Prospects for COVID-19 vaccination vary widely across Middle East

For poor countries, obtaining the vaccine is the first of many obstacles to getting shots into the arms of citizens.

Grooms attend their mass wedding held by the Houthis, amid the spread of the coronavirus disease (COVID-19), in Sanaa, Yemen December 9, 2020.  (photo credit: REUTERS/KHALED ABDULLAH)
Grooms attend their mass wedding held by the Houthis, amid the spread of the coronavirus disease (COVID-19), in Sanaa, Yemen December 9, 2020.
Vaccine campaigns against the coronavirus are well underway in countries such as Israel, the United Arab Emirates and Bahrain. But poorer countries in the Middle East and North Africa, as well as developing countries around the world, are nowhere near close to obtaining the vaccine against COVID-19.
Some analysts say the earliest these countries will receive the vaccine is 2022; others project as late as 2024.
This is true in countries like Yemen, the leader for the third year in a row on the International Rescue Committee (IRC) ranking as the “country most at risk of humanitarian catastrophe in 2021.”
“Yemen is historically the poorest country in the region and one of the poorest in the world, which means that social services, including health systems, have been historically fragile,” Juliette Touma, chief of communications at UNICEF Middle East and North Africa, told The Media Line.
Afghanistan and Syria follow Yemen as the second- and third-most vulnerable, respectively, to humanitarian disaster on IRC’s list. Also on the watchlist is Somalia, a country that has been devastated by 30 years of civil war.
To help reduce the gap between richer and poorer countries in procuring vaccines against the coronavirus, the COVAX program was created last April, co-led by Gavi, the Vaccine Alliance (formerly known as the Global Alliance for Vaccines and Immunization); the Coalition for Epidemic Preparedness Innovations; and the World Health Organization (WHO), in partnership with organizations such as UNICEF.
The international effort’s objective is to equalize access to the vaccines so that poorer countries will be able to inoculate their citizens.
“The coronavirus vaccine, like any vaccine, is a global good, and it needs to reach everyone across the world equitably,” Touma said.
Somalia, Yemen, Afghanistan and Syria have applied for and been granted the vaccine with complete financial assistance from COVAX, which is backed by a total of 190 countries.
“They are expected to receive vaccines covering up to 20% of their population through COVAX if enough resources are available to Gavi,” WHO epidemiologist Dr. Amgad El-Kholy told The Media Line. “This 20% aims to cover the high-priority groups including the health [units] and elder age groups. Other populations are expected to be targeted later.”
El-Kholy said these countries are projected to get the vaccines this year.
Touma, however, said that their arrival date is “difficult to tell.”
COVAX faces an uphill battle. Oxfam notes that 50% of the COVID-19 vaccine doses estimated to be produced have been reserved by first-world countries that account for only 13% of the global population, in a practice known as “vaccine hoarding.”
With most of the world’s people potentially without access to the vaccine, the level of aid needed is enormous.
“The scale of delivery required will be one challenge, as we will be trying to reach a significant percentage of the population quickly,” a Gavi spokesperson told The Media Line. “One of the most important considerations that must be made in these first few months is how to optimize the relatively small amounts of doses each country will receive. Here, innovative technologies such as digital identification can play an important role in helping identify those that can benefit most from vaccination.”
However, for poorer countries, obtaining the vaccine is only one of a series of obstacles in the process of getting COVID-19 shots into citizens’ arms.
These challenges will most likely be similar to those encountered by other vaccination campaigns in these countries, Touma said.
“There are restrictions on humanitarian access and then you also have very unstable health systems. The world needs to be focused and concentrated to support the health system so that they are able themselves to give the jabs to the people,” she said.
A common trait of the four countries that cannot afford to contribute to paying for their vaccines is ongoing war, with Afghanistan’s current conflict going back 20 years, and Syria’s and Yemen’s civil wars going on for a decade and half a decade, respectively.
“The other challenge we are likely to face is the conflict itself in places … where it is difficult to undertake vaccination campaigns, so it is also a chance for us to call for long-term cease-fire so that vaccination campaigns against COVID-19 are facilitated,” Touma said.
El-Kholy also lists security as one “of the main challenges that might hinder the timely dissemination of the vaccine.”
The experts at the WHO, UNICEF and Gavi all say weak infrastructure and bureaucracy pose logistical challenges to vaccination campaigns in these poorer nations.
When it comes to infrastructure, developing countries – including those in the MENA (Middle East and North Africa) region – might not have the systems in place to store the vaccine without it spoiling.
“A country [must be] equipped with the correct storage assets for the temperature profile of the vaccines they will be deploying,” a Gavi spokesperson said. “For example, one of the two mRNA COVID-19 vaccines [Pfizer’s] requires Ultra-Cold Chain equipment capable of storing vaccines at between [-76 and -112 degrees Fahrenheit].”
Also, using new vaccines requires even the mostly dysfunctional governments to authorize their legal deployment.
“There needs to be emergency approval for the vaccine so that we are able to buy and then deliver,” Touma said.
Perhaps the biggest challenge in getting people vaccinated in the less well-off MENA countries is COVAX having enough money to purchase the vaccines, with funding coming from member states and foundations.
“It is important that the expressions of solidarity translate into action, which is to fund the facility… to avoid delays,” Touma said, adding that COVAX needs to raise $4.9 billion in the next two months to buy and distribute the stated goal of two billion doses by the end of 2021 to countries including Yemen, Afghanistan, Syria and Somalia.
Touma contends that the health of the wealthy countries with access to the vaccine is at risk if lack of funding renders COVAX unable to provide vaccinations to countries in need.
“We are not safe until everyone is safe and that’s not just a slogan,” she said. “This virus doesn’t know any borders; it travels, as we’ve seen, so we’ve got to all get together … and reach everyone with the vaccines.”