Distribution problems, hesitation slowing the supply of vaccination in Uganda

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GULU, Uganda (AP) – The light bulb hanging from the ceiling flickered, infuriating the technician in this isolated Ugandan town as he checked refrigerators filled with vaccine doses to confirm they were still working.

If the power supply didn’t stabilize, he said, he would have to requisition fuel and start the generator.

“It keeps turning on and off, like a disco light,” said technician Tony Elong. “This is our biggest problem. … If I’m not there and the power goes out for many hours, we may lose the vaccines. We need a quick response. “


Power outages are rampant in Gulu district in northern Uganda. For Elong, the problem is urgent; two refrigerators were destroyed by power outages this year. This is one of the many logistical challenges facing health officials as they expand COVID-19 vaccination to rural areas with the arrival of substantial doses in this previously vaccine hungry country.

Gulu, home to 325,000 people, distributed around 9,000 doses, with only 2,795 people fully vaccinated. The district had 30 doses of AstraZeneca and 300 doses of Chinese-made Sinovac as of September 23, an artificial shortage in a country whose vaccine stock is increasing by millions of doses.

In recent days, Uganda has received more than 2.2 million doses – including Pfizer and Moderna – from the United States, as well as 985,000 injections of AstraZeneca from France, Belgium and Ireland.

A total of 11,978,840 doses – donations and purchases through the African Union – are expected in Uganda by December, President Yoweri Museveni said last week. But Uganda’s central storage facility near the capital, Kampala, can only hold 5 million doses of Pfizer vaccines requiring ultra-low temperatures, and some rural areas like Gulu are not equipped to handle the injections. Pfizer or Moderna.

As supply increases, authorities are trying to build enthusiasm for vaccines in rural districts where many, citing safety fears, would prefer to wait.

John Nkengasong, head of the African Centers for Disease Control and Prevention, told reporters last week that while some African countries such as Rwanda and Zimbabwe “are doing well” in rolling out vaccines, others like the Uganda are struggling, and the agency will be looking to community and religious leaders for help.

Health systems in Africa are among the poorest in the world, plagued by chronic shortages of essential supplies, corruption and an unmotivated workforce. In Nigeria, Africa’s most populous country, these challenges are exacerbated by insecurity, with vaccine distribution in rural areas, especially in the unstable north of the country, crippled by the threat of violence. Only 3% of Nigeria’s 200 million people received their first dose.

In Uganda, an East African country of 44 million people, authorities have stepped up immunization in the Kampala region, but efforts have largely stalled in rural districts such as Gulu, hampered by reluctance as well as refrigeration and other distribution problems.

Museveni said last week that officials risk being made redundant in rural areas, which now account for most of the 268 COVID-19-related hospitalizations in the country, if vaccines expire under their watch.

“We are literally dancing,” said Dr Misaki Wayengera, head of a committee advising the Uganda pandemic response, speaking of the slow rollout of the vaccine.

The government ration doses to districts based on demand expectations, and supplies are not restocked until authorities take into account the doses they have previously received.

As a result, shortages resulting from delays in reporting immunization data may occur.

“The demand is there,” Dr. Kenneth Canna said. “But right now, what is bogging us down (…) is the availability of the vaccine, both in urban and rural areas.”

Associated Press reporters reached a remote area of ​​Gulu where a health center without running water had the district’s last supply of 30 doses of AstraZeneca. Because a vial contains seven doses that must be counted, the vaccines are not distributed until seven people are online. So people come and go without receiving a jab.

“You can’t open the vial when there are few people. If there are few people, you will be wasting the vaccine, ”said Okello Labedo, a clinical manager in charge of the Awach health center, speaking through a frayed mask. “The participation of the elderly is very low. I think it’s because of the distance.

Amos Okello, a farmer who had waited several hours under a mango tree, expressed disappointment at getting home without a gunshot after riding many miles on a rented bicycle.

“They said, ‘If you come alone you can’t get the shot,’” Okello said. “I can’t go and force someone from his home to come here to get the vaccine.

If it is “important for me to be vaccinated, tomorrow I may not be able to come back,” he added.

Patrick Okot, a commodities trader in Gulu who received his first injection of AstraZeneca in May, said he plans to travel to another district for the second, but is put off by the cost.

“You could go and find out that they don’t have any vaccines either,” he said.

Uganda’s goal is to immunize 4.8 million of its most vulnerable people – including those aged 50 and over – but so far 348,000 are fully immunized, official figures show. And only 37% of the country’s 150,000 health workers are fully immunized, underscoring the slow deployment that has led authorities to start immunizing students and others in an attempt to prevent expiration of doses.

Authorities have warned that schools will not reopen until all teachers and staff are fully immunized, a mandate that briefly caused queues at rural immunization sites. Still, many came hoping there would be no doses, underscoring the reluctance following reports of rare blood clots in a small number of people receiving the AstraZeneca vaccine.

“The pressure is bringing them on now,” said Lily Apio, an immunization nurse at the Aywee health center, just outside the town of Gulu.

Alfred Akena, a teacher who is waiting to receive the Sinovac vaccine, said he was under the government’s mandate to get the vaccine, but urged his wife not to do so, citing safety concerns.

“They put pressure on us, so today I came to get the vaccine,” he said. “I said to my wife, ‘Let me go first.’ At worst, she will take care of my children.

This view was echoed by college student Onen Richard, who referred to vaccination as “just like the rules and regulations of the school” which he did not think was in his “best interests”.

That morning, after six men signed consent forms, Apio informed them that only five doses of Sinovac were available.

One of the men quickly got up and left.

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Chinedu Asadu in Lagos, Nigeria contributed to this report.


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