War, instability poses vaccine challenges in poor countries

A convoy of Saudi military vehicles patrols the southern Yemeni city of Aden on April 26, 2020.


Arifullah Khan administered another polio vaccine when the surrounding hills came under fire.

Recalling the description of an attack in Pakistan’s Bajaur tribal area near the Afghanistan border five years ago, he said, “It happened suddenly. There was a lot of heavy fire.”

A bullet hit his thigh and he fell to the ground. In the vaccination campaign, his childhood friend and companion, Ruhullah, was bleeding on the ground in front of him.

“I couldn’t move forward,” Khan said. “I saw him lying in front of me as he breathed his last.”

Getting vaccines in Pakistan can be fatal. Militants and fundamentalist religious groups have claimed that the polio vaccine is a Western settlement to sterilize Muslim children or distance them from religion. Since 2012, more than 100 health workers, commentators and security officials involved in polio vaccination have been killed.

The violence is an extreme example of the difficulties of many poor and developing countries in Asia, Africa, the Middle East and Latin America as they tackle the monumental task of vaccinating their populations against COVID-19.

It is not just the problem of being on the back line of rich countries in applying or receiving vaccines.

Poor infrastructure often means roads are treacherous and electricity is sporadic for vaccines that conserve refrigerators. Wars and rebellions endanger commentators. Corruption can siphon off funds, and planners of vaccination campaigns must sometimes navigate through multiple armed factions.

“The most challenging areas … are conflict settings where violence prevention vaccination outbreaks occur, and areas where misinformation is circulating that discourages community involvement,” UNICEF Deputy Chief of Global Immunization , Said Benjamin Kreber.

Many nations are relying on COVAX, an international system aimed at ensuring equal access to vaccines, although it is already low on funding.

UNICEF, which runs vaccination programs worldwide, is gearing up to help procure and administer COVID-19 vaccines, Schreiber told The Associated Press. He has already stocked half a billion syringes and aims to provide 70,000 refrigerators, most of which are powered by solar energy.

The agency aims to transport 850 tons of COVID-19 vaccines a month next year, doubling its normal annual monthly rate for other vaccines, UNICEF executive director Henrietta Four said in a statement.

The situation can vary widely by country.

Vaccination is expected to begin in Mexico soon. The military will handle the distribution, and the government has promised to impose free vaccines for about 130 million residents of Mexico by the end of 2021.

Meanwhile, Haiti, the poorest country in the Western Hemisphere, has not yet announced any vaccination plans. Health experts worry that widespread rumors may set back vaccination – including the claim that hospitals will give lethal injections to increase COVID-19 death figures and receive more foreign aid.

On November 28, 2020, 43 farm workers attend the funeral in Zabaramari, Nigeria on November 29, 2020 after being killed by Boko Haram fighters in rice fields near Koshobe village.

Audu Mart | Via AFP Getty Image

The African Centers for Disease Control and Prevention is spearheading an ongoing, comprehensive effort to immunize 1.3 billion people in Africa in 54 countries. The agency is coordinating efforts to obtain supplements and is seeking funding from the World Bank – anticipating that the acquisition, distribution and administration of vaccines would take $ 10 billion.

The aim is to vaccinate 60% of Africa’s population within two years – about 700 million people – that have exceeded the continent, said John Nekengsong, director of the African CDC.

“The time for action is now,” Nekengsong said. “The West cannot defeat COVID-19 alone. It must be defeated by the whole world and this includes Africa.”

Congo faces campaign constraints.

The country has overcome the Ebola outbreak with vaccination campaigns. But it struggled in eastern Congo, where the Allied Democratic Forces continued to attack insurgents and other armed groups insisted for control of mineral wealth.

The rough terrain and insecurity meant the commentators had trouble going to all areas. Some were attacked.

Rumors about Ebola vaccines kept flying, with the idea that they were meant to kill people, an Ebola survivor, Dr. Said Maurice Kakule, who worked in vaccination campaigns. Education programs have generated a lot of resistance, but similar doubts are circulating about the COVID-19 vaccine, he said.

In Beni, the area’s main town, Danny Momoti, a businessman, said he would get vaccinated because of his work. He said, “I need to accept this COVID-19 vaccination card in Dubai and elsewhere, where I go to buy stuff for Beni.”

Civil wars present perhaps the greatest obstacles.

The health system in Yemen has collapsed within six years of the war between the Houthi rebels who control the north and government-allied factions in the south.

Yemen saw its first outbreak of polio in the summer of 15, centered in the northern province of Sada. UNICEF said that the commentators have not been able to work there for the last two years. In November and December, agencies gave new admissions to parts of the north and south.

There has been an outbreak of cholera and diphtheria, and once again, there is a new upsurge in hunger in Yemen. UN officials have warned of a possible famine in 2021.

No plans for COVID-19 vaccination have been announced yet, whether by the Houthis, Southern authorities or WHO and UNICEF.

Only half of Yemen’s health facilities are functional. Roads, electricity networks and other infrastructure have been destroyed. The Houthis have interrupted some programs, seeking concessions from UN agencies, including blocking a shipment of cholera vaccines amid the 2017 outbreak.

“Even common and commonly preventable diseases can prove fatal due to lack of health care,” said Wasim Bahja, director of the Yemen country for the International Medical Corps.

In Pakistan, public distrust erupted when in 2011 the CIA used a scandal vaccination program to identify the whereabouts of al-Qaeda leader Osama bin Laden, killing him by special forces.

Pakistan, Afghanistan and Nigeria are the only countries in the world where polio is still endemic. There have been 82 new polio cases this year alone, largely because vaccination was suspended due to the epidemic, Drs. Rana Safdar, who coordinates polio vaccination campaigns.

Safdar said that the Bajaur area, where Khan was shot, remains a more dangerous area.

Khan tried to assuage deep mistrust in his area. Deeply conservative tribal elders believe “the reason for the vaccine is the young people who were given it because the children are abusive and show little concern for Islamic traditions and values.”

“Everyone is scared” of COVID-19, he said. “But they doubt Western things.”

Khan said he signed up to be polio vaccinated because he was paid the equivalent of $ 56 for just a few days of work. “I needed to feed my family.”

He will likely sign up to deliver COVID-19 vaccines.

“But first I’ll check if there’s any danger there,” he said.


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