Some nations left to wait for first doses
Experts say lack of vaccines in Africa raises risk of virus variants’ emergence
N’DJAMENA, Chad — At the small hospital where Dr. Oumaima Djarma works in Chad’s capital, there are no debates over which coronavirus vaccine is the best. There are no vaccines at all.
There aren’t even doses for the doctors and nurses who care for covid-19 patients in Chad, one of the least-developed nations in the world.
“I find it unfair and unjust, and it is something that saddens me,” the 33-year-old infectious disease doctor said. “I don’t even have that choice. The first vaccine that comes along that has authorization, I will take it.”
While wealthier nations have stockpiled vaccine doses for their citizens, many poorer countries are still scrambling to secure enough. A few, like Chad, have yet to receive any.
The World Health Organization said nearly a dozen countries — many of them in Africa — are still waiting. Those last in line on the continent along with Chad are Burkina Faso, Burundi, Eritrea and Tanzania.
“Delays and shortages of vaccine supplies are driving African countries to slip further behind the rest of the world in the covid-19 vaccine rollout, and the conti
nent now accounts for only 1% of the vaccines administered worldwide,” the WHO warned Thursday.
And in places where there are no vaccines, there’s also the chance that virus variants could emerge, said Gian Gandhi, UNICEF’s supply division coordinator for the Covax vaccine-access initiative.
“So we should all be concerned about any lack of coverage anywhere in the world,” Gandhi said, urging higher-income countries to donate doses to the nations that are still waiting.
While the total of confirmed covid-19 cases among those waiting countries is relatively low compared with the world’s hot spots, health officials say that figure is likely a vast undercount, as those countries in Africa are among the least-equipped to track infections because of their fragile health care systems.
Most of the continent has avoided the huge death tolls seen in Western countries because of a combination of factors, including swift imposition of lockdowns and its relative lack of inclusion in global networks of travel and trade.
Chad has confirmed only 170 deaths since the pandemic began, but efforts to stop the virus have been unsuccessful. Although the capital’s international airport was closed briefly last year, the city’s first case came via someone who crossed one of Chad’s porous land borders illegally.
And regular flights from Paris and elsewhere have resumed, heightening the chance of infections in Chad, which has 4,835 confirmed cases.
The Farcha provincial hospital in N’Djamena is a gleaming new campus in an outlying neighborhood, where camels nibble from acacia trees nearby. Doctors Without Borders has helped supply oxygen for covid-19 patients, and the hospital has 13 ventilators. The physicians also have plenty of Chinese-made KN95 masks and hand sanitizer. Still, not a single employee has been vaccinated, and none has been told when that might be possible.
That was easier to accept at the beginning of the pandemic, Djarma said, because doctors all around the world lacked vaccine doses. That has changed as vaccines developed in the West and in China and Russia have gone to other poor African countries.
“When I hear, for example, in some countries that they’ve finished with medical staff and the elderly and are now moving on to other categories, honestly, it saddens me,” Djarma said. “I ask them if they can provide us with these vaccines to at least protect the health workers.
“Everyone dies from this disease, rich or poor,” she said. “Everyone must have the opportunity, the chance to be vaccinated, especially those who are most exposed.”
LONG WAITS
Covax, the U.N.-backed program to ship vaccines worldwide, aims to help lowand middle-income countries get access. But a few of the countries, including Chad, have expressed concerns about receiving the AstraZeneca vaccine through Covax for fear that it might not protect as well against a variant first seen in South Africa.
Chad is expected to get some Pfizer doses next month if it can put in place the cold storage facilities needed to keep that vaccine safe in a country where temperatures regularly soar to 110 degrees.
Some of the last countries also took more time to meet the requirements for receiving doses, including signing indemnity waivers with manufacturers and having distribution plans in place.
Those delays, though, now mean an even longer wait for places like Burkina Faso, since a key vaccine manufacturer in India scaled back its global supply because of the virus surge there.
“Now with global vaccine supply shortages, stemming in particular from the surge of cases in India, and subsequently the Indian government’s sequestration of doses from manufacturers there, Burkina Faso risks even longer delays in receiving the doses it was slated to get,” said Donald Brooks, CEO of Initiative: Eau, a U.S. aid group engaged in the covid-19 response.
Frontline health workers in Burkina Faso said they’re not sure why the government hasn’t secured vaccines.
“We would have liked to have had it like other colleagues around the world,” said Chivanot Afavi, a supervising nurse who worked on the front lines of the response until recently. “No one really knows what this disease will do to us in the future.”
In Haiti, not a single vaccine dose has been administered to the more than 11 million people who live in the most impoverished country of the Western Hemisphere.
Haiti was to receive 756,000 doses of the AstraZeneca vaccine via Covax, but government officials said they didn’t have the infrastructure needed to conserve them and worried about having to throw them away. Haitian officials also expressed concerns over potential side effects and said they preferred a single-dose vaccine.
Several small island nations in the Pacific also have yet to receive any vaccines, although the lack of outbreaks in some of those places has meant there is less urgency. Vanuatu, with a population of 300,000, is waiting to receive its first doses of the AstraZeneca vaccine later this month, but it has recorded only three cases of the coronavirus, all of them in quarantine.
At the Farcha hospital in Chad, nine health care workers have gotten the virus, including Dr. Mahamat Yaya Kichine, a cardiologist. The hospital now has set up pods of health care worker teams to minimize the risk of exposure for the entire staff.
“It took almost 14 days for me to be cured,” Kichine said.
“There were a lot of caregivers that were infected, so I think that if there is a possibility to make a vaccine available, it will really ease us in our work.”
RAISING CONCERNS
With Africa accounting for so few of the global vaccinations, health officials on the continent are looking warily at waves of infections sweeping India and elsewhere that have stoked fears of a long tail end of the pandemic.
Current timelines for mass vaccination campaigns in most African countries run well into next year, if not further. Confirmed cases have been rising steadily in many African countries, though quick but economically destructive restrictions on movement have clamped down surges before they’ve gotten out of control in most places.
The slow rollout has made Africa’s hunt for variants, which tend to emerge where spread goes unchecked, more urgent.
The continent’s top health official as well as leaders at its main virus genome sequencing laboratories in Nigeria and South Africa said they were trying to avoid a crisis like the one in India. Despite efforts to contain variants, the emergence of new ones in Africa is likely this year, they said, thanks to vaccine hoarding by wealthier nations, delivery delays and low vaccination capacity.
“My big concern is that if vaccine nationalism continues, and if people [in Africa] are not vaccinated early enough, the virus will keep mutating, and as the virus keeps mutating, we may end up having a virus that is completely resistant to all of the vaccines out there,” said Christian Happi, director of the African Center of Excellence for Genomics of Infectious Diseases in southern Nigeria.
“Eventually, the world could be back to square one.”