New COVID Excess Mortality Number Highlights Vaccination Challenges

By Andi Kezh, Communications Intern

A report published earlier this month from the World Health Organization (WHO) indicates that the actual COVID-19 death toll is nearly 15 million, far greater than the existing estimate of six million lives lost.

“The health system actually has not been adequately able to respond because it has been overwhelmed by the COVID deaths,” said Dr. Somnath Chatterji, senior adviser at WHO’s department of data and analytics.

Many factors have contributed to the challenges, among them difficulties in vaccinating people, particularly in low- and middle-income countries.

Dr. Victor Mejia, an epidemiologist working in Central America, said that once the COVID-19 vaccines were approved “it was necessary to better organize and in some cases reconstruct national vaccination programs altogether.”

Dr. Victor Mejia. Photo courtesy of Mejia

Such activities are extremely time consuming and require significant resources, making it difficult for countries to do while being overwhelmed by the  high volume of cases and deaths.

Mejia is the Central American Regional Epidemiologist for The Task Force’s COVID-19 Vaccine Implementation Program (CoVIP), which works with 35+ low- and middle-income countries to ensure their vaccination programs can deploy, use and evaluate COVID-19 vaccines.

Visit to a COVID-19 vaccination post in Belmopan, Belize. Photo courtesy of Mejia.

Mejia supports the countries of Belize, El Salvador, Honduras and Guatemala with technical and administrative monitoring. A resident of San Salvador, El Salvador, Mejia understands first-hand  the challenges faced by countries in the region. However, despite the continued hurdles, all four of the countries with whom he works have been able to adapt to organizational changes to make progress towards vaccination coverage. Current vaccination rates continue to progress with 66% of people fully vaccinated in El Salvador (on par with the U.S.), 54% in Honduras, 50% in Belize, and 34% in Guatemala.

CoVIP and partners like the National immunization Technical Advisory Group of independent experts have assisted countries by providing technical and financial support to develop implementation plans, build capacity to receive and rapidly administer vaccines, expand surveillance capacity and adverse vaccine safety, and monitor vaccine delivery.

“Most countries had traditional immunization systems with support from the Ministry of Health,” Mejia said, “however, COVID-19 brought the need to improve cold storage systems, logistics to transport vaccines, as well as registration systems of vaccinated people.” In many ways, he noted, these improvements have revolutionized the traditional systems countries had prior to the pandemic.

Adequate rates of COVID-19 vaccine administration remain the highest in countries such as Mainland China, the United Arab Emirates, and Cuba, where well-resourced health systems and other elements like strong leadership and tight-knit communities supported timely delivery strategies. A recent study shows that vaccine inequality is continuing to widen due to disparity in vaccine supply access between high-income countries and low-income countries , as well as increased pressure on vaccine supply chains from new booster programs. But the countries with whom Mejia works have seen gains.

He credits much of the region’s progress to leadership by ministries of health, as well as local implementing partners such as Asociacion de Pediatria in El Salvador and other immunization programs that have built on existing routine immunization systems to roll out vaccines. Progress  also reflects the work of many CoVIP and Task Force partners, including shipments of vaccines from the COVAX facility and the COVID-19 Vaccines Global Access partnership (GAVI). Support is also provided from the technical team of the CDC Central America office located in Guatemala, who support the technical follow-up of COVID-19 international vaccine implementation and evaluation projects in Central American countries.

“All this becomes satisfying, knowing that, with the monitoring and management that I carry out to the different projects in Central America, I am contributing to the global response too,” said Mejia.

A report published earlier this month from the World Health Organization (WHO) indicates that the actual COVID-19 death toll is nearly 15 million, far greater than the existing estimate of six million lives lost.

“The health system actually has not been adequately able to respond because it has been overwhelmed by the COVID deaths,” said Dr. Somnath Chatterji, senior adviser at WHO’s department of data and analytics.

Many factors have contributed to the challenges, among them difficulties in vaccinating people, particularly in low- and middle-income countries.

Dr. Victor Mejia, an epidemiologist working in Central America, said that once the COVID-19 vaccines were approved “it was necessary to better organize and in some cases reconstruct national vaccination programs altogether.” 

Such activities are extremely time consuming and require significant resources, making it difficult for countries to do while being overwhelmed by the  high volume of cases and deaths.

Mejia is the Central American Regional Epidemiologist for The Task Force’s COVID-19 Vaccine Implementation Program (CoVIP), which works with 35+ low- and middle-income countries to ensure their vaccination programs can deploy, use and evaluate COVID-19 vaccines.

Mejia supports the countries of Belize, El Salvador, Honduras and Guatemala with technical and administrative monitoring. A resident of San Salvador, El Salvador, Mejia understands first-hand  the challenges faced by countries in the region. However, despite the continued hurdles, all four of the countries with whom he works have been able to adapt to organizational changes to make progress towards vaccination coverage. Current vaccination rates continue to progress with 66% of people fully vaccinated in El Salvador (on par with the U.S.), 54% in Honduras, 50% in Belize, and 34% in Guatemala. 

CoVIP and partners like the National immunization Technical Advisory Group of independent experts have assisted countries by providing technical and financial support to develop implementation plans, build capacity to receive and rapidly administer vaccines, expand surveillance capacity and adverse vaccine safety, and monitor vaccine delivery.

“Most countries had traditional immunization systems with support from the Ministry of Health,” Mejia said, “however, COVID-19 brought the need to improve cold storage systems, logistics to transport vaccines, as well as registration systems of vaccinated people.” In many ways, he noted, these improvements have revolutionized the traditional systems countries had prior to the pandemic.

Adequate rates of COVID-19 vaccine administration remain the highest in countries such as Mainland China, the United Arab Emirates, and Cuba, where well-resourced health systems and other elements like strong leadership and tight-knit communities supported timely delivery strategies. A recent study shows that vaccine inequality is continuing to widen due to disparity in vaccine supply access between high-income countries and low-income countries , as well as increased pressure on vaccine supply chains from new booster programs. But the countries with whom Mejia works have seen gains.

He credits much of the region’s progress to leadership by ministries of health, as well as local implementing partners such as Asociacion de Pediatria in El Salvador and other immunization programs that have built on existing routine immunization systems to roll out vaccines. Progress  also reflects the work of many CoVIP and Task Force partners, including shipments of vaccines from the COVAX facility and the COVID-19 Vaccines Global Access partnership (GAVI). Support is also provided from the technical team of the CDC Central America office located in Guatemala, who support the technical follow-up of COVID-19 international vaccine implementation and evaluation projects in Central American countries.

“All this becomes satisfying, knowing that, with the monitoring and management that I carry out to the different projects in Central America, I am contributing to the global response too,” said Mejia.

Header photo: Honduras Field Epidemiology Training Program (FETP) assists in vaccination rollout and monitoring in Honduras. Photo courtesy of Honduras FETP.

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