Distribution problems, hesitation slow Ugandan vaccination bid

GULU, Uganda – A ceiling-hung light bulb flickered on and off, enraging technicians in this remote Ugandan city as they checked refrigerators full of vaccine doses to confirm they were still working .

If the power supply did not stabilize, he said, they would need fuel and start the generators.

Home to 325,000 people, Gulu has given nearly 9,000 doses, with only 2,795 people fully vaccinated. As of 23 September the district had 30 AstraZeneca doses and 300 Chinese-made Sinovac ones, an artificial shortage with the country’s growing vaccine stock of millions of doses.

In recent days, Uganda has received more than 2.2 million doses — including from Pfizer and Moderna — from the United States, as well as 985,000 AstraZeneca shots from France, Belgium and Ireland.

A total of 11,978,840 doses – donated and procured through the African Union – are expected to be in Uganda by December, President Yoweri Museveni said last week. But Uganda’s central storage facility near the capital, Kampala, can hold only 5 million doses of Pfizer vaccines, which require ultra-low temperatures, and some rural areas like Gulu are equipped to handle Pfizer or Moderna shots. are not.

As supplies ramp up, officials are trying to boost enthusiasm for vaccines in rural districts, where many would prefer to wait, citing safety fears.

John Nkengasong, the head of the Africa Centers for Disease Control and Prevention, told reporters last week that some African countries such as Rwanda and Zimbabwe are “doing well” with vaccines, others like Uganda are struggling, and the agency is looking to help. For community and religious leaders.

Health systems in Africa are among the world’s poorest, plagued by chronic shortages of essential supplies, corruption and an obsolete workforce. In Nigeria, Africa’s most populous nation, those challenges are exacerbated by insecurity, especially in the country’s unstable north, paralyzed by the threat of violence, with vaccine distribution in rural areas. Of the 200 million people in Nigeria, only 3% have received the first dose.

In Uganda, an East African country of 44 million, officials have ramped up vaccination in the Kampala region, but efforts have largely stalled in rural districts such as Gulu, with hesitation hampered by refrigeration and other distribution problems. happened.

Museveni said last week that officials in rural areas, which now account for most of the country’s 268 COVID-19 hospitals, face dismissal if vaccines end up under their surveillance.

“We’re literally dancing around,” Dr. Misaki Waengera, the head of a committee advising Uganda’s pandemic response, spoke of a slow vaccine rollout.

Government rations dosing districts based on demand expectations, and supplies are not replenished unless officials are previously responsible for the doses received.

As a result, delays in reporting back vaccination data can result in shortages.

“The demand is there,” said Dr. Kenneth Kana. “But what is bothering us right now is the availability of the vaccine, both in the urban environment and in the rural environment.”

Associated Press journalists arrived in a remote area of ​​Gulu where a health center with no running water contained the district’s last supply of 30 AstraZeneca doses. Because a vial contains seven doses that must be accounted for, vaccines are not distributed until seven people line up. That’s why people come and go without a job.

“You can’t open the vial when people are few. If people are few, you will be wasting the vaccine,” said Okello Labedo, a clinical officer at the Awake Health Center, speaking through a frayed mask. “The turnout among the elderly is very low. I think it’s because of the distance.”

Farmer Amos Okello, who waited several hours under a mango tree, expressed disappointment that he would be going home without a shot after traveling several kilometers on a rented bike.

“They said, ‘You can’t get the vaccine if you come alone,'” Okello said. “I can’t go and force someone to come here from his house and get vaccinated.”

However, “it is important for me to get the vaccine, tomorrow I won’t be able to come back,” he said.

Patrick Ocott, a commodities trader in Gulu who received his first AstraZeneca shot in May, said he is considering traveling to another district, but is disappointed with the cost.

“You can go there and you’ll find they don’t even have vaccines,” he said.

According to official figures, Uganda aims to vaccinate 4.8 million of its most vulnerable people – including those aged 50 and older – but so far 348,000 have been fully vaccinated. And only 37% of the country’s 150,000 health care workers have been fully vaccinated, highlighting the slow rollout that has led officials to start vaccinating students and others to prevent dosing. inspired to do.

Officials have warned that schools will not reopen until all teachers and staff are fully vaccinated, a mandate that has led to brief lines at rural vaccination sites. Yet many people were hoping there would be no dose, underscoring the hesitation following reports of rare blood clots in a small number of people receiving the AstraZeneca vaccine.

“The pressure is bringing on them now,” said Lily Apio, the nurse in charge of vaccinations at the Ivy Health Center outside the city of Gulu.

Alfred Akena, a schoolteacher waiting to receive the Sinovac vaccine, said he was forced to get the shot by a government mandate, but urged his wife not to do so, citing safety concerns.

“They put pressure on us, so today I have come to get vaccinated,” he said. “I told my wife, ‘Let me go first.’ When the worst happens, she will take care of my kids.”

That view was echoed by college student Onan Richard, who spoke of vaccinations as “like school rules and regulations” that he did not think were in his “interest”.

That morning, after the six men signed consent forms, Appio informed them that only five Sinovac doses were available.

One of them quickly got up and left.


Chinedu Asadu in Lagos, Nigeria contributed to this report.


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