* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Critics pointed to hesitancy and misinformation after Malawi discarded 20,000 expired COVID-19 shots. The reality is far more complicated
By Alinafe Kasiya, Malawi Country Director for VillageReach
My home country, Malawi, has made international headlines for discarding COVID-19 vaccines. Many fingers have pointed to hesitancy and misinformation, but the reality is far more complicated, and increasingly concerning.
In fact, the unused doses are consequences of failures to support the complex delivery system that gets vaccines into arms. And the effects on people’s lives are dire – for COVID-19 and other health emergencies.
First though, I want to set the record straight. In March, Malawi received a shipment of 102,000 vaccine doses 18 days before their labeled expiration date. Despite this, Malawi managed to administer nearly 90% of those doses in time – a testament to the country’s skill and experience conducting mass vaccination campaigns.
Of course, while we made gallant efforts to accelerate delivery, that wasn’t enough to use up every dose, and we all know that every vaccine matters right now. With limited time and resources, we could only accelerate so much.
So let’s take a look at why that was, as our experience may illuminate what’s happening in other countries rolling out COVID-19 vaccines.
One of the major challenges we faced was limited access. We could only open a few vaccination sites as both demand and supply were still ramping up. Opening sites also carries financial considerations, such as staffing, training and management overhead – and when resources are limited and there are not enough doses for more sites, it is hard to justify the expense.
The domino effect was that some people had to travel long distances to reach vaccination sites, affecting uptake and equitable access. Most sites are currently located in urban areas, but few in rural locations. A relative of mine shared that in his home district people had to travel 40 kilometers to reach the closest vaccination site. This amounted to hours away from work, at a time when we are seeing considerable economic impact from the pandemic.
As we prepare for the next phase of rollout, we need to ensure that we’re investing in and building the critical infrastructure that allows us to get vaccines flowing into communities.
Another challenge was generating demand for the vaccine – and that meant more than addressing misinformation. In Malawi, we moved fast to conduct a public information campaign and community outreach that would help people understand the risk of COVID-19 and why the vaccines are important. This was complicated by the fact that we’re facing multiple health emergencies. For example, the COVID-19 pandemic has severely curtailed services to diagnose and treat HIV around the country.
However, we did see impressively high turnout, just not high enough. Our demand generation budget was not fully funded, so we were limited in what we could do. Further, for our awareness-building activities to bear fruit, they needed to be synchronized with adequate supply so that when people asked for the vaccine, they could get it. That wasn’t the case.
Finally, we needed a strong supply chain and information system to streamline distribution. When vaccines could not be administered at a site, staff were on the phone calling other sites and hurriedly driving vaccines across the country, moving them to new locations when needed to realign supply with demand. A strong data system would have helped expedite this process.
Malawi knows how to vaccinate large populations, we’ve been doing it for decades. Unfortunately, as the world has been rallying around the importance of procuring doses for low- and middle-income countries, conversations about delivery once those doses arrive in the country have not taken place with the same fervor.
Our recent experience with COVID-19 vaccines makes clear that we need to reexamine and address all the factors that impact our ability to get vaccines into arms – ensuring adequate and predictable supply, supporting all facets of delivery systems that help us scale up, and funding critical health infrastructure and information campaigns for the long-run.
Ultimately, equitable vaccine delivery will require procuring enough vaccine doses for everyone, wherever they are. But we cannot forget all the pieces of the puzzle that must come together to effectively deliver vaccines. After all it’s vaccinations, not vaccines, that protect people.