NGWERERE, Zambia – Four people came to a health clinic tucked into a sprawl of commercial maize farms on a recent morning in search of Covid-19 vaccines. The staff had stored bottles of the Johnson & Johnson vaccine in the refrigerator. But the staff apologetically refused to vaccinate the four and suggested we try another day.
A vial of the Johnson & Johnson vaccine contains five doses and the staff were instructed not to waste any.
Ida Musonda, the nurse overseeing the vaccination efforts, suspected her team might have found more takers had they packed the vials in Styrofoam coolers and taken them to markets and churches. “But we don’t have fuel for the vehicle to get the vaccines there,” she said.
They vaccinated as many as 100 people on their last trip to a farm; the records from that trip were on a stack of papers in the clinic because the data manager didn’t have an internet connection to access an electronic record system.
For months, the biggest challenge has been to vaccinate Africans against Covid and protect both the continent and the world from the emergence of dangerous variants: A continent of about 1.4 billion people has received only 404 million doses of vaccine and only 7.8 percent of the population is fully vaccinated.
But as the supply begins to sputter into something like a more reliable flow, other daunting obstacles come into play. They can all be seen on and around Ngwerere.
Weak health care systems with limited infrastructure and technology, and no experience in vaccinating adults, are trying to get into the poor people who have much more pressing priorities. At the same time, the global flow of information and deliberate misinformation on social media is stirring the same skepticism that has hampered vaccination efforts in the United States and other countries.
Some Zambians are hesitant, but others have an attitude better described as vaccine indifference. This is a poor country where the economy has shrunk during the pandemic and many unvaccinated people are more focused on putting food on the table.
“I’d love to have it, but I work Monday to Saturday and I don’t know if they vaccinate on Sunday,” said Bernadette Kawango, who supports a large family with her wages from an auto parts store in a low-income neighborhood on the eastern side. outskirts of Lusaka, the capital. She has heard many rumors: that people who receive the vaccine will die within two years; that the vaccine is part of a plot by Europeans to kill Africans and take their land; that Bill Gates is campaigning to reduce the world’s population.
Stories like this make her roll her eyes. But Covid isn’t at the top of her list of health care concerns. “It’s cholera season, and people have malaria, and there’s HIV and TB,” she said. She does not know anyone who has been diagnosed with Covid.
All of these challenges create two major problems. First, the vaccination rate is far too slow to prevent unnecessary deaths in a fourth wave, already beginning in southern Africa, or to delay the emergence of new variants such as Omicron, which was first identified in South Africa late last month. prevent. The vaccines now in stock — many of them donations that are nearing their expiration date when they arrive — should not be used until they must be destroyed.
Second, the pressure to vaccinate against Covid is drawing resources from health systems that can barely afford them, which could have disastrous consequences for the fight against other devastating health problems.
Ngwerere’s health clinic lacked the usual bustle and screeching in the mother-child health room, where babies are checked for signs of malnutrition and receive childhood vaccinations, as all of that staff had been rebranded as Covid vaccinators.
“Every time we have a wave here, it really threatens the investments that have been made in HIV, maternal and child health, and TB and malaria, and it’s important that we protect those,” said Dr Simon Agolory, who the great Zambia. program of the US Centers for Disease Control and Prevention.
dr. Andrew Silumesii, the health director of the Zambia Ministry of Health, said there was already clear evidence that surveillance of infant growth and immunization had declined over the course of the pandemic. He fears that malaria, TB and HIV infections will also increase.
So far, 7 percent of Zambians, about five million people, have been vaccinated against Covid. President Hakainde Hichilema has set a target of vaccinating an additional two million by Christmas, and 70 percent of the population by the third quarter of 2022, a target that seems extremely ambitious.
Zambia’s vaccines come primarily from Covax, the global vaccine sharing initiative, with additional donations from China and the African Union. The fact that Zambia is largely dependent on donations means that it has to adapt its program to all the shipments that come in – a bit like making a meal with what comes in a box of farm subscriptions. The country controls the distribution of five different vaccines, each with different dosing schedules, storage requirements and vial volumes.
That created an enormous additional administrative burden for skeletal staff such as Ms. Musonda’s team. Her staff has no budget for cell phone calls to remind people of second injections, and the effect can be seen in the charts stapled to the wall of the vaccination room: of the 840 people who received a first dose of AstraZeneca in April, only 179 returned for a follow up in July.
When Zambia experienced a severe third wave of Covid earlier this year, media coverage of people dying in hospital parking lots due to their oxygen deprivation shook a population that believed the virus was something that only affected white or wealthy people. . There were lineups outside vaccination sites before dawn that couldn’t keep shots in stock.
But as the wave subsided, so did the demand.
Many people here remember the time when Zambians died en masse from AIDS and Western pharmaceutical companies refused to produce affordable life-saving medicines. There is skepticism now that the same companies offer free solutions.
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Misinformation about vaccines is spreading on TikTok and WhatsApp, and in evangelical churches where pastors are warning that the shot “contains the mark of the beast.”
“No matter how educated people are, if their pastor says they don’t trust the vaccine, they don’t trust it,” said Dr. Morton Zuze, the clinical care coordinator at Chongwe District Hospital, serving seven staff members in an empty vaccination tent.
As in the United States, in Zambia there are false rumors that the vaccine causes female infertility or erectile dysfunction. Zambians have heard that AstraZeneca is not used in many countries due to reports of blood clots in a very small number of people who have received that injection. “It’s a global village and anyone can turn on DailyExpertNews,” added Dr. Get ready for it.
Zambia normally only vaccinates small children and has no primary care practices. An adult only goes to a clinic if he is pregnant, receiving HIV treatment or in an emergency.
dr. Lawrence Mwananyanda, an assistant professor at the Boston University School of Public Health and a special adviser to President Hichilema, said the government must balance between creating a demand for vaccines and not creating too much, while unsure whether it will. have the offer to deliver.
“To just walk up – and these health facilities are sometimes very far away, two, five, seven kilometers away and people don’t have cars, you have to be very motivated – sometimes people have gone to a health center and then there’s no vaccine.” he said. “They are only told, ‘You can only vaccinate if there are five or six people, so you can’t be vaccinated today.’ What are the chances of you coming back?”
Charity Machika was recently vaccinated at a rural health center in Chongwe district. She went to the clinic for a prenatal check-up and was then encouraged to move to the next building, where the HIV treatment center was used for vaccinations. “I was afraid because people tell a lot of stories, that I will pass out, that I will not be able to walk, that I will die,” she said. “I took the risk to come and protect myself and my baby.”
She is the only vaccinated person in her family. Her husband tried twice, but the locations he went to never had vaccines in stock, and it was difficult for him to find the time to walk the four kilometers to try again, she said.
Felix Mwanza, a veteran HIV activist in Lusaka, said the government has not yet tapped into the country’s extensive network of HIV and TB treatment activists. “We don’t seem to be learning from our past,” he said, recalling how HIV testing and treatment did not reach critical mass until care was delivered in bars, schools and on the sidewalk.
“If they don’t use the structures that we already have, donors will keep sending the vaccines and they’ll pile up here and expire and then they won’t send us anymore,” he said.
said Dr. Mwananyanda that the main strategy for the planned rapid scaling up of vaccination was to do just that, by bringing vaccines to people in shopping malls and bus stops.
Amid the hustle and bustle, no one thinks about what happens next. “We’re just tackling the vaccination issues for now — but we don’t have a long-term system in place,” said Dr. Agolory of the CDC. “And what are we going to do if boosters are needed or if there are some new variants that escape the vaccine altogether, and we have to start from scratch and give people more vaccines?”
Zambia will need help to purchase more, and it will need funding to attract temporary health workers to administer vaccines so that existing programs, such as the Ngwerere Mother-and-Child Clinic, are not abandoned, said Dr. Agolory.
Even with a massive surge in vaccination rates, the country won’t have enough coverage to blunt the coming wave, or, most likely, the wave after.
“I hope we keep getting vaccines so we don’t get into a situation where people need vaccines and they can’t get them,” said Dr. Silumesii of the Ministry of Health. “The flip side, something I really wouldn’t like to see happen, is where we’ve brought in vaccines and we don’t have enough demand and vaccines are wasted. These are vaccines that cost a lot. Surely that sniff would sting so badly.”
