Jabs only way out of Covid trap, say experts

Health experts and activists have asked the government to accelerate inoculation of citizens to reverse Covid devastation and break the chain of knee-jerk cyclical lockdowns whenever cases escalate.

Uganda, which recorded its first Covid-19 case in March 2020, has to-date vaccinated only 1.07m of its citizens – or 5 per cent of the targeted 21.9 million population – all with donated doses of Oxford-AstraZeneca jabs.

This leaves almost 21 million of the eligible persons in need of urgent vaccination as the government for the first time commits --- of the Shs41b secured last year to buy vaccines, but through the United Nations Children’s Fund (Unicef).

Of the inoculated 5 per cent, only 201,053 have received the prescribed double Oxford-AstraZeneca shots while up to 878,890 have received single jabs, rendering their immunity to the disease less effective.

In multiple televised addresses, President Museveni said Uganda, currently in a second lockdown, would fully reopen only when at least 4.4 million Ugandans receive the jab, among them, mandatorily teachers and health workers who still need to keep their government jobs.

Following a staggered journey to access vaccines, which the Ministry of Health honchos blame on global competition, health experts and civil society activists dissatisfied with the government explanation warn that marooning the population at home through lockdown, and without inoculation, is unlikely to tame the virus as infections, and deaths, are certain to surge once a semblance of  normality returns.

In a July 6 petition to the government, the activists urged the government to fast-track immunisation against the pandemic, improve coordination and working conditions for frontline health workers.

Family Comfort Foundation, Life Enhancement Therapies (LETs), Camel Communities and the Public Committee are the petitioners who, like the World Health Organisation (WHO) Africa Regional Office, warn of an impending third wave of the pandemic.

Uganda plunged into a second lockdown after daily infections grossed for the first time in sixteen months 1,000 and daily fatalities from Covid inched closer to 50 in June amid nationwide oxygen crisis, months after tighter restrictions were relaxed from July 2020 and general elections held in January 2021.

President Museveni on June 18 ordered schools that had re-opened in phased manner closed alongside worship places and non-essential businesses as he announced a 42-day lockdown due to lapse at the end of this month despite the government making infant progress on required vaccination.

In their petition, the Civil Society (CSOs) actors wrote: “There should be a deliberate plan to allow, support and supervise private vaccination programmes for those who can afford. This should enable institutions like banks, private schools, universities, telecommunications, and the rest to pay for the vaccination of their workers and fully re-open.”

They added: “National Social Security Fund (NSSF) can pay for vaccines for their 2 million subscribers. Private tertiary institutions can be allowed to use the National Council for Higher Education (NCHE) 2021 annual fees plus the 2021 annual convocation fees to vaccinate.”

The budget for Universal Primary Education and Universal Secondary Education should instead be used to vaccinate 60 per cent of learners and teachers, especially that educational institutions are closed.

The CSOs have also suggested that the government should swap cash loans from International Monetary Fund and World Bank for vaccines.

“[The] government could also explore negotiating with partners such as Global Fund to re-allocate money from other programmes they intended to undertake to vaccination,” the petition reads in part.

Mr Amos Lugoloobi, the State minister for Planning, last month said the government has, due to constrained resources, earmarked only Shs560 billion to procure vaccines, which is less than half of the Shs1.3 trillion that the Health ministry has asked for.

The petition by the CSOs demands government’s “clear public stand … on the way forward for vaccination”.
“At this critical stage of the response, there should be one clear message on the how, when, where and who of Uganda’s vaccination strategy. This will create hope and a sense of direction for the citizenry,” they wrote in the petition.

But last week, Dr Jane Ruth Aceng, the Health minister, told Members of Parliament that she cannot promise when the country will get vaccines that the government is procuring because of high global demand that has hampered access.

“I don’t know when, I have said I don’t know. I don’t know whether you want me to say it in my language or English,” the minister said, defensively.

The government had said that it placed an order for 18 million doses of Oxford-AstraZeneca vaccines with the Serum Institute of India, but this hit a snag after India suspended exportation of vaccines to focus on its population following an explosion in Covid-19 cases and fatalities there.

The ministry, however, said they are expecting doses of vaccines from global sharing initiative –Covax - and the 300,000 doses of Sinovac vaccines pledged by Chinese government this month or early August.

Mr Matia Kasaija, the Finance minister, last week said some scientists that he did not name were demanding $14 million (Shs50b) to establish a vaccine manufacturing facility, but details of the investment and investors remain sketchy.

Uganda has over the past 16 months since registering its first Covid case in March 2020, recorded 2,203 deaths, according to revised Health ministry statistics and 63,140 recoveries out of 88,674 infections.

Revise vaccination strategy
Prof Freddie Ssengooba, a health policy specialist at Makerere University School of Public Health, told this newspaper that the government should address the poor coordination in the vaccination strategy.

“It is going to be hard to get vaccines due to high global demand and importation of vaccines should be well regulated to avoid fake versions. But the vaccines that we are getting should be given to the right people,” he said.

Prof Ssengooba added: “High risk groups should be prioritised as opposed to giving vaccines to everyone as it happened at Kololo [Ceremonial Grounds]. Giving vaccine to those who are due for second dose, if they are not in the high-risk group, will not help us.”

The expert said the government should work with local council officials to identify senior citizens for vaccination since they are more vulnerable than to immunise youth that have higher immunity.

Dr Alfred Driwale, the head of immunisation programme at the Ministry of Health, said they had to balance many things to come up with the vaccination strategy, which is being used at the moment.

He said they also struggled with getting funds for the vaccination exercise and that stationing vaccination at particular points was one of the decisions they had to make to keep the exercise running.

Doctors, nurses’ welfare
Ms Ellon Kiwumulo, the executive director of Family Comfort Foundation, one of the CSOs that has petitioned the government, said the government should address the issue of wellbeing of health workers.

A psychologist, Ms Kiwumulo said a total of 43 health workers have so far succumbed to Covid-19, worsening psychological distress for overworked and exhausted doctors and nurses, which in turn slackens their performance at work. We could not independently verify the reported number of fatalities.

“During the second wave of Covid-19, the health workers are struggling amidst several challenges to provide testing, care and treatment to the overwhelming number of patients every day and increased workload,” she said, adding:“The health workers are also seeing more death of their patients every day, including friends, relatives and colleagues. This is leading to stress, burn-out and panic – exacerbating the already challenging situation.”

In the petition, the CSOs asked government to designate Bombo and Mbuya military hospitals as emergency care centres for health workers who contract Covid-19 in line of duty.  They said this will require government to appropriate emergency funds of at least Shs5 billion to prepare the facilities.

Mr Mukuzi Muhereza, the secretary-general of Uganda Medical Association (UMA), asked the government to address the problem of shortage of personal protective equipment for health workers that is increasing infections.

UMA president, Dr Richard Idro, asked the government to take over Intensive Care Unit management across the country, increase functional ICU beds beyond the central region and improve medical oxygen supply.

CSOS recommendations 
• Shs200b for Parish Development Model be redirected for Covid-19 fight. 
•  Government engages the private sector and offer concrete strategy that can support small and medium enterprises to remain afloat and save jobs.
• Design and implement a new Covid response communication strategy, designate a spokesperson for the national Covid-19 taskforce and synergise information delivery through all government spokespersons.
• Prime Minister Robinah Nabbanja engages and galvanises with the national leadership of religious institutions, non-governmental organisations and professional bodies to fight Covid.
• The NGO Forum should mobilise NGOs providing relief services to support the Covid response.
• All medical schools and nursing schools should open to support the manpower needs for the response.
• Health ministry to prioritse Covid-19 testing and treatment.
• Home-based care for Covid patients be mainstreamed into public health, with Village Health Teams and HCIIIs as first responders.
 • Government should address the issue of wellbeing of health workers.