NAIROBI, Kenya – The nurse was lying in bed this month, coughing, hissing and dizzy with fever.
It was three months after rich countries started vaccinating health workers, but Kenyans like nurse Stella Githaiga were left behind: employed in the country’s largest public hospital, she contracted the coronavirus on a trip to remote communities in February, she believes, leaving it aside, even as Kenya struggles with a third outbreak of infections.
Ms. Githaiga and her colleagues are victims of one of the most terrible injustices in a pandemic that has exposed so many: Across the global south, health professionals are falling ill and dying from a virus that doctors and nurses in many wealthy countries are now widely exposed to. protected.
This is just the most visible cost of the divide between rich and poor that deepened in the second year of the pandemic. Of the vaccine doses administered globally, about three quarters went to just 10 countries. At least 30 countries have not yet injected a single person.
Scientists have long warned that this unfair treatment could not only haunt the poorest countries, but also the rich ones, if the continued spread of the virus allows it to mutate in order to undermine vaccines. But the highest human costs will almost certainly be borne by the less affluent nations.
Already, unvaccinated doctors and nurses died this year in countries like Kenya, Mozambique, Nigeria and Zimbabwe, depleting health systems that are unlikely to lose more workers and threatening to lower the level of care in nations invaded by variants.
The number of victims in Africa can be especially profound. The continent has 17% of the world’s population, but has so far administered about 2% of the vaccine doses administered globally.
“I don’t think we have the capacity, as a country and even as Africa, to take care of our own,” said Hazel Miseda Mumbo, deputy dean at the Great Lakes University of Kisumu in Kenya, who studied the country’s health system. “While these countries in the West are still fighting for vaccines, Africa will have to wait. It can be a sad situation. “
In a worrying sign of how uneven the distribution is, even Kenya, one of the richest countries on the continent, is doing poorly.
The first million doses of the Covid-19 vaccine arrived shortly before midnight on March 2. The exultant health minister, Mutahi Kagwe, said the country “had been fighting the virus with rubber bullets”, but now it has finally acquired the metaphorical equivalent of “machine guns, bazookas and tanks. “
But this arsenal was not all that it seemed. The doses were a month late and a quarter of what had been promised. India recently came on the scene with a relatively small but welcome addition of 100,000 doses. Kenya has no idea when exactly the next batch of vaccines will arrive.
Even under the best of circumstances, the country expects to inoculate just 30% of its population, or about 16 million out of almost 50 million, by mid-2023. When the rest of the population will receive their vaccines, no one knows.
The initial loading of doses is being distributed to health professionals and other essential professionals.
For health professionals who have been trying to manage a tenfold increase in daily cases since the end of January, the initial vaccines arrived only after the illness. Ms. Githaiga watched from her sickbed while the media showed health officials and other nurses and doctors receiving their vaccines.
“There was a lot of shock and anxiety in dealing with this virus last year,” said Githaiga, who was recently discharged after a week in the hospital. “So, it is ironic that I was sick on the day the vaccine was launched. I felt left out. “
For rich countries, Kenya’s vaccination schedule is unthinkable. Waiting for months seems quite difficult, especially with dangerous variants circulating around the world. President Biden promised to have vaccines for all adults in the United States by the end of May. Israel vaccinated 60% of its people and Britain vaccinated 41%.
Like many developing countries, Kenya depends on the global vaccine procurement and distribution mechanism known as Covax. The program was built on the idea that many countries, including the wealthiest, would use it to buy vaccines as a way to spread their bets among vaccine manufacturers. Instead, dozens of wealthy nations bought doses directly from pharmaceutical companies, getting the international effort out of the way and delaying shipments to the developing world.
Still, analysts said, the poorest countries are in a stronger position than they would be without the effort. Covax plans to cover at least 20 percent of people in participating countries by the end of the year.
In Kenya, strict restrictions – blockades, curfews, flight suspensions and school closings that eventually forced children to repeat the school year – prevented the virus from dominating the country last year, as well as its relatively young population.
But control measures like blockades, available to rich and poor countries, are no longer the best defense against the coronavirus. The most valuable currency now is vaccines, opening a huge gap between those who can afford it and those who cannot.
The pandemic has worsened in Africa since a variant first seen in South Africa, which proved to be able to reinfect people, began to increase cases in the southern parts of the continent.
“Before that, it was believed that Africa had escaped this pandemic,” said Tulio de Oliveira, a geneticist at the Nelson Mandela School of Medicine in South Africa. “Unfortunately, that didn’t happen.”
With the increase in cases in Kenya, delays in vaccines will cost more lives. The number of reported Covid-19 cases – more than 120,000 infections that led to about 2,000 deaths – is considered an underestimated count.
The country expected more doses of Covax vaccine. But his health officials also hoped that the country’s security and trade relations with the European Union and Britain would help secure vaccines. Kenya also ignored other countries’ concerns about being used as “guinea pigs” and participated in vaccine testing, raising expectations for previous shipments.
“Clinical trials have resulted in vaccines,” said Dr. David Ngira, a postdoctoral researcher in global health legislation at Cardiff University, who has been monitoring the launch of vaccines in Africa. “And based on this premise, Kenyan participants, as well as neighboring communities and the country in general, should have been given some priority in accessing the vaccine.”
but it didn’t happen. Even Kenya’s low expectations have been reduced: the promise of 4.1 million doses of Covax by May has been reduced to 3.6 million doses. The country ordered a total of 24 million doses.
Health officials say they are grateful, but even Covax injections come with problems. The vaccines that covered the first 20% of Kenya’s population were free, but only because the government paid for enough doses to cover another 10% of the population.
For Kenya, this project is expected to come close to a budget of $ 130 million.
An African Union vaccination task force is trying to ease the burden by helping countries gain access to enough doses to vaccinate 60 percent of the continent’s population by mid-2022.
Vaccine delays are expected to cause economic devastation far beyond those countries that are low on doses. In the most dire scenario predicted by a group of researchers, with the poorest countries virtually out of vaccines this year, the global economy could suffer losses in excess of $ 9 trillion, almost half of which would fall in rich countries like the United Kingdom, Canada and the United States. United .
In Africa, however, the costs of slow deployment for people and health systems are already rising.
In late January, a cardiologist from Zimbabwe – a mentor to younger doctors and a pillar of the country’s health care system – was killed by Covid-19. That same month, a senior doctor in northern Nigeria died of the virus, confined to an isolation center.
Kenya’s health system has already been damaged in the past year by mistreatment of doctors and nurses. Many health professionals, without being paid for months in some cases and often receiving inadequate protective equipment, left their jobs, forcing some hospitals to spend months without nurses. It was necessary to close the Covid-19 isolation unit and send patients home. In December, a 28-year-old doctor died of Covid-19 after having worked without pay for months.
“It is a moral emergency to protect healthcare professionals around the world,” said Gavin Yamey, associate director of policy at the Duke Global Health Institute. “Illness and death of health workers in systems that are already weak can make these problems even worse.”
For Nyachira Muthiga, a doctor at a public hospital who worked in a Covid-19 ward in Nairobi last year, the arrival of Kenya’s first vaccines brought a sense of relief. But last year’s overwhelming experiences made her suspicious.
Before contracting the disease, she lost many patients. Substandard protective gear left her vulnerable, she said. And reports of corruption that stole much-needed money from hospitals, she said, broke something in it.
Although she received the vaccine last week, she fears that the same endemic problems in the health care system – combined with the accumulation of vaccines by wealthy countries – could put vaccines out of reach of ordinary Kenyans for much longer.
“I still have hope,” she said, “that the health of our citizens will be a high priority at some point.”
Abdi Latif Dahir reported from Nairobi and Benjamin Mueller from London.