Country: Uganda.
Abstract
This article analyses the COVID-19 vaccine situation in Uganda with a focus on strategies that have been put in place to distribute it to the population, offering a comparison to what is happening in other African countries such as South Africa or Kenya. Starting from the Ugandan situation, here we discuss what needs to be done to tackle COVID-19 misinformation and stereotypes that are affecting vaccine distribution and limit the success of vaccination campaigns in many African countries.
Introduction
Uganda recorded its first COVID-19 case on March 21, 2020, with its first patient being a 36-year-old male who arrived in the country from Dubai. The country recorded its first COVID-19 death on July 23, 2020, a day after President Museveni eased the lockdown. However, Uganda is among the African countries with a low number of COVID-19 deaths. This has been partly attributed to the draconian measures that the government used to contain the spread of the virus.
On March 5, 2021, the Ministry of Health Uganda received the first dose of the COVID-19 vaccine. The 864,000 doses of the AstraZeneca COVID-19 vaccine were shipped using the COVAX facility and additional 100,000 jabs were donated by India. However, the remaining 2,688,000 doses were expected to reach Uganda by June 2021.
The country rolled out the second round of vaccination on June 28, 2021, after receiving an additional donation of 175,200 doses of AstraZeneca from the French government. So Far 854,443 people have been vaccinated by June 30, 2021, which is approximately 2% of the population. However, by November 26, 2021, Uganda had 126,965 confirmed cases and 3,239 deaths with 4,835,777 total doses administered according to the Ministry of Health Uganda data.
Critics are of course questioning the vaccines’ availability, affordability, and its equal suitability to different populations and settings. It would only be wise to analyze what vaccines work and don’t work in order for Uganda to increase the uptake of the vaccination. Strategies such as removing practical barriers to vaccination, rethinking how we talk about and perceive the vaccine, presenting vaccination as a social norm, and carrying out different research in different countries including its contexts would increase the vaccination rate in Uganda and the whole world.
COVID-19 Vaccine in Uganda
When the government ordered 18 million doses of the AstraZeneca vaccine manufactured by the Serum Institute of India (SII). It was criticized for paying $7 per dose, a price that is 20% higher than that paid by South Africa and roughly triple that of what has been paid by the European Union according to the Health Policy Watch report. Countries like Brazil, Saudi Arabia, and South Africa are being supplied vaccines at the cost of $5.25 per dose by the very same institute.
Uganda began vaccinations on March 10, 2021. However, by Friday, July 2, 2021, only 4.5% of the targeted 21.9 million people had been vaccinated since the launching of the nationwide mass vaccination on March 10, 2021. This shows an extreme gap in vaccine distribution although generally there have been low vaccinations in many developing countries. Rising concerns that even the vaccinated face a higher risk of being infected due to the new variants [delta] in Uganda which has caused severe fear of Ugandans to even vaccinate because of numbers of death.
With all these controversies about the pandemic, Uganda is still currently set to buy two million COVID-19 vaccines from American pharmaceutical company, Johnson & Johnson via Afri-Exim Bank and African Union. The country has also collected nearly 41 billion Uganda shillings from different countries such as the United States, United Kingdom, Cuba, Russia, and China to buy COVID-19 vaccines. Through the Covax facility, Uganda has additionally concluded the legal requirement process to procure 9 million doses of vaccines under the cost-sharing framework. The first phase of Janssen by the American firm is also expected to reach Uganda in August 2021, although the vaccination is expected to start until mid next year.
These are really historic steps for Uganda to ensure equitable distribution of COVID-19 vaccines globally by providing at least 2 billion doses of COVID-19 vaccine by the end of 2021. Even so, only about half of Uganda’s population will be vaccinated by the end of the year.
There have also been alleged claims of more than 800 people vaccinated with fake COVID-19 vaccines in June 2021. This has led to the death of some recipients who died in the second wave of the pandemic. Fake vaccination could have come as a result of the high prices of COVID-19 vaccines. Besides this, the country has also discovered delta variant, a new and highly transmissible form of coronavirus alleged to be from India. This new variant has led to increased numbers of death and hospitalisation for both young and old Ugandans. Uganda has also been faced with recently the Omicron variant.
Despite all these, there is a ‘silent pandemic’ that is silently killing both COVID-19 patients and non-patients–depression and post-traumatic stress disorder. This is affecting the mental health of many including the health workers caused majorly by the pandemic SOPs guidelines and increasing death.
Strategies to distribute the Vaccine to Uganda’s population
The Ministry of Health in Uganda released a strategy for the distribution of COVID-19 Vaccines to the population. This has offered unprecedented opportunities to mitigate the pandemic in the country. The ministry also uses the social media infographics for COVID-19, holds radio talk shows, and established the Ministry of Health Toll-Free line to create awareness on COVID-19 disinformation, and report COVID-19 cases as strategies were put in place to distribute the vaccine in the country.
In the distribution of the vaccine, it has been clearly evident that there is a priority for the most vulnerable groups. For example, according to the ISER Uganda report, 3% of health workers and 17% of older persons were to receive vaccines in the COVAX first phase. Additionally, the Ministry of Health is in the process of accrediting private health facilities to provide COVID-19 vaccination. However, this may further risk entrenching inequality in access.
Concerns have also been raised that not everyone was involved in the planning process of managing the pandemic spread based on what the Constitution of Uganda envisaged that in case of a situation that endangers public safety of everybody, a state of emergency needs to be declared and managed. However, Uganda decided to use the Public Health Act of 1935. This is a colonial law that has not even been updated. This act places the responsibility of managing public health emergencies in the hands of the chief medical officer of Uganda which no longer exists (the office). Even though this act was chosen for use, it was not used, they chose to use the Office of the Prime Minister, the Resident District Commissioners (RDCs), and later gave directives that are highly political.
The country’s plan to vaccinate over 21.9 million of its population has been staggered since over 3,000 people have died due to the pandemic. This is because, at the start of the vaccination exercise in March 2021, the majority of Ugandans had negative perspectives towards the vaccines. For instance, in Pallisa District, cultural myths surrounding the spread and treatment of the pandemic have led to the rise of infections. However, when the pandemic began to rapidly spread in May 2021, the stock was done.
Although an additional 175,200 doses of Oxford-AstraZeneca vaccines were shipped in from France, this was too few to make an impact due to high infection and death rates.As a result of the outbreak of the second wave of the COVID-19 pandemic in June 2021, there was a discovery of the supplementary drug–Covidex by Patrick Ogwang, the founder of Jena Herbals Uganda Limited and professor at Mbarara University of Science and Technology (MUST) to treat COVID-19 in Uganda. However, there has been a rapid increase in price from 6,000 to about 160,000 Uganda shillings per 20mls bottle which is against the manufacturer’s agenda.
On July 6, 2021, President Museveni commissioned a vaccine facility in Matuga, Wakiso District called Biological Drugs and mRNA (Messenger Rigonucliec Acid). This is set up with the mandate to make vaccines readily available in Uganda.
What is happening in other African countries?
There have been rising concerns regarding access to COVID-19 vaccines in many African countries due to vaccine hoarding by wealthy nations that secured hundreds of millions of vaccines months before the first COVID-19 vaccine was even approved. This behavior has exposed the stack inequities and has left Gavi, an initiative tasked with ensuring more equitable access to the COVID-19 vaccine, grappling to meet its goal of vaccinating 20 percent of participating countries by the end of 2021.
Countries such as South Africa established an expert Ministerial Advisory Committee and a National Technical Working Group (NTWG) to coordinate the introduction of COVID-19 vaccines. Close collaboration will be or has been done with provincial health departments and the private health care sector in South Africa. This is hoped to ensure effective vaccine delivery and administration. Additionally, the country is also using a phased approach to roll out the vaccine.
This approach also puts into consideration the societal impact and principles of social solidarity and not only the scientific evidence regarding infection and transmission risks. So far, the total number of adults vaccinated in South Africa by July 19, 2021, was nearly 1.8-million after only 146,000 people were vaccinated a week ago. Although the civil unrest in Gauteng and KwaZulu-Natal is causing most of the vaccination sites to close temporarily.
By July 19, South Africa had 2,302,304 registered cases and 67 000 Covid-19 deaths. In neighbouring countries, Kenya’s vaccination plan covers nine areas from regulatory preparedness to monitoring and evaluation systems. An antiviral surgical mask that kills viruses on contact has been created by a Kenyan scientist and doctor at Kenyatta National Hospital.
On the other hand, Tanzania started releasing figures on coronavirus, confirming 100 cases since the third wave of infections began. President Samia Hassan says Tanzania has budgeted $470 million to buy the COVID-19 vaccine. In April 2021, she also formed a special committee of experts to professionally evaluate the COVID-19 pandemic situation in the country. The country has also hinted on plans to start manufacturing vaccines locally.
The actions mark a sharp turn from Hassan’s predecessor, the late John Magufuli. President Magufuli died after weeks of suspense that he contracted the virus on Thursday, March 18, 2021. At the time of his death, he had left Tanzania as an outlier with no vaccination programme and an unknown number of infections. Complacency from former leaders like Magufuli has undermined the fight against the virus at the national, regional, and global levels because halting the ongoing pandemic requires compliance from people and nations across the board.
Over 1.7 million doses of Astra Zeneca COVID-19 vaccine shipped through OVAX, a partnership between the Coalition for Innovations in Epidemic Preparedness (CEPI), Gavi, UNICEF, and WHO, arrived on Tuesday, March 02, 2021, in Kinshasa, Democratic Republic of Congo (DRC).
Some countries have achieved the 90 percent goal of the Vaccine Action Plan with the COVAX, program, although many African countries such as Angola, the Democratic Republic of the Congo (DRC), Ethiopia, Nigeria, South Africa, and Tanzania haven’t. Though this hasn’t been achieved, there is still a need for effective vaccine awareness campaigns and community engagement to combat vaccine misinformation and hesitancy in Uganda, Africa, and other parts of the world.
This will eventually require consultation of the communities when distributing the vaccine and the need for provision of access to information. Public health is a public good that needs collective measures and resources. Even though it is the role of the government to provide it, it needs to be demanded to be done.
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Sandra Aceng is a gender and ICT researcher, policy analyst, writer, and a Wikimedian. She is a Global Voices contributor, a 2020 Global Network Initiative (GNI)/Internews Fellow, 2021 AfriSIG Fellow, a 2021 OPTIMA Data-Driven Activism Fellow by Internews, Associate Editor at DOAJ, and a Freedom House Contributor.
