DAR MANGI, Pakistan (AP) – Arifullah Khan had just administered another polio vaccine when the shooting came from nearby hills.
“It happened so suddenly. There was so much shooting that it looked like an explosion, ”he said, recalling details of the attack five years ago in the Bajaur tribal region of Pakistan, near the border with Afghanistan.
A bullet broke through his thigh and he fell to the floor. His childhood friend and vaccination campaign partner, Ruhollah, lay bleeding in front of him.
“I couldn’t move,” said Khan. “I watched him lying right in front of me while taking his last breath.”
In Pakistan, vaccine administration can be deadly. Militants and radical religious groups spread allegations that the polio vaccine is a Western ploy to sterilize Muslim children or alienate them from religion. More than 100 health professionals, vaccinators and security officials involved in polio vaccination have been killed since 2012.
Violence is an extreme example of the difficulties that many poor and developing countries in Asia, Africa, the Middle East and Latin America face in facing the monumental task of vaccinating their populations against COVID-19.
It’s not just the problem of providing vaccines or lagging behind rich countries in receiving them.
Poor infrastructure often means that roads are tricky and electricity is sporadic for refrigerators vital to vaccine preservation. Wars and rebellions put vaccinators in danger. Corruption can divert funds, and vaccination campaign planners sometimes need to navigate across multiple armed factions.
“The most challenging areas … are conflict environments, where outbreaks of violence prevent vaccination, and areas where misinformation is circulating, which discourages community participation,” said UNICEF’s deputy head of global immunization, Benjamin Schreiber.
Many nations rely on COVAX, an international system that aims to ensure equitable access to vaccines, although it already has little funding.
UNICEF, which runs immunization programs around the world, is preparing to help obtain and administer COVID-19 vaccines, Schreiber told the Associated Press. It has stocked half a billion syringes and aims to supply 70,000 refrigerators, most with solar energy, he said.
The agency plans to transport 850 tonnes of COVID-19 vaccines per month next year, double its usual annual monthly rate for other vaccines, UNICEF executive director Henrietta Fore said in a statement.
The situation can vary widely from country to country.
Mexico is expected to start vaccinating soon. The military will take care of the distribution and the government has promised free vaccines to almost 130 million inhabitants of Mexico by the end of 2021.
Meanwhile, Haiti, the poorest country in the Western Hemisphere, has yet to announce a vaccination plan. Health experts fear that widespread rumors could delay vaccinations – including claims that hospitals will give fatal injections to increase the number of deaths from COVID-19 and receive more foreign aid.
The African Centers for Disease Control and Prevention is leading a continental effort to vaccinate 1.3 billion people in 54 countries. The agency is coordinating efforts to obtain doses and seeking help from the World Bank in financing – estimating that $ 10 billion will be needed to purchase, distribute and administer vaccines.
The goal is to vaccinate 60% of Africa’s population in two years – about 700 million people – more than the continent has done in the past, said John Nkengasong, director of the African CDC.
“The time to act is now,” said Nkengasong. “The West cannot defeat COVID-19 alone. It must be defeated all over the world, and that includes Africa. “
Congo highlights the obstacles that the campaign faces.
The country overcame Ebola outbreaks with vaccination campaigns. But he fought in eastern Congo, where Allied Democratic Forces rebels carry out frequent attacks and other armed groups vie for control of mineral wealth.
The rugged terrain and insecurity meant that vaccinators were having trouble reaching all areas. Some were attacked.
Rumors have circulated about Ebola vaccines, including the idea that they should kill people, said Dr. Maurice Kakule, an Ebola survivor who worked on vaccination campaigns. Education programs have overcome much of the resistance, but similar suspicions are spreading about the COVID-19 vaccine, he said.
In Beni, the region’s main city, Danny Momoti, a merchant, said he would get the vaccine because of work. “I need this COVID-19 vaccination card to be accepted in Dubai and other places where I am going to buy products for Beni,” he said.
Civil wars represent perhaps the greatest obstacles.
In Yemen, the health system collapsed in six years of war between the Houthi rebels who control the north and allied government factions in the south.
Yemen saw its first polio outbreak in 15 years this summer, centered in northern Saada province. Vaccinators have been unable to work there for the past two years, in part because of safety concerns, UNICEF said. The agencies rushed to deliver new vaccines in northern and southern parts in November and December.
Cholera and diphtheria have increased and, once again, Yemen faces a new outbreak of hunger. UN officials warned of potential hunger in 2021.
No plans for vaccination COVID-19 have been announced yet, either by the Houthis, southern authorities or by WHO and UNICEF.
Only half of Yemen’s health facilities continue to function. Roads, power grids and other infrastructure have been devastated. The Houthis disrupted some programs, trying to obtain concessions from UN agencies, including blocking the delivery of cholera vaccines in the midst of a 2017 outbreak.
“Even the mildest and normally preventable diseases can be fatal due to the lack of access to health care in a conflict scenario,” said Wasim Bahja, Yemen’s director for the International Medical Corps.
In Pakistan, public suspicion increased when the CIA in 2011 used a fraudulent vaccination program to identify the hiding place of Al Qaeda leader Osama bin Laden, leading to the operation of the special forces that killed him.
Pakistan, Afghanistan and Nigeria are the only countries in the world where polio is still endemic. There have been 82 new cases of polio this year alone, mainly because vaccinations have been suspended due to the pandemic, said Dr. Rana Safdar, who coordinates polio vaccination campaigns.
The Bajaur region, where Khan was shot, remains one of the most dangerous areas, Safdar said.
Khan tried to explain the deep distrust in his region. Deeply conservative tribal elders “believe that the vaccine is the reason why young people who received it as children are disrespectful and show little concern for Islamic traditions and values.”
“Everyone is scared” of COVID-19, he said. “But they are suspicious of Western things.”
Khan said he signed up to administer polio vaccines because he received the equivalent of $ 56 for just a few days’ work. “I needed to feed my family.”
He will probably sign up to deliver COVID-19 vaccines as well.
“But first I would like to see if there is any danger there,” he said.
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Meldrum reported from Johannesburg, Keath from Cairo. Associated Press writers Samy Magdy in Cairo, Maria Verza in Mexico City, Sonia Pérez D. in Guatemala City, Evens Sanon in Port-au-Prince, Haiti and Al-Hadji Kudra Maliro in Beni, Congo contributed to this report .