The difficult task of delivering vaccines to all in Africa


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(2 Dec 2020) LEAD IN:
Despite the World Health Organisation's COVAX initiative to ensure access of lower income countries to COVID-19 vaccines, there's concern many African countries will not get enough doses.
Countries like Malawi currently don't have the infrastructure to support vaccines which require constant freezing to prevent spoiling.

This is how hospital vaccines are stored at the Bwayira hospital in Lilongwe, Malawi's capital.
At the moment it is not suited to storing the vaccines which have been most successful in medical trials.
Moderna and Pfizer/BioNTech vaccines, which have declared success rates of 90 percent plus, need storing in deep freeze temperatures of minus 20 and minus 80 degrees Celcius respectively.
Countries like Malawi face some daunting challenges.
First they have to compete for doses of vaccines with wealthy nations.
Any vaccines they do acquire will need large stable storage facilities with reliable power supplies.
Refrigerators like this keep supplies at two to eight degrees Celcius.
Malawi already has a robust vaccine programme called Expanded Programme on Immunisation (EPI).
But in a report in the science journal Nature the Director of Africa CDC (Centres for Disease Control and Prevention) said most existing vaccine programmes are for children.
Dr. Nonhlanhla Rosemary Dlamini is the World Health Organisation's Malawi Representative.
She says: "So normal vaccines that we are using in our EPI (expanded programm on immunisation) schedule right now are between 2 to 8 degrees centigrade but as you may have seen, the two vaccines that have now come up with the effectiveness of over 90 percent require ultra-cold chain, from minus 20 degrees centigrade to minus 80 degrees centigrade. The kind of equipment that many countries have including Malawi is not that ultra-cold chain kind of equipment. As we are doing our assessment we look at that, but however, we still do not know what kind of vaccine is going to come into the country."     
Dlamini believes funding from the vaccine alliance GAVI has meant Malawi has been able to set up some cold chain facilities, but this would not be adequate to supply the vaccines needed.
According to Africa CDC the continent needs to vaccinate 60 percent of  its population to gain the minimum requirement of herd immunity.
To achieve this Africa CDC says it will need about 1.5 billion doses of vaccine.
The cost of the vaccine and of building systems and structures required for the delivery of it is estimated at between seven and ten billion American Dollars.
The World Bank says Malawi is one of the poorest countries in the world.
Dr. Charles Mwansambo is the Principal Secretary for Health in Malawi.
He believes other vaccine candidates such as the Oxford AstraZeneca vaccine might be more suited.
"Though it is seventy percent effective, there might be a schedule that may improve that performance. So if we are to look at the last candidate I just talked about, as a country, we are ready because the EPI programme already has these storage facilities and Malawi is one of those countries on the continent that does well in its immunisation programes so we have the infrastructure in place already in all the regions. So we have warehouses that can keep this vaccine," says Mwansambo.
At the local hospital Fanny Banda and Ellenita Patrick wait to be seen.
Ellenita Patrick, another Lilongwe resident, believes Malawi needs lots of support to implement the vaccine.

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