COVID-19 Vaccination of Ugandan Health Workers on Track – As Country Races To Meet Targets
Ugandan doctor Samson Wamani getting his COVID-19 vaccine.

KAMPALA – On 12 March, Samson Wamani, a doctor at Mukono General Hospital, received his COVID-19 vaccine under a tent placed outside the hospital as Uganda implements its plan to vaccinate half the population in the next year.

As the government already had a database of its health workers registered, all Wamani had to do was present his National Identification Number (NIN) to confirm and tally with the government register. “The vaccine arrived before we were registered. They already had our details, so we just needed to confirm with the NIN,” says Wamani. “The process was not hard at all.”

The Ugandan Ministry of Health received 864,000 doses of the AstraZeneca COVID-19 vaccine, shipped via the COVAX facility – the world’s facility for universal access to COVID-19 vaccines. The first consignment arrived in the country on 5 March and vaccination started five days later.

Uganda targets to vaccinate half its population, almost 22 million, in a phased manner within the next year. Each phase is planned to cover 20 percent of the population – approximately 4.38 million people. 

Other health workers who are not employed by the government, namely those working in the non-profit and private health facilities, had to register to get the vaccine distributed free to all. 

COVID-19 has heavily jolted the health workforce in the African region. Since the beginning of the pandemic, 267 health worker infections have been recorded on average every day, translating to 11 new health worker infections per hour. 

To date, more than 100 000 health workers have contracted COVID-19 in the African region. Health worker infections account for 3.5% of the total number of cases in the region according to WHO.

Meanwhile, 30 out of 55 African countries have started immunisations for health workers, and Uganda has been doing well with its COVAX vaccine allocation.

“The pandemic has nearly knocked loose the lynchpin of the health systems in many countries,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We must further protect and equip our health workers to effectively contribute to the efforts to contain COVID-19. Everyone’s wellbeing is at stake without an adequately supported health workforce.

“Doses will remain limited and it’s critical that frontline health workers and other priority groups are at the front of the queue. Health workers deserve protection because without their pivotal role, efforts against the pandemic can go only so far, ” said Moeti. 

Health care workers need to be protected

“Health care providers have been pivotal in managing the COVID-19 pandemic in Uganda. With their crucial role, dealing with patients comes the high risk of being infected with the disease. We shall immunise them first to protect them,” said the WHO Representative to Uganda, Yonas Tegegn Woldemariam.

“Unless we protect health care providers, health systems will remain overwhelmed, and the most vulnerable children will continue to lose access to life-saving services, risking years of progress and resulting in the poorest children falling further behind,” said UNICEF Uganda Representative Munir Safieldin.  

“We are taking care of the caretakers – health workers are normally forgotten – we are starting with frontline health workers so that they are able to also protect you,” said Phiona Atuhebwe, a vaccinologist at the WHO Africa office. 

“I got my first shot but I still fit and I am here facilitating this workshop. I am not feeling anything and can get into my car and drive to Arua (district in Northern Uganda),” said Alfred Driwale, the programme manager of Uganda National Expanded Programme on Immunization (UNEPI).

Health Minister Dr Jane Ruth Aceng, was the first Ugandan to take the jab. She said health workers and all their support personnel, numbering to 150,000, will be vaccinated first. 

Thereafter, up to 250,000 security personnel will be vaccinated. Following this, teachers and staff in all education institutions will be next – an estimated 550,000 persons. 

Essential service workers who interact with many people in their work and people aged 50 years and above will be next. In total about 3.3 million will get the vaccine. COVAX allocated 3,552,000 doses to Uganda. The remaining doses are expected in the country by June 2021. 

 

Covid19 vaccination of Ugandan health workers are on track.

Wamani’s vaccination took about 10 minutes. The nurse spent about 5 minutes explaining the procedure and then he had to sign a consent form before taking the jab.  “I fear injections as a person. There was a bit of muscular pain and the injection was painful,” he says. After that, he had to spend 30 minutes under observation. 

There has been a lot of debate about vaccines being tied to NINs. The Initiative for Social Economic Rights and Unwanted Witnesses challenged the decision in court, saying it would leave out many Ugandans who have never received IDs or have lost them. The government eventually agreed to relax its decision but at the vaccination sites it is still a requirement.

“I got my vaccine today. After the shot, I was advised to rest for 30 minutes. I felt a bit thirsty but I was given some water. At the moment I feel normal. You have to present your NIN. It is a requirement,”  said Joyce Matovu, a hospital liaison coordinator.

‘Consent Form Needs to be Simpler’

“I hope the consent form will be modified. For instance, the headline with side effects should be in bold and include some images so that it is easy to peruse through. People like me do not read long text,” says Wamani. “It is an implied consent”. 

He says the consent should also be summarised to make it simpler, letters should be bigger, have imagery and important points should be bolded to enable easy reading. The consent forms are also only in one language – English. 

“The consent forms will eventually be in every language so that people agree to what they understand and the government is not held accountable, so no one is going to be forced to be vaccinated,” said Monica Musenero, the presidential advisor on epidemics. 

“They will be translated. Right now we are dealing with a category of people who are 100 percent literate,” says Driwale, who added that the vaccination exercise is going well. 

However, some media reports have pointed to a refusal by some health workers to take the jab because the President has not been seen to take it.

During his televised address on 14 March, President Yoweri Museveni said that he was yet to decide on which COVID-19 vaccine to use although so far only the AstraZeneca vaccine manufactured by the Serum Institute of India (SII) is available. 

“WHO gave us assurance and our national drug authority (National Drug Authority -NDA) also gave us assurance. We shall use AstraZeneca – there is no business of delaying – the challenge we are having is that of inadequate stock and we will do whatever it takes to address this issue,” said Driwale. “When the WHO says it is okay and our National Drug Authority says so we go ahead with it.”

Pharmacovigilance and Security

WHO says pharmacovigilance for any country requires a rigorous process both from the government and the manufacturer. Countries also need to be able to identify, detect and monitor any adverse event that has come from the vaccine and to show that they can manage it.  

“The structures needed to be in place before any manufacturer accepted to ship the vaccine. There had to be signatures between the government and the manufacturers and the government being able to prove that any person who gets a side effect can be followed up to the last level,” said Atuhebwe. 

“We establish the causality of a side effect – and investigate up to the manufacturer. We have a model laboratory in Uganda the Uganda Virus Institute (UVRI) in case of any problem,” says Atuhebwe.  “Countries have invested so much and we know that if anything happens the population is protected.”

Driwale explained that the security of the vaccines is tight. They are being guarded at the National Medical Stores (NMS) and distributed under armed escort. When they arrive in a district, they are received by the district security officer and district health officer and are locked in fridges at the health facilities.

“They are accounted for on a daily basis, and any person who fails to account for a vaccine will face tough consequences,” said Driwale. 

  

 

   

 

Image Credits: Supplied, supplied.

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