Why Ghana’s Covid rollout is stalled
Coronavirus seen as less important than other health threats
Crouching on dusty orange soil outside a clinic, a 4-yearold wretches up blood in a gutter. For minutes, bile forces itself out of her small body. The girl straightens; gently dabs sweat from her face and smooths down her pink dress. Her mother guides her to a bench and a doctor confirms she has malaria.
Ghana is home to 32 million people, many of whom face the wrath of vicious infectious diseases. Local clinics — the cornerstone of the country’s healthcare system — are plastered with posters warning of tuberculosis, malaria and yellow fever. Infant mortality is high — 33 children out of 1000 die before the age of 1, and 44.7 die before the age of 5. In the UK, these figures are 3.6 and 4.2 respectively.
It is against this backdrop of serious and crippling diseases that Covid19 vaccination uptake is stagnating.
Ghana was dubbed a major success story of Covax, the vaccine scheme aimed at distributing jabs across lower- and middle-income countries. In February 2021, the west African nation received the first Covax shipment in the world — 600,000 Astrazeneca doses. Its rollout is now the longest running in Africa.
But only 30 per cent of Ghanaians have received one coronavirus jab, and 19 per cent two. So why has demand started to flag? ‘Bad for my business’
In Mamprobi, a suburb in the capital Accra, nurses are struggling to use the Covid shots before they expire — partly because of short expiration dates on donated doses, partly because people are not desperate for the vaccine.
Nurses and community volunteers walk house to house and shop to shop with the donated vaccines in cooler boxes.
A 29-year-old nurse named Doletta Konney is part of the effort. She visits roughly 55 houses a day in Mamprobi, and says half of the families will accept a vaccine — a higher success rate than most districts. “But people fear side-effects — headaches, swelling at the site of injection, dizziness,” she says.
For those that opt in, the process is quick. They are jabbed, recorded, and given a vaccine slip.one man did not accept a vaccine because of sideeffects. “Getting sick for one or two days is bad for my business,” he says, adding that he works alone — there’s no one to cover him if he falls ill.
“There’s no Covid anymore,” adds another unvaccinated Ghanaian. When the vaccinator asks him “Who said that?”, he replies: “The president.” He points to Nana Akufo-addol’s announcement in March — that restrictions, mandatory travel testing and face masks were to end — as a sign that coronavirus is no longer a threat.
Another man jokes with the vaccinators. He will get the vaccine, he says — for a fee.
“There’s more resistance [to vaccines] now — now that people don’t see others suffering,” says
Christina Zarodei, a vaccine supervisor in the district.
While coronavirus touched Ghana, according to Ministry of Health data, it did so only lightly. Though testing has been patchy at times, the country has confirmed 161,000 cases and 1445 deaths. Roughly 45 people have died per million, compared to South Africa’s 1671, and the UK’S 2572. Cases have been declining since December, and on average only eight cases are now recorded a day.
Although Covax doses arrived relatively quickly, rollout to the general public was slow. Initial batches were allocated to health workers, as was the case in most countries, and citizens were not offered a jab until August. By then, Covid had started to fade in the public’s collective memory.
Gavi, the vaccine alliance, says that Covid vaccine supply constraints were “severe” in much of 2021, and were “particularly felt by lowerincome countries”.
“Wealthy countries were able to immediately make down payments on vaccines, whereas Covax had to first raise cash from donors before placing orders,” a Gavi spokesperson explains.
Because of low national uptake, this year two mass campaigns, in which health workers went door to door with the vaccines, were launched to reach the unvaccinated. They were relatively successful, leading to an increase in doses administered from 9.7 million at the end of January to 13 million at the end of March. This approach has been critical, Zarodei says, because most people don’t have time to visit vaccination drives. “If you don’t come to them, they won’t get it.”
Officials are keen to push on with the Covid vaccine programme, concerned that a new variant could wreak havoc in its mostly unvaccinated population, large groups of whom do not live close to hospitals.
Other west African nations have similarly low Covid vaccine rates, fuelled by a delay in shipments and low uptake. Only 29 per cent and 24 per cent of Ghana’s neighbours Ivory Coast and Togo have received one vaccine. In the Ivory Coast, there was such concern about the blood clots associated with the Astrazeneca vaccine that the director-general of health issued a statement assuring people of its safety.
Still, Ghana is believed to have vaccinated its target population with at least one shot. Most taxi drivers, teachers, and medical workers have received a vaccine. Only 976,000 over-65s live in the country, many of whom are thought to have been jabbed. It is not clear how many have been boosted — integral to beat waning immunity.
Malaria, yellow fever and HIV Indifference about Covid jabs is also linked to the scale of other urgent and competing healthcare needs. While the country has reported 161,000 Covid cases in total, nearly six million people were diagnosed with malaria in 2020 alone.
Ghana has a high rate of malaria, accounting for 3 per cent of global deaths. In the most serious malaria cases, patients’ spleens rupture, kidneys fail, and they may enter a coma. In October to November, a yellow fever outbreak was declared in the north of the country, killing 35 people. Like malaria, the disease is transmitted by mosquitoes. It has a high case fatality rate — 20-50 per cent of severe cases die within 14 days. In these cases, people can bleed from the nose, mouth and eyes.
At Ghana’s main diagnosis laboratory, staff process thousands of blood and sample tests each week, Richard, a spokesperson in the laboratory, says. One of the centre’s main jobs is to check blood samples for HIV, which affects 350,000 Ghanaians. “At the Covid peaks, other services were impacted,” Richard says. “The ability to offer other tests, HIV used to be Monday, Wednesday and Friday. But we had to reduce it to one day a week.”
Despite the prevalence of infectious conditions, Dr Charlotte Alberts Cato, who runs a clinic in Accra, says it’s non-communicable diseases (NCDS) like hypertension, diabetes and strokes that are the most pressing. “Two years ago, these NCDS were at the bottom of our top 10 list of issues, now they are in the top five. A man recently died of a stroke at 28, he had hypertension.” Cato, and other doctors, say increasingly sedentary lifestyles and unhealthy eating are causing the spike.
Road traffic accidents also remain a major public health challenge too, with 19 people dying each day across the country, according to the WHO. ‘Too much’ Covid focus
Ghana has, though, made great strides in tackling its health issues. Roughly 96 per cent of people diagnosed with HIV receive sustained antiretroviral therapy, while highly protective vaccines are sent via drones to yellow fever outbreaks.
Testing and treatment for malaria is also widely available. Data shows that the proportion of deaths attributed to malaria per 100,000 people in Ghana decreased from 10.8 per 100,000 in 2012 to 1.1 in 2019. A new malaria vaccine has been trialled in Ghana over the past two years, and will soon be rolled out to under-5s, too, supported by Gavi. The vaccine prevents 30 per cent of severe malaria cases after four injections in children. The WHO believes it could save tens of thousands of young lives across Africa each year.
The young girl in the pink dress was given one tablet, which the doctor says should help her start to fight malaria within 24 hours. If not, she will be sent to the nearest hospital for more intensive treatment.
Some Ghanaians are frustrated by the amount of money poured into Covid vaccines. One healthcare professional said: “Malaria and Covid and health issues should be evenly distributed — one shouldn’t be spared at the expense of the other.”
Aboagye, a taxi driver, says that while he did get vaccinated, he couldn’t understand the politicians “obsession” with it. “Covid, we didn’t catch that. It’s malaria that’s dangerous.” — Telegraph Group Ltd
Malaria and Covid and health issues should be evenly distributed — one shouldn’t be spared at the expense of the other. Ghana healthcare professional