KABUL, Afghanistan – Afghanistan, whose citizens largely dismissed the coronavirus pandemic as overkill or a scam, is now preparing to distribute its first batch of vaccines.
Half a million doses of the AstraZeneca-Oxford vaccine, produced by an Indian manufacturer, were delivered in the capital, Kabul, by India on February 7. But the arrival was hailed with indifference by many Afghans, who rejected government warnings that the virus is a deadly threat to public health.
The cheap, easy-to-store AstraZeneca-Oxford vaccine is being delivered as part of the Covax program, a worldwide initiative to buy and distribute vaccines to poor countries for free or at a reduced cost. On February 15, the World Health Organization authorized the use of the vaccine, which requires two doses per person, paving the way for Afghanistan to start its inoculation campaign.
Global tests have found that the vaccine offers complete protection against serious illness and death. But its effectiveness against the virus variant seen for the first time in South Africa is in question, after the vaccine failed a small trial to prevent study participants from having mild or moderate cases of Covid.
The vaccine arrives while Afghanistan is battling a second deadly wave, even while most Afghans live their daily lives as if the virus never existed. Many people refuse to wear masks and crowd in dense crowds inside bazaars, supermarkets, restaurants and mosques, oblivious to the ubiquitous public health posters.
In an impoverished nation, stricken by war, famine, poverty and drought, an invisible virus is considered false or a later thought.
“Of course, I’m not going to get the vaccine because I don’t believe in the existence of the coronavirus,” said Muhibullah Armani, 30, a taxi driver from the southern city of Kandahar.
Expressing a feeling shared by many Afghans, Armani added: “When I see people covering their mouths and noses, afraid of Covid, it makes me laugh at them.”
And even among Afghans who believe the virus is real and want to be inoculated, there is little faith that the government, mired in widespread corruption, will equitably distribute limited supplies of vaccines.
“This vaccine will only be available to people of high status,” said Khalil Jan Gurbazwal, a civil society activist in Khost province, in eastern Afghanistan.
Nizamuddin, a tribal elder in a Taliban-controlled district in northern Afghanistan’s Faryab province, said he feared the vaccine would be appropriated by well-connected politicians and warlords.
“It is common in Afghanistan that even food aid is stolen by corrupt people,” said Nizamuddin, who, like many Afghans, has only one name.
The Attorney General’s Office said on Thursday that 74 government officials from five provinces were accused of embezzling funds in response to the coronavirus. Among those accused were former provincial governors and vice governors.
In northern Afghanistan’s Kunduz province, a hospital administrator told authorities that hospital staff collected medical expenses for Covid-19 treatments for 50 beds in a hospital with only 25 beds, pocketing expenses for “ghost workers”, the Recently reported Special Inspector General for Reconstruction of Afghanistan.
“This misconduct costs Afghan citizens not only financially, but also delays access to life-saving medical care,” the United States embassy said in a statement. But for many Afghans, the vaccine is a solution to a problem that does not exist.
When the vaccination program started on Tuesday, the first dose was administered at the presidential palace in Kabul to Anisa Shaheed, a television reporter who covered the pandemic.
Distributing any vaccine in a desperately poor nation consumed by disorders is a daunting logistical challenge. In addition to overcoming public suspicions and crossing dangerous territories, the Ministry of Public Health must also control the delivery of the vaccine in remote provinces with poor roads and primitive infrastructure.
The pandemic has generated an increase in polio cases in Afghanistan because it has made it more difficult for polio teams to reach remote areas, said Dr. Osman Tahiri, public affairs adviser to the Ministry of Health, who reported 56 polio cases in 2020, up to 29 in 2019.
But equally worrying are the 305 cases of a polio variant in Afghanistan in 2020, against none of those reported in 2019, said Merjan Rasekh, head of public awareness for the ministry’s polio eradication program.
Rasekh attributed much of the increase in variant polio cases to Afghan refugees who returned from neighboring Pakistan, who also struggled to eradicate polio. WHO should grant emergency approval by the end of the year for a vaccine against the variant.
While struggling with the increase in polio cases, Tahiri said health professionals would try to distribute the coronavirus vaccine even in areas controlled by the Taliban, where militants have allowed government-run clinics. The Taliban has set up public health programs warning of the pandemic and distributed personal protective equipment, allowing government health workers to enter their areas.
But Tahiri admitted that vaccination teams will not be able to reach large areas of the country, where fighting is most intense between the Taliban and government forces.
A thousand vaccination teams were trained last week, Tahiri said. The ministry hopes to receive more donated vaccines; Afghanistan, he said, has the capacity to store 20 million doses.
The first doses will go to health professionals and security officials “who are at risk and working in crowded places,” said Tahiri, although there is still not enough vaccine for everyone in this category. Journalists can also apply to receive the vaccine, he added.
Afghanistan has recorded more than 55,000 cases of coronavirus and nearly 2,500 Covid-related deaths, according to the Ministry of Public Health.
But due to limited testing and an inadequate public health system, experts say the real number of cases and deaths is exponentially higher. A WHO model estimated in May that more than half of Afghanistan’s estimated 34 million people could be infected. The Ministry of Public Health estimated last fall that more than 10 million Afghans may have contracted the virus.
Regardless of whether Afghans believe the virus is real, there is an unshakable faith that Allah determines the fate of a believer.
Ahmad Shah Ahmadi, a resident of Khost province, said there was no need to get the vaccine. “Infidels do not believe in God and that is why they fear the coronavirus. For Muslims, there is little danger, ”he said.
But Imam Nazar, 46, a farmer in Kunduz province, said that most residents of his village believed the virus was real because several residents died from Covid-19. He said he and other residents were eager to get the vaccine, but doubted it would reach his remote city.
“This government does not keep its promises,” said Nazar.
Fatima Faizi and Fahim Abed contributed reporting from Kabul; Farooq Jan Mangal from Khost province; and Taimoor Shah from Kandahar province.