Ready, set, wait: Inside the prep for vaccines

Recently public health authorities vaccinated 220,000 children against measles within 10 days, through 700 vaccine sites including health posts and mobile stops. With the first COVID-19 vaccine due to land within a month, authorities are confident of reproducing the success. Staff Writer, MBONGENI MGUNI reports

For many other African states, getting the coronavirus (COVID-19) vaccines at the airport is simply the first part of a much bigger battle that involves overcoming traditionally weak logistics, as well as infrastructure and resource issues to effectively distribute the jabs.

The fact that the vaccines also require special storage and handling adds to the difficulty, meaning after the videos of the vaccines arriving at the airport and the photoshoots with politicians receiving jabs, health authorities begin climbing mountains, sometimes literally, to distribute the shots. Getting a COVID-19 in the arm for most Africans is the culmination of a lengthy process that begins with jostling in the queue at manufacturers, pushing through the required regulatory approvals, including indemnities, then preparing the tricky local logistics that for some countries may mean a substantial gap between the fanfare photo ops at the airport and actual countrywide vaccination. Local public health authorities are buzzing with confidence, certain that while there is despair that the country is lagging behind its peers in receiving vaccines, once these land, the distribution campaign will be ‘warp speed’, to use a phrase popularised by former US president, Donald Trump. Authorities this week said a budget of P164 million has been set aside for distribution and other vaccine-related costs while pledging to ‘cross rivers and use boats’ to get shots in the arms of Batswana.

“Some we will follow by car, others by boat but no one will be left behind,” Health and Wellness permanent secretary, Kabelo Ebineng told a televised briefing on Tuesday.

“Government and the private sector will work together, which the law provides for.

“The vaccine we expect first requires special refrigeration and storage and we have ensured we have high-quality equipment to make certain it arrives properly.” Health Services director, Malebogo Kebabonye’s confidence stems from the recent measles and rubella vaccination campaign run countrywide for children under fiveyears-old. “The measles campaign we did was sort of a test or to sharpen ourselves for when the COVID-19 vaccine arrives,” Kebabonye told a televised briefing on Tuesday. “We had a target of immunising 230,000 children and we managed 95% within 10 days. This was through clinics, mobile stops and other outreach measures meaning we had 700 vaccination sites countrywide. “This tells us that when the COVID-19 vaccine arrives in the coming days, we will be able to pass it onto people properly and quickly.”

According to government information and data dug up by Mmegi, the first COVID-19 vaccines to land in Botswana will be about 120,000 doses of the AstraZeneca/SK Bio vaccine which is AstraZeneca’s product manufactured under licence in South Korea. Questions have been raised about whether the AstraZeneca is best suited for Botswana given the presence of the COVID-19 variant first reported in South Africa. South African officials recently purchased, then rejected the AstraZeneca vaccine in favour of the Johnson and Johnson dose, after a limited test showed it was ineffective against their dominant variant. Locally, an inter-agency coordinating committee comprising government and private sector experts is advising on the changing information about vaccines and their suitability for local conditions. The Botswana Institute of Research, Technology and Innovation (BITRI), together with the National Health Laboratory and other stakeholders is also due to carry out genomic surveillance of COVID-19 viruses in the country.

Already, however, BITRI has sequenced 20 genomes of the variant first described in South Africa, meaning that 20 individuals in Botswana were found to have been infected with the variant.

“This surveillance will help determine the distribution and prevalence of this variant and other lineages of interest that are circulating in Botswana,” Maitshwarelo Matsheka, senior researcher Nanomaterials at BITRI told Mmegi.

Meanwhile, the Botswana Medicines Regulatory Authority (BoMRA), a member of the inter-agency committee, says it is ready to support the vaccine distribution effort.

“BoMRA will not be vaccinating but will be working together with the Ministry immunisation team, both to train their teams in the identification and recording of any adverse reactions encountered by vaccinated persons,” CEO, Stephen Ghanie, told Mmegi.

“BoMRA will do their collection and analysis, and communicate regulatory actions where necessary.” The first COVID-19 vaccines, which will be under the COVAX facility, are expected to be followed up by an African Union allocation under the African Vaccine Acquisition Task Team (AVATT). Botswana expects about 900,000 doses in total under the COVAX, the majority scheduled to arrive by June, while the AVATT doses are allocated as a proportion of the population. AVATT has secured 270 million doses from manufacturers. “Each country has an allocation which equals its population divided by the African Union population, but the way it works is that a country may say it only requires a certain amount to order,” AVATT spokesperson, George Sibotshiwe told Mmegi.

“There’s no stockpile of vaccines; it is scheduled production and the commitment made by manufacturers and we expect countries to start accessing by the end of March.”

While countries can secure funding from the Afreximbank for the AVATT doses, Health Minister, Edwin Dikoloti recently told Parliament that Botswana had paid $7 million for its allocation. Another $3 million has been paid for COVAX.

The distribution campaign, depending on vaccines becoming available and landing in the country, is expected to run until the end of the year, beginning with frontline workers, then essential workers involved in the economy and finally, the general public, which is essential for reaching herd immunity.

It could, however, take as little as 14 weeks, if the various vaccine platforms government is securing, deliver on time, as Dikoloti said the vaccination of the different target populations will run concurrently. While the measles campaign relied on parents and guardians availing their children for immunisation, the COVID-19 campaign may encounter resistance from citizens suspicious of the vaccines.

“We will not manage if the people who should receive them do not cooperate,” Ebineng told the nation on Tuesday.

“That’s why we are working with faith leaders, Dikgosi, district commissioners and others to prepare Batswana.”