Where a vaccination campaign faces skepticism, war and corruption

KABUL, Afghanistan – Afghanistan, whose citizens have largely sidelined the coronavirus pandemic as exaggerated or a joke, is now preparing to distribute its first batch of vaccines.

Half a million doses of the AstraZeneca-Oxford vaccine, produced by an Indian manufacturer, were delivered to the capital Kabul by India on February 7. But the arrival was met with indifference by many Afghans, who have rejected government warnings that the virus is a deadly threat to public health.

The inexpensive and easy-to-store AstraZeneca-Oxford vaccine is distributed as part of the Covax program, a global initiative to purchase and distribute vaccines to poor countries for free or at reduced cost. On February 15, the World Health Organization authorized the use of the vaccine, which requires two doses per person, clearing the way for Afghanistan to begin its inoculation campaign.

Global trials have found that the vaccine offers complete protection against serious illness and death. But its efficacy against the variant of the virus first seen in South Africa is in question, after the vaccine failed in a small trial to prevent study participants from having mild or moderate Covid cases.

The vaccine comes as Afghanistan is battling a deadly second wave, even as most Afghans go about their daily lives as if the virus never existed. Many people refuse to wear masks and gather in dense crowds inside bazaars, supermarkets, restaurants and mosques, oblivious to the omnipresent public health posters.

In an impoverished nation battered by war, hunger, poverty, and drought, an invisible virus is considered fake or an afterthought.

“Of course I will not get vaccinated because I do not believe in the existence of the coronavirus,” said Muhibullah Armani, 30, a taxi driver from the southern city of Kandahar.

Expressing a sentiment shared by many Afghans, Armani added: “When I see people covering their mouths and noses, fearful of Covid, I laugh at them.”

And even among Afghans who believe the virus is real and want to be vaccinated, there is little faith that the government, mired in widespread corruption, will fairly distribute limited supplies of vaccines.

“This vaccine will be available only to people of high status,” said Khalil Jan Gurbazwal, a civil society activist in the Khost province of eastern Afghanistan.

Nizamuddin, a tribal elder in a Taliban-controlled district of Faryab province in northern Afghanistan, said he feared the vaccine would be appropriated by well-connected politicians and warlords.

“It is common in Afghanistan for even food aid to be stolen by corrupt people,” said Nizamuddin, who, like many Afghans, has only one name.

The Attorney General’s Office said Thursday that 74 government officials from five provinces had been charged with embezzlement of coronavirus response funds. The defendants included former provincial governors and deputy governors.

In northern Afghanistan’s Kunduz province, a hospital administrator told authorities that hospital officials collected the medical costs of Covid-19 treatments for 50 beds in a hospital with only 25 beds, pocketing the costs. costs of “ghost workers”, the Special Inspector General for Reconstruction of Afghanistan recently reported.

“This misconduct costs Afghan citizens not only financially, but also in delayed access to medical care that could save their lives,” the US Embassy said in a statement. But for many Afghans, the vaccine is a solution to a problem that does not exist.

When the vaccination program began on Tuesday, the first dose was administered in Kabul’s presidential palace to Anisa Shaheed, a television reporter who has covered the pandemic.

Distributing any vaccine to a desperately poor nation consumed by unrest is a daunting logistical challenge. In addition to overcoming public suspicions and traversing dangerous territories, the Ministry of Public Health must also navigate the delivery of vaccines in remote provinces with dilapidated roads and primitive infrastructure.

The pandemic has led to an increase in polio cases in Afghanistan by making it difficult for polio teams to reach outlying areas, said Dr. Osman Tahiri, a public affairs advisor to the Ministry of Health, who reported 56 polio cases. in 2020, up from 29 in 2019.

But equally worrisome are the 305 cases of a variant of polio in Afghanistan in 2020, up from zero such cases reported in 2019, said Merjan Rasekh, head of public awareness for the ministry’s polio eradication program.

Mr. Rasekh attributed much of the rise in variant polio cases to Afghan refugees returning from neighboring Pakistan, who have also fought to eradicate polio. The WHO is expected to grant emergency approval before the end of the year for a vaccine against the variant.

While dealing with a surge in polio cases, Dr. Tahiri said health workers would attempt to distribute the coronavirus vaccine even in Taliban-controlled areas where militants have allowed government-run clinics. The Taliban have mounted public health programs that warn of the pandemic and have distributed personal protective equipment while allowing government health workers to enter their areas.

But Dr. Tahiri admitted that vaccination teams will not be able to reach large areas of the country where fighting is most intense between the Taliban and government forces.

Last week 1,000 vaccination teams were trained, Dr. Tahiri said. The ministry hopes to receive more donated vaccines; Afghanistan, he said, has the capacity to store 20 million doses.

The first doses will go to health workers and security officials “who are at risk and who work in crowded places,” Dr. Tahiri said, although there are still not enough vaccines for everyone in this category. Journalists would also be eligible to apply for the vaccine, he added.

Afghanistan has recorded more than 55,000 coronavirus cases and nearly 2,500 Covid-related deaths, according to the Ministry of Public Health.

But due to limited evidence and an inadequate public health system, experts say the actual number of cases and deaths is exponentially higher. A WHO model estimated in May that more than half of the 34 million people estimated in Afghanistan could be infected. The Ministry of Public Health estimated last fall that more than 10 million Afghans may have contracted the virus.

Regardless of whether Afghans believe that the virus is real, there is an abiding faith that Allah determines the fate of a believer.

Ahmad Shah Ahmadi, a resident of Khost province, said it is not necessary to get vaccinated. “The infidels do not believe in God and that is why they fear the coronavirus. For Muslims, there is little danger, ”he said.

But Imam Nazar, 46, a farmer from Kunduz province, said that most residents of his village believe the virus is real because several villagers have died from Covid-19. He said he and other villagers were eager to receive the vaccine, but doubted it would make it to their remote town.

“This government is not keeping its promises,” Nazar said.

Fatima Faizi and Fahim Abed contributed reports from Kabul; Farooq Jan Mangal from Khost Province; and Taimoor Shah from Kandahar province.

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