People in Somaliland and other low and middle-income countries faced systemic racism in the global COVID-19 response, leaving millions without access to COVID-19 vaccines, tests, and treatments, according to a study from global health consultancy firm Matahari Global Solutions, the People’s Vaccine Alliance, and the International Treatment Preparedness Coalition (ITPC).
Researchers studying communities in 14 low and middle-income countries found that a combination of undersupply of vaccines and treatments, underfunding of health systems, undervaluing of health workers, and poor adaptation to local needs were the key drivers behind low vaccination rates. Moreover, unpaid community health workers have been compared to “modern-day slavery”.
The report contradicts the repeated allegations from pharmaceutical companies and wealthy country leaders that people in lower-income countries are “vaccine hesitant”; an accusation again leveled by Pfizer CEO Albert Bourla at a recent public event.
“Throughout this pandemic, low vaccination rates in lower-income countries have been conveniently dismissed as the result of ‘vaccine hesitancy’. Our report finds this allegation to be false,” said Dr. Fifa A. Rahman, Principal Consultant, Matahari Global Solutions.
People face a litany of barriers to accessing vaccines and treatments — from undersupply of vaccines and treatments to underfunding of health systems, and poor adaptation to local needs.
“These are issues of equity,” Rahman added.
The global health researchers studied access to COVID-19 tools across Bangladesh, the Democratic Republic of the Congo, Haiti, Jamaica, Liberia, Madagascar, Nepal, Nigeria, Peru, Senegal, Somalia, Somaliland, Uganda, and Ukraine.
“Testing and vaccination sites have been inaccessible, meaning true infection and death rates are likely to be far higher than official figures,” the report found.
“Vaccines have been delivered inconsistently and in insufficient numbers, leading to stock fluctuations at vaccination sites. Doses can arrive with little or no notice or information about what kind of vaccine will be delivered or whether they are suitable to conditions in a country,” it added.
Saeed Mohamood from Somaliland’s Ministry of Health is quoted saying: “Sometimes we will find out that the Somaliland shipment is on a plane in the air, en route, and we do not know when it’s going to expire and how much resources we will have.”
According to the report, Health Poverty Action is implementing a project funded by the Foundation for Innovative Diagnostics (FIND) to provide rapid antigen tests to seven health facilities in Hargeisa and five facilities in the Sahil region in Somaliland.
“According to Somaliland’s Ministry of Health, there is no PCR capability or capacity in rural areas, with PCR infrastructure only functional in two of four regional capital cities (Hargeisa and Borama), given that at the time of interview (July 2022), two machines were broken. Given that more than 60% of the population is nomadic, rapid antigen tests (both professional use and self-tests) are necessary to ensure access,” said the report.
Access to antiviral treatments was nonexistent in most countries surveyed.
“This report shows that communities have repeatedly been let down by a system geared towards protecting people in wealthy countries. People in the global south have been abandoned. Their lives have been treated as an afterthought,” said Maaza Seyoum, Global South Convenor of the People’s Vaccine Alliance.
The report said that oxygen supply planning and financing has been poor and essential community health workers often go unpaid.
“Governments, pharmaceutical companies (including domestic manufacturers), and international agencies must meaningfully address the real issues that prevent people from accessing vaccines and treatments,” said Nadia Rafif, ITPC Advocacy, and Influence lead.
Key findings include:
- Testing and vaccination sites have been inaccessible, meaning true infection and death rates are likely to be far higher than official figures. PCR test results can take anywhere from 8-12 hours in Bangladesh to more than two weeks in rural DRC. People cannot leave work at short notice, travel long distances to a vaccination/testing site, and then wait for a long unpredictable period of time. For rural populations and nomadic people in countries like Somalia, this problem is particularly acute. Mobile vaccination and testing are not widespread enough.
- Vaccine supply is still a major problem. Vaccines have been delivered inconsistently and in insufficient numbers, leading to stock fluctuations at vaccination sites. Doses arrive with little or no notice or information about what kind of vaccine will be delivered or whether they are suitable to conditions in a country. Dr. Saeed Mohamood from Somaliland’s Ministry of Health said, “Sometimes we will find out that the Somaliland shipment is on a plane in the air, en route, and we do not know when it’s going to expire and how much resources we will have.”
- Access to antiviral treatments is nonexistent in most countries surveyed. Health workers on the ground in some countries are not even aware that treatments like Paxlovid exist. Some countries will have access to doses through generic licensing agreements, but that is unlikely to happen this year, meaning the grave inequities experienced with the global vaccine rollout will be repeated with treatments. Peru, among other middle-income countries, is considering overriding patents to secure access.
- People cannot access accurate information in a format that is accessible to them, reducing the likelihood of vaccine uptake. Information campaigns are often in the “official language” of former colonizers (e.g. English, French, Spanish), instead of local languages, and use technical terms that are hard to understand. Richard Musisi, executive director of MADIPHA in Uganda, said: “When the key vaccinations started, the fact [was] that people could not find access to such information, most of the information was communicated in English, it was not put into local languages.”
- A history of colonial oppression and racist medical experimentation means that people in some areas distrust Western medical products delivered by white doctors and Western aid programs. This has compounded with access issues and a broader distrust in government in certain areas. Building more pharmaceutical manufacturing in lower-income countries could help tackle these perceptions, campaigners say.
- Oxygen supply planning and financing have been poor. A public health officer at WHO Nigeria told researchers, “The Oxygen plant breaks down whenever there’s high demand and it needs upgrading in other wards and further installation of another one with regular maintenance.” Governments need multiyear oxygen supply and infrastructure plans that include national inventories on oxygen infrastructure and technical support, and modified donor requirements that include medical oxygen.
- Essential community health workers often go unpaid. Vuyiseka Dubula, former head of the Treatment Action Campaign, described the erratic and sometimes non-existent payment as “a form of modern-day slavery.” In DRC, nurses in North Kivu earn just $80 per month, and some reported not having been paid since the beginning of the pandemic. A clinician in Haiti, Dr. Marie Delcarme Petit-Homme, told researchers: “Sometimes doctors and nurses can go 6 months, a year without receiving remuneration. Lower bands have it worse, they don’t really have access to remuneration. Sometimes we are forced to leave the country if we want a better pay.”
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