Why govt is failing to meet Covid jab target

More than half of the 5.6 million doses of Covid-19 vaccines that Uganda has received through donations and direct procurement have not yet been utilised despite low numbers of citizens who have taken the jab.

Health officials have since the launch of the nationwide vaccination against the pandemic on March 10, so far administered 2.3 million doses.  

Out of these, 1.8 million have only got a single shot while 584,066 are double jabbed, which is under a-half of the targeted 4.8 million in the priority groups and a minuscule of the overall 21.9 million citizens that the government plans to vaccinate.

The priority populations, alternately called vulnerable groups, either due to their high exposure to the public or infirmity, include health workers, teachers, security personnel, elderly persons and individuals with co-morbidities.

While giving a national update on the Covid-19 situation and response yesterday, Health Minister Jane Ruth Aceng partly highlighted the challenges arising from the vaccination exercise of priority groups majorly elders and teachers.

“The challenge is accessibility. Uganda is large and there are many districts out there where we have not sent adequate vaccines, but also the vaccination points are few,” Dr Aceng said.
She added: “The ones (vaccination points) in Kampala have just been increased over the last few weeks and that is why people can access them from anywhere. We are concluding on the vaccination plan that will see us taking vaccines closer to the people now that the vaccine [doses in the country] have increased.”

The minister said out of the 5.7 million doses of vaccines that the government has received through donations and direct procurement, 2.4 million doses have been utilised countrywide. 
This leaves 3.3 million doses lying idle in storage at the National Medical Stores in Entebbe yet the country is short on target for the fewer priority groups, and miles behind the overall bigger 21.9 million.

Explaining the irony, Dr Alfred Driwale, the manager Immunisation programme at the Ministry of Health, said initially there were few Covid vaccines in the country and the entire government infrastructure could not be leveraged to mobilise the population as it is done with other national inoculation exercises.

However, as the number of Covid jabs in the country began increasing, officials found themselves and their outreach plans stymied by fewer vaccination outlets distant from targeted populations, especially the elderly, while slower local government-level healthcare providers’ responsiveness added to unmet demand for vaccines in the countryside.

“We encourage local governments [superintending the last mile vaccination exercise] to accelerate outreaches and open more outlets for vaccination in parishes and villages and nearer to the people who most need them such as the elderly. Our advice is that they diversify the outlets to include churches, mosques and other social gatherings,” Mr Driwale said.

Experts say the fact that majority Ugandans have received only their first dose of the Covid vaccine suggests that their immunity against the disease is less effective.

The concerns about low vaccine uptake has worsened after teachers, security personnel, and even health workers --- who are in the frontline and presumed to be the first to take the jabs --- elected to hold out despite the government prioritising them to get the jabs.

The government has premised reopening of schools, planned for next January, for instance, on the inoculation of all teachers, non-teaching staff and elderly parents and warned that the country will fully be reopened, following the second lockdown imposed on June 18, only when the 4.8 million vulnerable people are inoculated.

The latest Health ministry statistics shows that only 81,950 out of the 550,000 teachers have been fully vaccinated, 51,300 out of 150,000 health workers have been double jabbed while only 48,500 out of 250,000 security personnel have filed for the vaccines twice.

The situation is worse with the elderly and those with comorbidities.
Currently, there is an ongoing vaccination exercise in various designated points in Kampala city and its neighbouring suburbs.
In yesterday’s address, minister Aceng said people were responding well to the vaccination drive.

“What we have realised [though] is that the youth are more agile and come quickly for the exercise. The elderly, meanwhile, are requesting that we follow them to where they are, because of challenges of transport and accessibility,” she said.

The plan in the pipeline, according to Dr Aceng, is to have more vaccination points in places where there are large congregations and places that have increasing rates of transmission.
Similarly, Dr Misaki Wayengera, the chair of the Ministry of Health Scientific Advisory Committee (SAC), said the other issue hindering the success of the ongoing vaccination exercise is the fact that it is voluntary. 

“We have not been pushing people hard to get vaccinated and I think that is something to be looked at and considered. I will tell you that in some of the European cities, you cannot enter some public spaces if you are not vaccinated and may be those requirements might become mandatory as we go ahead,” he said.

Dr Wayengera said the country also struggled to acquire vaccines. More than half of the vaccines the government got were received between September and October, this year.

Breakdown of the Covid-19 situation, response and interventions 

Vaccine status of priority groups
As of today, a total of 2,378,171 doses of Covid-19 vaccines have been administered countrywide. The number of people who have received the first dose stands at 1,794,105 while 584,066 have received the second dose. 
The vaccination coverage of priority groups stands at:
• Health workers- 34.2 percent 
• Security personnel- 19.4 percent 
• Teachers- 14.9 percent 
• Elderly (50 years and above)-1.7 percent 
• People with comorbities-1.8 percent  
Current trends of Covid-19 in the country
• The country has so far registered 124,864 cases of Covid-19, a total of 96,321 recoveries and 3,179 deaths.
• There are currently 239 patients admitted in health facilities countrywide. 
• The positivity rate has dropped from 21 percent (the highest in this wave) to an average of 3.4 percent in the past 10 days. 
• The dominant variant that is currently circulating is the delta. 
• The daily average number of confirmed cases over the last one month has declined and stabilised at 124 cases countrywide, from an average of 1,445 cases at the peak of the second wave in June. 
• The daily average number of deaths has declined to six from 57 deaths at the height of the peak of the second wave.  
Update on Covid-19 vaccination 
• To date, government has received a total of 5,690,363 doses through donations and direct procurements. 
Vaccines in the pipeline
Several vaccine molecules are in the pipeline and between October and December, the country will receive the following vaccines:
• 700,000 doses of Sinovac from China
• 1,342,400 doses of AstraZeneca from Belgium and France.
• 300,000 doses of AstraZeneca from the European Union.
• 3 million doses of Pfizer vaccines from the US government. 
• 1.2 million doses of Johnson and Johnson procured by government.
• 2,060,400 doses of Sinopharm procured by government of Uganda
Therefore, a total of 5,342,400 doses will be received through donations and 3,260, 400 doses through direct procurement by government. 
The pipeline vaccines expected are sufficient to vaccinate upto 13.5 million people. Therefore, the priority population (4.8 million) should be fully vaccinated by the end of December.  
Covid-19 infections depending on sex and age
• More females have been infected with Covid-19 in the second wave than males. 
• Hospitalisation and death due to Covid-19 is predominant among those aged 50 years and above
 
Covid-19 infections by region 
The affected regions with pockets of intense transmission include:
• Kampala City 
• Teso Sub-region (Soroti, Katakwi, Ngora and Kalaki)
• Acholi Sub-region (Amuru, Gulu and Nwoya)
• Lango Sub-region (Oyam) 
The main drivers of transmission in these regions have been identified as:
• Mass gatherings (burials and weddings)
• Weekly markets
• Widespread use of local remedies that have created false sense of security and delayed seeking of care at health facilities
• Failure to follow standard operating procedures (and congestion in the city centre
 
Where to go for vaccination
• City square 
• Old taxi park
• Namboole stadium 
• Mayor’s garden, Entebbe
• Okuvu church 
• Ntinda Primary School 
• Mutungo parents 
• Kyambogo university medical centre
• Wandegeya Market 
• Kalerwe market 
• St Paul Primary School Kyebando 
• Makerere Yellow Primary School 
• Bat Valley Primary School
• Kitante Primary School
• Kamwokya Primary School 
• Old Kampala Secondary School, and, mosque
• Wankulukuku stadium 
• Kigobe Primary School 
• St Peters SS Kawala 
• Busega KCCA primary School 
• Kibuli PTC 
• St Dennis Sebugwawo SS Gaba
• Makindye SSS
• Munyonyo COU Primary School