TRÓCAIRE

from Reality Magazine October 2021

CARMEL WYNNE

SOMALIA’S COVID CHALLENGE

A SHORTAGE OF COVID-19 VACCINES AND VACCINE RESISTANCE IS THREATENING TO COLLAPSE SOMALIA'S FRAGILE HEALTHCARE SYSTEM

BY DR ABDI TARI ALI

Less than 1 per cent of Somalians have been vaccinated, but lessons can and should be learned from the polio eradication campaign. The vaccination rollout in Somalia is nowhere near European success rates – we have a limited supply. There is also a growing vaccine resistance driven by misinformation and a lack of public awareness.

Wealthy nations struck deals with vaccine manufacturers, securing a disproportionately large share of early supply, leaving vulnerable nations like Somalia in a more precarious situation. This has undermined the ability of COVAX (the system which aims to provide innovative and equitable access to COVID-19 vaccines in the developing world) to distribute shots equitably and has widened the vaccination gap between Africa and other parts of the world.

Despite the challenges, COVAX has delivered more than 31 million doses to 46 countries in Africa. It aims to supply 520 million doses to the continent by the end of 2021. According to the African Union (AU), Somalia received 716,000 doses, but this is against a population of almost 16 million.

We need to borrow from lessons learned in mass vaccination campaigns such as the polio eradication campaign to make the rollout as effective as possible. The Global Polio Eradication Initiative (GPEI) estimates that vaccination efforts saved more than 1.5 million lives and prevented 16 million people from polio-induced paralysis. The success of the polio eradication campaign comes down to several key factors which can be adopted in Somalia's COVID-19 vaccination efforts for an effective outcome.

The polio eradication campaign had a large team of trained community and health workers (vaccinators) available to reach as many children as possible. There was also strong commitment and goodwill from the government, partners and health care workers throughout. The campaign integrated robust data systems and analysis, which supported more accurate, data-driven decision-making in response efforts.

The incorporation of a strong monitoring network that reached urban and rural areas was geared towards first detecting acute flaccid paralysis in children, supported by testing to confirm diagnosis and identifying the target area for vaccination efforts.

WHAT BARRIERS ARE THERE TO MASS VACCINATIONS IN SOMALIA?

One of our biggest challenges in Somalia is a limited supply of vaccines. We need more vaccines. We need support to ensure we have enough healthcare workers to strengthen our vaccination efforts. We need support to promote uptake of the vaccines amongst hesitant communities. Only 35 per cent

of our supply has been administered so far. Unfortunately, we haven't adequately dispelled misinformation on COVID-19 vaccination.

COVID-19 vaccines have a short shelf life and require ultra-cool storage. We don't have enough refrigerators to store our limited supply. Each vaccines dose is a chance to save a life, and we need to rebuild trust amongst our communities to inspire them to get vaccinated.

We need to develop a plan that decentralises our vaccination efforts. Most vaccinations are happening in urban areas and are not targeting populations in hardto-reach places. We need to end the control of vaccines by armed opposition groups. Somali people living in areas controlled by armed opposition groups (AOGs) will have to choose between taking the COVID-19 vaccine and other vaccines or face the risk of defying AOGs directives.

The AU, through the African Vaccine Acquisition Trust (AVAT), has signed an agreement to purchase 220 million doses of the Johnson & Johnson single-shot vaccine, with the potential to order an additional 180 million doses. It was hoped that around six million would be delivered this August, but funding to purchase doses through the AU facility remains a challenge for many countries like Somalia.

COVID-19 threatens to weaken the health care system further and exacerbate the effect of current crises, leading to more deaths and an increase in the number of people needing assistance. The most up-to-date figures here report a total of 16,103 daily cases of COVID-19. This, on top of the reduction in aid funding, threatens to exacerbate the humanitarian situation on the ground.

We are calling for a more equitable distribution of vaccines which we urgently need, and an increase in bilateral supply to African states to prevent inequalities that will effectively delay global recovery efforts.

HOW DID THE GLOBAL VACCINE ROLLOUT GO WRONG IN AFRICA?

With most African governments unable to buy vaccines themselves, they have relied on GAVI, the global vaccine alliance behind COVAX, to deliver vaccines for various illnesses, including COVID-19. However, wealthy nations secured a disproportionately large share of early supply. This has undermined the ability of COVAX to distribute shots equitably.

COVAX also depended on the Serum Institute of India, the world's largest vaccine producer, for its supply. But, with soaring COVID-19 cases in India, vaccine exports were halted, disrupting COVAX efforts in 36 African countries.