a potential famine in 2021.

COVID-19 vaccination plans have not yet been announced, either by Houthis, southern authorities or by WHO and UNICEF.

Only half of Yemen’s health facilities remain operational. Roads, electricity networks and other infrastructure were devastated. The Houthis have thwarted some programs, trying to snatch concessions from UN agencies, including blocking a shipment of cholera vaccines amid a 2017 outbreak.

“Even the mildest diseases that can normally be prevented can prove fatal due to lack of access to healthcare in a conflict context,” said Wasim Bahja, the country’s director for the International Medical Corps in Yemen.

In Pakistan, public distrust was fueled when the CIA used a scam vaccination program in 2011 to identify the hiding place of al-Qaeda leader Osama bin Laden, leading to a raid by special forces that killed him.

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

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

Khan tried to explain the deep distrust in his region. The deeply conservative tribal elders “believe that the vaccine is the reason why young people who were given it as children are disrespectful and have no concern for Islamic traditions and values.”

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

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

It will probably sign up to deliver COVID-19 vaccines as well.

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