Poor Vaccines Coverage in Pandemic Blamed on Multiple Barriers
Dr Elia Badjo, co-founder and executive director of the Democratic Republic of the Congo’s Conseils sur la Santé et Académie de Médecin ( COSAMED), helps people in the North Kivu region

Some of the biggest obstacles to expanded vaccines coverage in the world’s poorest and most conflict-ridden nations are lack of cold chain storage, unpredictable supply chains, and transport barriers, not claims of “vaccine hesitancy” in the Global South, according to a new report.

The picture of the steep challenges faced by 14 nations during the COVID-19 pandemic “is more nuanced than a simple attribution to ‘hesitancy’ or ‘poor education,’ consistent with findings elsewhere,” two advocacy groups and a research company conclude in a joint 55-page report Friday.

“Our findings demonstrate that as the world moved and transitioned from COVID-19, massive inequities remain in access to all COVID-19 tools, including oxygen and rapid tests,” the report says. 

Among developed nations, some 1.1 billion COVID-19 vaccines were likely wasted since the global rollout began, according to findings in July by Airfinity, a global health surveillance firm.

The two groups — International Treatment Preparedness Coalition (ITPC) and People’s Vaccine Alliance — and the Malaysian research company, Matahari Global Solutions, say “numerous structural access barriers exist” to the fair, widespread distribution of COVID-19 vaccines.

Those include “insufficient” local cold chain storage and advance notice about arrival dates, which impedes national planning and implementation abilities.

Other barriers include physical infrastructure, such as access roads, and in some places limited access to transportation that works and is affordable. Unpredictable wait times, fluctuating supply stocks and people’s inability to leave their jobs also play an important role, the study finds.

In addition, it says, the lower vaccination rates are influenced by a lack of “access to information and suspicion of medical technologies brought to countries by Westerners and white men, owing to historical memory and perceptions of experimentation on Black bodies.”

In most cases the information, including technical terms, was delivered in the “official language” — most often English, French or Spanish — instead of local languages.

Study Dismisses Claims About Importance of Skepticism About Vaccines

That contrasts with the so-called vaccine hesitancy that some pharmaceutical companies have blamed for low vaccination rates among poorer countries.

The study looked at Bangladesh, Democratic Republic of the Congo (DRC), Haiti, Jamaica, Liberia, Madagascar, Nepal, Nigeria, Peru, Senegal, Somalia, Uganda and Ukraine, reflecting a variety of factors.

Some, such as the DRC and Haiti, had internal conflicts and vaccination rates of less than 10% — in contrast to the World Health Organization’s recommended 70% target rate that some high-income countries already have achieved.

Others such as Nigeria, Somalia and Ukraine were included primarily for their domestic turmoil or insecurity. Peru was studied due to its high numbers of COVID-19 deaths; Madagascar was put on the list because of relative exclusion from discussion among academic and policy circles.

Dr. Elia Badjo, founder and executive director of COSAMED and the lead local consultant for the ITPC/PVA project in the Democratic Republic of Congo (DRC), said health workers hadn’ been paid since the start of the vaccination campaigns at the beginning of the pandemic due to lack of funds.

“Many are not trained either,” he said, adding that Ebola and monkeypox outbreaks exacerbate the situation and stretch scarce public health resources. Violent conflicts also have displaced people and made them more inaccessible to health workers.

In Uganda, Richard Musisi, executive director of Masala Association of Persons with Disabilities Living with HIV/AIDS (MADIPHA), said people with disabilities “were disproportionately affected by the COVID-19 pandemic. There were consistent vaccine stock-outs and limited awareness.”

The study says doctors and nurses in several rural communities reported never having heard of Paxlovid or novel antivirals for COVID-19, while some nations had no outreach to LGBTIQ persons, those who cannot afford to self-isolate if they tested positive, or people living in single-room homes.

“These point to the need for direct cash transfers during pandemics and long-term planning on social security nets on the domestic level, but also to the failure of global pandemic platforms to account for local and specialized contexts,” the study says.

Report Cites Role in Vaccines of ‘Modern Day Slavery

The unsalaried community health workers that are essential for pandemic response also are a top concern.

“Across the 14 countries and territories, community health workers play an essential role in deployment of tools, community engagement, and vaccine uptake,” it says. “Yet they largely remain unpaid — a phenomenon some have described as modern day slavery.”

The People’s Vaccine Alliance says the disregard for the needs of people in lower-income countries is evidence of “systemic racism” in the global COVID-19 response, though the study does not mention this term or others such as “racism” or “racial discrimination.”

The group also emphasizes that true infection and death rates are likely to be far higher than official figures due to the inaccessibility of testing and vaccination sites among the studied nations.

“PCR test results can take anywhere from 8 to 12 hours in Bangladesh to more than two weeks in rural DRC. People cannot leave work at short notice, travel long distances to a vaccination/testing site, and then wait for a long unpredictable period of time,” it says.

“For rural populations and nomadic people in countries like Somalia, this problem is particularly acute. Mobile vaccination and testing is not widespread enough.” 

Approach to Vaccines in the Global South Left People ‘Abandoned’

Maaza Seyoum, the group’s Global South convenor, says the report shows that communities have repeatedly been let down by a system geared towards protecting people in wealthy countries – leaving people in the Global South abandoned.

“Their lives have been treated as an afterthought,” Seyoum said.

“Local populations are expected to shoulder blame and be grateful for what vaccines they do receive, when there has been little effort to meet their needs,” she said. “It is yet more evidence of the systemic racism that has plagued the global response to COVID-19.”

Fifa A. Rahman, the report’s lead author and principal consultant at Matahari Global Solutions, says the report found “layered issues why people are not accessing vaccines” rather than an outright, widespread distrust of vaccines.

“The vaccine hesitancy narrative is rooted in racism and colonialism and the idea that some people don’t know how to do certain things,” she said.

“It’s the same kind of condescension that still happens and it’s really problematic. Part of it is intellectual laziness, but it’s largely due to ingrained racism and colonialism.”

Image Credits: Joe Karp-Sawey/People's Vaccine Alliance.

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