Lack of access to COVID vaccines is preventing many low- and middle-income countries from protecting their citizens and helping end the pandemic. Countries with the highest incomes are getting vaccinated more than 30 times faster than those with the lowest incomes (see Bloomberg map); and many countries, including those hardest hit, have less than 10% coverage, with dozens having less than one percent.
A recent Wall Street Journal article detailed the challenges of the COVID-19 Vaccines Global Access program (COVAX), a worldwide initiative directed by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and the WHO.
“The Covax program, conceived in early 2020 as a kind of Operation Warp Speed for the globe, was supposed to be a model for how to vaccinate humanity, starting with those who needed it the most. Instead, the idealistic undertaking to inoculate nearly a billion people collided with reality, foiled by a basic instinct for nations to put their own populations first, and a shortage of manufacturing capacity around the world.”
At last month’s 74th World Health Assembly, WHO Director-General Tedros Adhanom Ghebreyesus called on WHO Member States to vaccinate at least 10% of the population of every country by September and at least 30% by the end of the year.
“There is no diplomatic way to say it: a small group of countries that make and buy the majority of the world’s vaccines control the fate of the rest of the world,” Tedros said. “The number of doses administered globally so far would have been enough to cover all health workers and older people, if they had been distributed equitably. We could have been in a much better situation.”
To support this effort, The Task Force’s COVID-19 Vaccine Implementation Program (CoVIP) is providing financial and technical support to 30 low- and middle-income countries. See map of countries.
With funding from the CDC, CoVIP is working with regional field epidemiologists on vaccine campaign planning, implementation, and monitoring. The goal is to ensure that countries are able to deploy and evaluate COVID-19 vaccines as they become available.
Boniface Kitungulu is the regional field epidemiologist responsible for COVIP’s work in East and Southern Africa, supporting countries like Kenya, Uganda, Eswatini, Lesotho, Zambia, and South Sudan – all of which have vaccination coverage rates around one percent.
“From a theoretical perspective, it is possible for us to reach 10% COVID vaccination coverage by September, but from a practical perspective, there are dynamics, particularly political considerations, that make it difficult,” said Kitungulu. “While it’ll take a concerted effort from the WHO to get countries to commit, actually realizing it by getting vaccines to communities will take the shared effort of countries and organizations like The Task Force, catalyzing cross-pollination of lessons learned.”
In Kenya, where Kitungulu is based, a first wave of 1.12 million vaccines was received in March from COVAX. These were administered to healthcare workers, educators, security forces, and people 58 years and older, but still only 32% of this target population as of June 23 had received one dose. And now Kenyans must wait for the next shipment of vaccines as they prepare for a potential fourth spike in COVID cases in the coming months.
“It is of major concern and even fear among the people who have been vaccinated already that they won’t get the second dose and for those that haven’t received anything at all, it’ll stay that way,” said Kitungulu. “The government is doing everything it can to figure out how to get more vaccines. Neighboring countries have shared some vaccines that are about to expire, but it is not enough.”
Many countries were relying on procuring vaccines from COVAX which in turn was sourcing its supply from India, but with the spike in cases in India, the country has slowed exports in order to vaccinate its 1.3 billion citizens (just over three percent of Indians are fully vaccinated). Efforts to procure vaccines from other suppliers are underway, including receiving excess Pfizer vaccines from the U.S.
While the supply issues are addressed, Kitungulu and his counterparts in other countries like Uzbekistan, Vietnam, and Guatemala help partners develop plans and systems to receive and rapidly administer vaccines.
“Now is the time to be communicating with communities about what to expect and the importance of getting the vaccine when the time comes,” said Kitungulu. “Like many countries, there are groups in Kenya and other East African countries that are concerned about getting vaccinated, so we want to be proactive and start having those conversations and sharing the facts with citizens.”
As an example, recently in Namibia a group of faith leaders and representatives from the ministry of health held a community meeting to discuss the role of the religious community in supporting Namibia’s Covid-19 vaccination roll-out. The meeting, which was supported by the CoVIP project, was described in a local media article.
Once a vaccination campaign is underway, CoVIP helps countries develop a monitoring and evaluation system to track vaccine delivery, use, timeliness, safety and effectiveness. CoVIP also provides a mechanism for countries and regional partners to disseminate lessons learned.
Header photo: People wait outside the Likia CDF Dispensary in Njoro subcounty, Nakuru county in Kenya. Photo courtesy of Reyoh Photography for PIVI.