Wars and instability pose vaccine challenges to poor nations

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

“It happened so suddenly. There were so many shots that looked like an explosion,” he said, recalling details of the attack five years ago in the Bajaur tribal region of Pakistan near the border with Afghanistan.

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

“I couldn’t move,” Khan said. “I saw him lying in front of me while he was breathing the last one.”

In Pakistan, administering vaccines can be fatal. Militants and radical religious groups spread claims that the polio vaccine is a Western strategy to sterilize Muslim children or turn them away from religion. More than 100 health professionals, 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 when tackling the monumental task of vaccinating their populations against COVID-19.

It’s not just the problem of offering vaccines or being behind the line behind rich countries when they receive them.

Poor infrastructure often means roads are treacherous and electricity is sporadic for refrigerators vital to preserving vaccines. Wars and insurgencies endanger vaccinators. Corruption can wipe out funds, and sometimes vaccination campaign planners have to navigate multiple armed factions.

“The most challenging areas … are conflict environments, where outbreaks of violence make vaccination difficult and areas where misinformation circulates, which discourages community participation,” said UNICEF’s Deputy Director-General for Immunization. , Benjamin Schreiber.

Many nations rely on COVAX, an international system aimed at ensuring equitable access to vaccines, even though it no longer has funding.

UNICEF, which runs vaccination programs around the world, is preparing to help acquire and administer COVID-19 vaccines, Schreiber told The Associated Press. It stored a billion syringes and aims to provide 70,000 refrigerators, mostly with solar energy, he said.

The agency aims to transport 850 tonnes of COVID-19 vaccines a month next year, double its usual monthly annual rate for other vaccines, UNICEF Executive Director Henrietta Fore said in a statement. communiqué.

The situation can vary greatly from country to country.

Mexico is expected to start vaccinations soon. The military will be in charge of distribution and the government has promised free vaccines to Mexico’s nearly 130 million people 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 may curb vaccinations, including claims that hospitals will make lethal injections to inflate COVID-19 death figures and receive more outside help.

The African Centers for Disease Control and Prevention is leading an effort across the continent to vaccinate Africa’s 1.3 billion people in 54 countries. The agency coordinates efforts to obtain doses and seeks assistance from the World Bank in funding; estimates that $ 10 billion will be needed to acquire, distribute and administer the vaccines.

The goal is to vaccinate 60 percent of the African 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 everyone, and that includes Africa.”

Congo highlights the obstacles facing the campaign.

The country has overcome Ebola outbreaks with vaccination campaigns. But he fought in eastern Congo, where Allied Democratic Forces rebels carry out frequent attacks and other armed groups fight for control of mineral wealth.

Rugged terrain and insecurity meant that vaccinators had trouble getting to all areas. Some were attacked.

There were rumors about Ebola vaccines, including the idea that they intended to kill people, said Dr. Maurice Kakule, an Ebola survivor who worked on vaccination campaigns. Educational programs overcame much of the resistance, but similar suspicions spread about the COVID-19 vaccine, he said.

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

Civil wars are perhaps the biggest obstacles.

In Yemen, the health system has collapsed during six years of war between Houthi rebels who control the north and allied factions of the government in the south.

Yemen saw its first polio outbreak this summer in 15 years, centered 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. Agencies rushed to give new inoculations to parts of the north and south in November and December.

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

Plans for vaccines against COVID-19 have not yet been announced, either by Houthis, southern authorities or WHO and UNICEF.

Only half of Yemen’s health facilities remain functional. Roads, power grids and other infrastructure have been devastated. Houthis have thwarted some programs, trying to get concessions from UN agencies, including blocking a shipment of cholera vaccines in the middle of a 2017 outbreak.

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

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

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

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

Khan tried to explain the deep mistrust in his region. The deeply conservative tribal elders “believe the vaccine is the reason young people who were given it as children are disrespectful and show little concern for Islamic traditions and values.”

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

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 needed to feed my family.”

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

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