Happy Nice Mall

NGWERERE, Zambia – Last morning, four people arrived at a health clinic trapped between commercial corn farms in search of Covid-19 vaccines. Staff had bottles of Johnson & Johnson vaccine stored in the refrigerator. But staff members apologized, refusing to vaccinate the four of them and suggesting they try another day.

One vial of the Johnson & Johnson vaccine contains five doses, and staff were ordered not to waste a single vaccine.

The nurse who oversaw the vaccine study, Ida Monsoonda, suspected that her team might find more buyers as they put the bottles in Styrofoam coolers and head for markets and churches. “But we don’t have the fuel for the vehicle to get the vaccines there,” he said.

On their last trip to a farm, they vaccinated 100 people; Because the data manager didn’t have an internet connection to access an electronic record system, the records from that trip lay in a pile of papers in the clinic.

For months, the biggest challenge has been to vaccinate Africans against Covid and protect both the continent and the world from the emergence of dangerous variants: A continent of approximately 1.4 billion people has received only 404 million doses of vaccine, and only 7.8 percent of the population is fully vaccinated. .

But other daunting hurdles are emerging as the supply begins to jump into something like a more reliable flow. All of them can be seen in and around Ngwere.

Weak healthcare systems, with limited infrastructure and technology and no experience in vaccinating adults, are trying to lure them into the arms of people with far more pressing priorities. At the same time, the global flow of information and deliberate misinformation on social media creates the same skepticism that has hampered vaccine efforts in the United States and other countries.

Some Zambians are hesitant, but others take an attitude that might better be described as vaccine apathy. This is a poor country whose economy has contracted sharply during the pandemic and many unvaccinated people are more focused on putting food on the table.

“I’d love to get one, but I work Monday to Saturday and I don’t know if they give the vaccine on Sunday,” said Bernadette Kawango, who supports a large family with low salaries from an auto parts store. – the income district on the edge of the capital Lusaka. He has heard many rumors: people who get vaccinated will die within two years; that the vaccine was part of a European plan to kill Africans and seize their lands; Bill Gates is running a campaign to reduce the world’s population.

Stories like these make her roll her eyes. But Covid is not at the top of the list of health concerns. “It’s cholera season and people have malaria and they have HIV and TB,” he said. He doesn’t know anyone diagnosed with Covid.

All these difficulties create two big problems. First, the pace of vaccination is too slow to prevent unnecessary deaths in the fourth wave that has already started in South Africa, or to prevent the emergence of new variants such as Omicron, which were first identified in South Africa late last month. Vaccines currently in stock – most donations close to their expiration date when they arrive – cannot be used before they are destroyed.

Second, the pressure to vaccinate against Covid is drawing resources from health systems that can hardly separate them, which can have disastrous consequences in the fight against other devastating health problems.

In the Ngwerere health clinic, there was no usual hustle and bustle in the mother-child health field, where babies were monitored for signs of malnutrition and childhood immunizations were given, as everyone on this staff had been repurposed as Covid vaccines.

The ruler of Greater Zambia, Dr. “Whenever there’s a wave here, HIV really threatens investments in maternal and child health, tuberculosis and malaria, and it’s important that we protect them,” said Simon Agolory. program of the US Centers for Disease Control and Prevention.

Director of public health at Zambia’s ministry of health, Dr. Andrew Silumesii said there is clear evidence that infant growth monitoring and childhood immunizations are declining throughout the pandemic. He worries that malaria, tuberculosis and HIV infections will also increase.

So far, 7 percent of Zambians, about five million people, have been vaccinated against Covid. President Hakainde Hichilema has set a goal to vaccinate two million by Christmas and 70 percent of the population by the third quarter of 2022, a goal that seems extremely ambitious.

Zambia’s vaccines mostly come from global vaccine sharing initiative Covax, with additional donations from China and the African Union. The fact that Zambia is heavily dependent on donations means it has to tailor its schedule to incoming shipments – it’s like cooking with what comes in a farm subscription box. The country manages the distribution of five different vaccines, each with different dosing regimens, storage requirements and bottle volumes.

This created a huge additional administrative burden for skeleton staff like Ms. Musonda’s team. Staff don’t have the budget to make cell phone calls to remind people of their second vaccination, and the effect can be seen in the charts hanging on the wall of the vaccination room: Of the 840 people who received their first dose of AstraZeneca in April, only 179 came back. A follow-up shot in July.

When Zambia suffered a severe third wave of Covid-19 earlier this year, media coverage of people dying in oxygen-depleted hospital parking lots shook a population that thought of the virus as something that only affects white or wealthy people. Outside the vaccination grounds, there were rows before dawn unable to keep the shots in stock.

However, as the wave waned, so did the demand.

Many people here remember when large numbers of Zambians died of AIDS and Western pharmaceutical companies refused to produce affordable life-saving drugs. Now there are doubts that the same companies have come to offer free solutions.

False vaccine information is spreading on TikTok and WhatsApp, and in evangelical churches where pastors warn that the vaccine “contains the mark of the beast.”

Chongwe District Hospital clinical care coordinator, where seven staff members sit idly by, Dr. “No matter how educated people are, if their pastor says don’t trust the vaccine, they don’t,” said Morton Zuze. vaccination tent

In Zambia, as in the United States, there are false rumors that the vaccine causes female infertility or erectile dysfunction. Zambians have heard that AstraZeneca is not used in many countries due to reports of blood clots in a very small number of people who get this vaccine. Dr. “This is a global village and anyone can turn on CNN,” Zuze said.

Zambia normally only vaccinates young children and has no primary care practices. An adult only goes to the clinic when they are pregnant or receiving HIV treatment or in an emergency.

D., assistant professor in the Boston University School of Public Health and special counsel to President Hichilema. Lawrence Mwananyanda said the government must strike a balance between trying to create demand for vaccines and not creating demand for vaccines. will have the supply to deliver.

“To walk – and these healthcare facilities are sometimes too far away, two, five, seven kilometers away and people don’t have cars, you have to be very motivated – sometimes people go to a healthcare facility and then there’s no vaccine there,” he said. “All they were told was, ‘You can only vaccinate if there are five or six people, so you can’t get vaccinated today’. How likely are you to come back?”

Charity Machika was recently vaccinated at a rural health center in Chongwe District. She went to the clinic for a prenatal checkup and was then encouraged to go to the next building where the HIV treatment center was redesigned for vaccines. “I was scared because people tell a lot of stories like I’m going to pass out, I can’t walk, I’m going to die,” she said. “I took the risk to come and protect myself and my baby.”

He is the only vaccinated person in his family. Her husband has tried twice, but has never been vaccinated at the sites he has been to, and says he hasn’t had time to try the four-mile hike again.

Felix Mwanza, a senior HIV activist in Lusaka, said the government has yet to tap into the country’s vast network of HIV and TB treatment activists. “We don’t seem to learn from our past,” he said, reminding that HIV testing and treatment only reach critical mass when it’s served in bars, schools, and on the doorstep.

“If they don’t use the structures we have, the donors will continue to send the vaccines and they will accumulate here and expire and they will not send us again,” he said.

Dr. Mwananyanda said the key strategy for the planned rapid expansion in vaccination is to do exactly that, getting the vaccines to people at shopping malls and bus stops.

In the midst of turmoil, no one thinks about what will happen next. CDC’s Dr. “We’re really just dealing with vaccine problems for now – but we don’t have a long-term system,” Agolory said. new variants that get rid of the vaccine completely, and do we need to start from scratch and give people more vaccines?”

Dr. Agolory said Zambia will need help with more supplies and funding to help bring in temporary health workers to administer vaccines so that existing programs such as the Ngwerere mother-child clinic are not abandoned.

Even with a large increase in vaccination rates, the country will not have enough coverage to blunt the upcoming wave, or possibly the next wave.

From the Ministry of Health, Dr. “I hope to continue to receive vaccines so that we don’t get into a situation where people need and can’t get vaccines,” Silumesii said. “The other side, which is something I really hate to see, is where we bring in the vaccines and we don’t have enough demand and the vaccines go to waste. These are very expensive vaccines. Surely that pinch would hurt so badly.”