By Evelyn Lirri
As the rollout of COVID-19 vaccines continues across the world, the key question Ugandans are asking at the moment is when it will arrive in the country. The other question is if the government is prepared enough to undertake the vaccination drive amidst the challenges that the health sector faces.
According to Dr. Juliet Babirye from the department of disease control and environmental Health at Makerere University School of Public Health, for a successful rollout, Uganda needs to come up with a vaccine introduction plan, with a separate schedule from what is currently being used for routine immunization.
“The COVID-19 vaccine cannot be given concurrently with other vaccines so we have to create its own schedule and then we need to choose a strategy. Usually the easier strategy is to do mass vaccination so you decide on who you will start with,” Dr. Babirye told Vox Populi in an interview.
Another option is to undertake a phased vaccination drive. Both strategies, according to Dr. Babirye, have advantages and disadvantages that need to be taken into account.
“The advantage of mass vaccination is that you gain herd immunity fast and raise coverage quite quickly. The disadvantage is that it relies on donor funding and during this period with donor fatigue and economies not doing well, external support is not guaranteed,” she adds.
With cumulative confirmed cases of 40,261 and 334 deaths as of February 24, the country’s coronavirus caseload and fatality is still considerably low compared to numbers reported elsewhere on the continent.
The government says its early preparedness efforts including a total lockdown contributed significantly to keeping the numbers low at the start of the outbreak, although that changed with new infections rising after the lockdown restrictions were eased.
Now with schools, which are a potential source of mass infections expected to re-open in early March, almost exactly one year since they were closed, the government is pinning its hopes on vaccines to avert any potential public health crisis. Already, teachers have been listed as some of the priority groups that will receive the first doses of the vaccines once they arrive in the country, alongside frontline health workers, members of the security forces, people over the age of 50 and those with pre-existing health conditions.
As Dr. Alfred Driwale, the assistant commissioner in charge of Vaccines and Immunization at Uganda’s health ministry explains, because of the highly contagious nature of the virus, social criteria, such as people working in conditions in which transmission is more likely to happen will get the vaccine first.
The Ministry of Health’s proposed plan aims to ensure that by the end of June 2021, at least 4.2million Ugandans should have been immunized against the coronavirus.
As per the proposed breakdown, this will include 110,000 health workers—both in the public and private facilities, 200,000 security forces, 100,000 teachers, 60,000 other essential workers, 3.4 million individuals who are over the age of 50 and 400,000 people under the age of 50 with pre-existing health conditions.
“Infections will continue, but those who are vaccinated can influence the outcome of the disease and fight it off better,” he says.
The target, he adds, is to ensure that at least 60 per cent of the population is vaccinated in order to attain the required herd immunity.
He explains that while most countries are vaccinating their populations over the age of 60, Uganda’s relatively young population gives it the advantage to lower the starting age to 50.
“With scarce vaccines, we can afford to lower our age cutoff to 50. There are only 3.3 million Ugandans aged 50 upwards,” says Dr Driwale.
The government says it is expecting the first batch out of the total 18 million doses of AstraZeneca’s vaccine by the end of March. The vaccines are being procured from the Serum Institute of India. A further 3.5 million doses of the COVID-19 vaccine is expected to come through the COVAX Facility—an initiative spearheaded by the World Health Organisation and other partners to get affordable vaccines to every country in the world.
Dr. Driwale further explains that Uganda has another opportunity to access vaccines through the African Union Initiative, which will be a donation. Uganda will also be able to access vaccines through the African Union’s African Vaccine Acquisition Task Team, which is making available 270 million doses available to member countries.
“These deals are expected to increase and countries willing to acquire vaccines through this route can do so. There is a credit facility to facilitate the process,” he added.
For the start, and based on the high demand for vaccines globally, Dr. Driwale says Uganda will receive its share on a quarterly basis, with 35 per cent expected to be made available in the first quarter and 60-65 per cent in the second quarter of the year.
However, all this will also depend on the country’s readiness and preparedness. Dr Driwale says the government is on course to receive its first batch of the vaccine and is already implementing rollout plans, including training of health workers, setting up distribution programmes and undertaking education and sensitization of the population across the country.
“What is remaining now is finalization of training material, guiding districts and allocating financial resources to facilitate downstream activities,” says Driwale.
But as the World Health Organisation (WHO) Vaccine Introduction Readiness Assessment Tool shows, African countries are still faring poorly when it comes to preparedness for the COVID-19 vaccine rollout, with an average score of 33 per cent compared to the recommended score of 80 per cent.
Speaking at a recent dialogue to understand Uganda’s preparedness and what would be needed to undertake a successful COVID-19 vaccination rollout, Dr. Annet Kisakye, the head of Immunization Vaccine Development Cluster at the WHO-Uganda office said one challenge Uganda will most likely face, especially getting the AstraZeneca vaccine into the country on time is the fact that it is still undergoing review under the WHO Emergency Use Listing.
At the moment, it is only the Pfizer vaccine that has gone through all the required approvals for a rollout. However, because of the logistical challenges involved in storing the Pfizer vaccine—at temperatures under minus 94 degrees Fahrenheit, not many African countries are looking at it as one of their preferred vaccination of choice.
Dr. Kisakye noted that for countries to receive vaccines under the COVAX Facility, at least six requirements must be met. These include submitting a vaccine request form to be accepted into the facility, developing a national deployment and vaccination plan, uploading it on a shared platform, having it reviewed by a select regional committee and receiving regulatory approval before the vaccines are shipped to the country.
Dr. Driwale noted that while Uganda has met these requirements, one impediment that could delay the arrival of the vaccines is the long queues as several countries have made the same request to the single manufacture.
“There is a lot of queuing at the Serum Institute and we may not get the vaccines at the time we need, but we are not giving up,” he said.
He added that Uganda is also exploring other options and vaccines on the market.
“Right now, our preferred option is AstraZeneca but there are discussions to circumvent the constraint of this sole source provider so other vaccine options will also be explored further. We are not going to close our windows to those options,” he said.
