Vaccinate against Covid-19 in the Central African Republic, a logistical and human challenge

Marie-Chantal is waiting for her injection. “But only because I was asked,” grumbled the fifty-something, resigned, before rolling up her sleeve. The Central African Republic has so far vaccinated only 7% of its population against Covid-19.

For the health authorities of this vast country, the second least developed in the world according to the UN and in civil war since 2013, the challenge is as much to obtain the vaccine as to convince people of its necessity.

In the moist heat of the small hospital of Bimbo, on the outskirts of the capital Bangui, Marie-Chantal was finally convinced, like the ten people who wait to receive a dose.

If in Bimbo the population is gradually adhering to vaccination, it is thanks to awareness-raising efforts, in particular by the international NGO Alima (The Alliance for International Medical Action), which operates mainly in Africa and conducts vaccination campaigns in hard-to-reach areas.

– Reluctant –

“At the beginning, people were reluctant, we relied on community relays to convince them,” explains Grévisse Kahindura, vaccination coordinator for Alima in the country.

Hospital facilities are sketchy. In her blue blouse and behind her protective glasses, Larissa Tongoma puts on her gloves before extracting a dose of the Johnson & Johnson vaccine from a small cooler on the table. The label with a red cross is worn by transport and dust.

“I vaccinated 43 people today,” boasts the nurse, disinfecting the arm of Prince, 28, before stinging and asking him to join a group to watch for possible immediate side effects.

“Many people do not believe in the existence of the coronavirus,” laments the head doctor of the Bimbo district hospital, Pétula Mandaba. “During the awareness campaigns we discovered a village where the pastor had said that the covid was an invention. It was impossible to convince the population to be vaccinated,” she says.

In Africa, reluctance is felt “almost everywhere, although they are different from one country to another”, explains Mélanie Tarab, Africa medical manager for Alima. “It is more difficult to vaccinate in urban areas, where the population has access to false news on social networks, than in rural areas,” she explains.

In the streets of Bimbo, the epidemic is quiet. Masks are compulsory only to enter official buildings in Bangui, a few kilometers to the north. The Ministry of Health has distributed two million masks but “nobody wears them”, laments Richard Fotsing, WHO health coordinator in Bangui.

– Undervalued figures –

The figures put forward by the ministry are relatively low, with only 12,000 cases for nearly 5 million inhabitants and 101 deaths since the start of the pandemic, but probably underestimated. “The covid statistics that come up come only from health centers,” explains Mr. Fotsing.

More generally, in Africa, notification of coronavirus cases is low, linked to the lack of means to test, which “slows down adherence to vaccination”, observes Mélanie Tarab.

“We do not have a system to trace information when death occurs in a community, so it is possible that people think it was malaria or the flu,” adds Mr. Fotsing.

And to vaccinate those we manage to convince, the logistical challenge remains sizeable.

Prince is satisfied this time, but he had already come to the hospital and left empty-handed: “the doses were missing”.

“In Bimbo, we know that we must vaccinate 37,000 people,” explains Grévisse Kahindura at the head of Alima who, in support of the Ministry of Health, has already vaccinated nearly 23,000 people throughout the country. He invokes in particular the difficulties of supply linked to the complexity of the Covax mechanism by which the international community tries to finance the delivery of doses to 92 disadvantaged states and territories around the world.

“Vaccines are trickling down” in the most difficult to access areas of the continent, deplores Mélanie Tarab, adding: “and when the doses arrive, they are often close to the expiry date, difficult to organize a second injection”.

In September, the WHO estimated that Africa was facing a deficit of “470 million doses”. “Less than 7% of the African population is vaccinated”, asserts Mélanie Tarab while stressing that it is the countries of North Africa and South Africa especially which “inflate” the average.

Return to Bimbo. Sitting on a bench among other freshly vaccinated people, Prince rubs his shoulder. “Like everyone else, I was scared,” he admits, now reassured.

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