Vaccine Holdouts in Africa Reject World’s Route to Recovery

A handful of vaccine holdouts in the world’s least-inoculated continent could pose another big challenge for global efforts to end the pandemic.

Burundi, Tanzania and Eritrea have so far rejected the World Health Organization’s advice to register for Covax, an initiative to distribute vaccines to poorer countries, with some officials downplaying the impact of Covid-19 and effectiveness of jabs that have allowed several countries to begin opening up. 

While Tanzania's new president, Samia Suluhu Hassan, has now appointed an advisory council, which recommended the country join Covax, the government has yet to say whether it will follow the advice.

The danger is that while the rest of the world slowly returns to normalcy, the virus will spread in these African nations, mutating into variants that can evade current vaccines, cause deadly new waves and spread far beyond their borders.

“If you allow the virus to continue to circulate anywhere, it allows the virus to mutate,” said Shabir Madhi, a vaccinologist from Johannesburg’s University of the Witwatersrand, who led a trial of AstraZeneca’s shot in South Africa. “Those variants are going to be a consistent threat not just to those countries — but globally.”

Together, the three African holdouts have a population of about 75 million, a little smaller than Germany’s, providing an ample reservoir for mutations to develop, much as they did in England, Brazil, South Africa and India. Highly-transmissible variants first identified in those countries were later detected in different parts of the world.

And the most mutated version of the coronavirus discovered to date is believed to have come from Tanzania, where people go about their lives with minimal precautions and no shots have been ordered so far. 

“They declared they had no intention to join Covax,” Phionah Atuhebwe, the WHO’s new vaccines introduction medical officer for Africa, said. “We can only continue with advocacy.”

Vaccine Holdouts in Africa Reject World’s Route to Recovery

So far, that advocacy has made halting progress.

In what seemed a break with his late predecessor, Burundi’s President Evariste Ndayishimiye declared in July that Covid-19 was the country’s “biggest enemy.” Former President Pierre Nkurunziza, who died in June amid speculation he’d contracted the virus, had scorned the disease and expelled WHO officials, saying his country was protected by God.

Yet almost a year on, Ndayishimiye has not secured vaccines, saying the battle had already been won. Burundi’s government says vaccines aren’t fully effective and long-term side effects are not understood though it’s allowed soldiers serving in peacekeeping missions overseas to receive them.

“Our position is that these vaccines are still on a trial,” Thaddée Ndikumana, Burundi’s health minister, said on May 4.

Eritrea still hadn’t decided on its approach, Information Minister Yemane Ghebremeskel said. Tanzania’s Suluhu Hassan has promised a shift away from her predecessor’s approach, and is now considering vaccinations. The late president, John Magufuli, who dismissed the severity of the disease and advocated steam treatments, died in March of heart ailments. There was speculation he’d also succumbed to Covid.

While there are other nations who've yet to immunize anyone, they at least plan to do so. Madagascar, which touted an herbal remedy, ultimately signed up for Covax on April 1.

“We have porous borders,” Atuhebwe said.  “The biggest worry is the mutations.”

Vaccine Holdouts in Africa Reject World’s Route to Recovery

In a continent with the world’s lowest vaccination rate — just 24.2 million doses have been administered to a population of 1.3 billion, according to the Africa Centres for Disease Control and Prevention — the perils of waiting are already evident.

Officially, Africa has confirmed about 4.7 million cases and 127,000 deaths, but testing’s been minimal with the exception of South Africa.

Anecdotal evidence of oxygen shortages at hospitals indicates a more severe epidemic than is publicly acknowledged. In South Africa alone, the excess death rate, or deaths above what would normally be seen, is triple the number of people certified to have died from Covid-19.

Travelers from Tanzania arriving in Angola were in March found to be carrying a variant of the virus that Tulio de Oliveira, director of Krisp, a South African scientific institute that conducts genetic testing, described as the most mutated yet.  Another is spreading rapidly in Uganda and Rwanda, he said.

There are concerns the latest mutations could spread further.

While some measures to curb Covid-19 are now in place in all three countries, in Burundi and Tanzania the influence of denialist presidents lives on, even after their deaths.

Vaccine Holdouts in Africa Reject World’s Route to Recovery

In Dar es Salaam, Tanzania’s commercial capital, food markets are busy, buses crowded and bars full, while churches and mosques are packed with worshipers, most without masks.

“I don’t think that coronavirus is such a big problem in Tanzania as it is in other countries,” said Tanzanian businesswoman Queen Maro. 

That assessment is belied by oxygen shortages that earlier this year hit hospitals overwhelmed with patients displaying Covid-19 symptoms.

“We aren’t seeing a huge number of patients as we did” between December and February, said a doctor in Dar es Salaam, who asked not to be identified as only four government officials are permitted to speak about the disease. “With the onset of the rainy season, I fear that a new wave of Covid-19 infections is coming and, believe me, it will be bad.”

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