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War and instability bring vaccine challenges to poor countries

On April 26, 2020, a convoy of Saudi military vehicles patrolled the southern city of Aden in Yemen.

SALEH AL-OBEIDI | AFP via Getty Images

Arifullah Khan had just received another polio vaccine when artillery fire exploded on the nearby hills.

He recalled the details of the attack in Pakistan’s Bahaur tribal area near the Afghanistan border five years ago. He said: “It happened suddenly. The gunshots were so loud, it was like an explosion.”

A bullet shattered his thigh and he fell to the ground. Ruhollah, his childhood friend and vaccination partner, bleeds on the ground in front of him.

Khan said, “I can̵

7;t move.” “When he held his breath, I watched him lying in front of me.”

In Pakistan, providing vaccines can be fatal. Radicals and radical religious groups spread the word about the polio vaccine, which is a Western strategy to sterilize Muslim children or keep them away from religion. Since 2012, more than 100 health workers, vaccinators and safety officials who participated in polio vaccination have been killed.

The violent incidents are extreme examples of the difficulties faced by many poor and developing countries in Asia, Africa, the Middle East and Latin America in the difficult task of vaccinating their populations against COVID-19.

This is not only a question of buying vaccines, but also a question of how rich countries are lagging behind in receiving vaccines.

Poor infrastructure usually means steep roads and scattered refrigerators, which are essential for preserving vaccines. Wars and rebellions endanger vaccinators. Corruption takes money away, and planners of vaccination campaigns sometimes have to cross multiple armed factions.

Benjamin Schreiber, deputy director of UNICEF’s Global Immunization, said: “The most challenging areas are…conflict environments, outbreaks of violence that hinder vaccination, and the spread of false information that hinders community participation.”

Many countries rely on COVAX, an international system designed to ensure equitable access to vaccines, even though the system already lacks funds.

Schreiber told the Associated Press that UNICEF is carrying out an immunization program worldwide and is currently stepping up preparations to help purchase and manage the COVID-19 vaccine. He said that the company has stockpiled one billion syringes and the goal is to provide 70,000 refrigerators, most of which are solar-powered refrigerators.

UNICEF Executive Director Henrietta Fore said in a statement that the agency’s goal is to transport 850 tons of COVID-19 vaccine per month next year next year, twice the usual annual use of other vaccines.

The situation varies greatly among countries.

Mexico is expected to begin immunization soon. The military will be responsible for the distribution, and the government has pledged to provide free vaccines to nearly 130 million inhabitants of Mexico by the end of 2021.

At the same time, Haiti, the poorest country in the Western Hemisphere, has not announced any vaccination plans. Health experts worry that rumors may delay vaccination-including claims that hospitals will give lethal injections to exaggerate the number of COVID-19 deaths and obtain more foreign aid.

The mourners attended the funeral of 43 farm workers in Zabarmari, Nigeria on November 29, 2020, who were killed by Boko Haram fighters on November 28, 2020 in a rice field near Koshobe village.

Audu Marte | AFP via Getty Images

The African Centers for Disease Control and Prevention is leading the work of the entire African continent, vaccinating 1.3 billion Africans in 54 countries. The agency is coordinating efforts to obtain doses and seeking financial support from the World Bank-an estimated $10 billion will be spent on the purchase, distribution and administration of vaccines.

The director of the African Center for Disease Control and Prevention, John Enkengasson, said that the goal is to vaccinate 60% of Africa’s population within two years, an increase of about 700 million over the past.

Nkengasong said: “Now is the time to take action.” “The West cannot defeat COVID-19 alone. It must be defeated by the world, including Africa.”

Congo emphasized the obstacles facing the election campaign.

The country has overcome the Ebola epidemic through vaccination campaigns. But it is struggling in eastern Congo, where rebels in the Democratic Republic of Congo have frequently launched attacks, and other armed groups are also vying for control of mineral resources.

The rough terrain and unsafe conditions mean that it is difficult for vaccinators to reach all areas. Some people were attacked.

Dr. Maurice Kakule, an Ebola survivor who worked in the vaccination campaign, said that rumors about the Ebola vaccine have spread, including the idea that people are planning to kill people. He said that the education program has overcome many obstacles, but people have similar doubts about the COVID-19 vaccine.

In Beni, the main city of the region, businessman Danny Momoti said that because of his work, he would get the vaccine. He said: “I need this COVID-19 vaccination card in Dubai and other places where I want to buy goods for Beni.”

The civil war may be the biggest obstacle.

In Yemen, the health system collapsed due to a six-year war between the Houthi rebels controlling the north and the government allies in the south.

Yemen had its first polio outbreak in 15 years in the northern province of Sa’ada this summer. UNICEF says that vaccinators have been unable to work there in the past two years, partly because of safety concerns. Agents rushed to carry out new vaccinations in parts of the north and south in November and December.

Cholera and diphtheria are rampant, Yemen is again facing a new trend of hunger. UN officials warned that a famine could occur in 2021.

Neither the Houthis, the southern authorities nor the World Health Organization and UNICEF have announced a COVID-19 vaccination plan.

Only half of Yemen’s medical institutions remain operational. Roads, power networks and other infrastructure were destroyed. Houthis blocked certain plans and tried to win concessions from UN agencies, including preventing the delivery of cholera vaccine during the 2017 outbreak.

Wasim Bahja, national director of the Yemen International Medical Team, said: “Even the mildest and usually preventable diseases can be fatal due to lack of medical services in conflict situations.”

In Pakistan, public distrust intensified when the CIA used a scam vaccination program in 2011 to identify the hiding place of Al-Qaida leader Bin Laden, leading to a surprise attack by special forces and killing him.

Pakistan, Afghanistan and Nigeria are the only countries in the world where polio is still endemic. Dr. Lana Safdar, who coordinated the polio vaccination campaign, said that this year alone, there have been 82 new polio cases, mainly due to the suspension of vaccination due to the pandemic.

Safdar said that the Bajar area where Khan was shot remains one of the most dangerous areas.

Khan tried to explain the deep distrust in his area. Tribal conservatives are very conservative, “believe that vaccines are the reason why young people disrespect and hardly care about Islamic traditions and values ​​when vaccinating children.”

He said, “Everyone is afraid” of COVID-19. “But they are skeptical of Western things.”

Khan said that he signed up for the administration of the polio vaccine because he was paid the equivalent of $56 for just a few days of work. “I need to feed my family.”

He may also contract to provide a COVID-19 vaccine.

He said: “But first I want to check if there is any danger there.”

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