Low- & Middle-Income Countries in Africa and Middle East Begin Vaccine Rollout
Sinopharm vaccines prepared to be flown to Zimbabwe on Sunday.

As low- and middle-income countries begin receiving their first batches of vaccines and commence their vaccination campaigns, at least 40 countries across Africa are seeing a second wave and record case numbers are being reported in the southern African region, where the B.1.351 variant is spreading.

Rwanda has become the first country in East Africa to start vaccinating its frontline health workers, according to the health ministry via an announcement on Twitter.  

The ministry simply referred to “WHO-approved COVID-19 vaccines acquired through international partnerships in limited quantities.” However, a government source told AFP that the country, which has over 12 million citizens, had acquired 1,000 doses of the Moderna vaccine for its frontline health workers.

The Moderna vaccine needs cold storage – but not at the ultra-cold temperatures required for the Pfizer/BioNTech vaccine. A month ago, the country purchased five ultra-cold storage freezers with the capacity to store vaccines up to -80°C in preparation for the arrival of the two mRNA vaccines. 

Rwanda is one of only four African countries – together with Cabo Verde, South Africa and Tunisia – that have been approved by COVAX to receive the Pfizer/BioNTech vaccine, which needs to be stored at -70°C.

After the initial vaccination phase, additional jabs will be provided both by COVAX and the African Union (AU), which secured over 600 million doses of vaccines for its member states. 

Kigali, the capital city, has been under lockdown since mid-January after a second wave of the pandemic hit. Rwanda has recorded over 17,000 cases and 239 deaths.

On Monday, Zimbabwe also received its first batch of COVID-19 vaccines, developed by Sinopharm and donated by the Chinese government. The 200,000 donated doses were delivered to the Robert Gabriel International Airport in the capital city of Harare and vaccinations will begin this week. 


Zimbabwe also purchased 600,000 doses of the Sinopharm vaccines, which will be delivered in early March. Frontline workers, including healthcare workers and immigration agents working at the borders, will be prioritized in the first part of the rollout plan. 

But the country will need millions more doses to reach herd immunity in its population of 14.6 million. As a result, the government submitted an expression of interest to be part of the initiative to receive vaccines from the AU. 

Lebanon Begins Campaign in Eastern Mediterranean Region

Lebanon began its vaccination campaign on Sunday after receiving 28,500 doses of the Pfizer/BioNTech vaccine, which arrived from Belgium on Saturday at the Rafic Hariri International Airport in Beirut.

This week, the government plans to vaccinate between 300 and 400 people per day in 17 approved medical centers and hospitals across the country, beginning with healthcare professionals working in COVID departments and individuals in senior care homes. 

Lebanon, a country of 6.8 million, has recorded over 330,000 COVID cases and 3,961 deaths. 

The hospitals have reportedly rehearsed their vaccination procedures to learn from “the mistakes of the Americans and French, and…[try] to avoid the same issues,” said Abdul Rahman Bizri, head of the National Committee for the Administration of COVID-19 Vaccines. 

The Oxford/AstraZeneca vaccine is also expected to arrive in Lebanon in two weeks. The government has ordered 2.1 million doses of the Pfizer/BioNTech vaccine and is set to receive 2.7 million doses from the COVAX facility. Talks are also underway to order 1.5 million doses of the Oxford/AstraZeneca vaccine. 

Lebanon’s Health Minister, Hamad Hassan, promised that all residents, including Syrian and Palestinian refugees, of which there are approximately 1.7 million, would be vaccinated. 

The COVID-19 pandemic has coincided with a political and financial crisis in Lebanon, which has caused the cost of importing medicines and food to skyrocket. In addition, the explosion in the port of Beirut in August, 2020 heavily damaged four hospitals in the capital. 

Nearby in the Israeli-occupied West Bank, the Palestinian Authority last week began to vaccinate health workers with several thousand doses of the Pfizer vaccine acquired from Israel along with a shipment of Sputnik V vaccines, acquired from Russia.  But  Israeli authorities were currently barring the PA’s delivery of some 2,000 vaccines to the Gaza Strip.  Israel has been demanding that Hamas, which controls the Strip, first return the bodies of two deceased soldiers as well as two Israeli citizens reportedly being held hostage there.

Under Reporting of Cases and Deaths in LMICS – Could Make Vaccines Appear Less Urgent

Meanwhile, some experts were expressing concerns that the underreporting of COVID cases in many low-income countries, due to the lack of capacity to conduct mass testing and collect reliable data on COVID cases and deaths, could also reduce the sense of urgency around vaccination for global policymakers.

“Some might argue the need for vaccines is much less urgent…so the vaccines will go to countries with stronger reporting systems and so further entrench inequity,” Oliver Watson, an infectious disease expert at Imperial College London, told the Guardian.

Several studies have suggested that only a fraction of the cases in developing countries of Africa have actually been reported, with one study estimating that only 2% of deaths due to COVID-19 were officially reported between April and September in Sudan.

“CV19 cases were under reported because testing was rarely done, not because CV19 was rare,” said a study conducted by the Boston University School of Public Health in Lusaka, Zambia. “If our data are generalizable, the impact of CV19 in Africa has been vastly underestimated.”

“The increasing deaths from COVID-19 we see seeing are tragic, but are also disturbing warning signs that health workers and health systems in Africa are dangerously overstretched,” said Matshidiso Moeti, WHO’s Regional Director for Africa, during a press conference last week.

Without accurate reporting, low-income countries could be left even lower on the priority ladder than they already are, delaying the protection of hundreds of millions of people.

Image Credits: Twitter – Chinese Ambassador to Zimbabwe.

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