This article, in which reporting was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunisation in Africa, focuses on the issue of inequity in the distribution of Covid-19 vaccines in Malawi and whether this could have an effect on Malawi’s goal of meeting children and adults’ vaccination targets. RICHARD CHIROMBO writes.

Considered by her peers as reserved, Ruth Faison Mwalyambwire from Group Village Head (GVH) Nyami in Chitipa District stirs into wakefulness when the issue of Covid-19 vaccines is introduced.

“I will never get vaccinated for coronavirus. Never. My grandmother lived for 102 years. My grandfather died at the age of 98. You think there were no diseases then? Covid-19 is just another name of the common cough we know but some people are out to wipe us off the face of the earth,” the 48-year-old mother of seven says equivocally.

In GVHs Zambwe and Mwenechendo, also in the district, the feeling was almost reciprocal.

In the three group village headmen’s areas, which are under Traditional Authority (T/A) Mwaulambya, community members claimed, there had never been a coronavirus case since April 2 2020, when Malawi’s first case of coronavirus was registered.

District Health Office officials think otherwise and have been working around the clock to sensitise community members to the importance of getting inoculated for coronavirus.

According to Chitipa District Health Office spokesperson Sam Chirwa, the efforts have included the use of static clinics (health facilities), outreach clinics— which are integrated with routine childhood immunisations— door-to-door vaccination campaigns s in villages as well as in urban locations.

“Of late, we embarked on ‘Express Vaccination’ [initiative] in mobile markets and trading centres to support the existing strategies, “he says.

With a population of 234,927 people, the district’s Covid-19 vaccination target has, since the onset of Covid-19 vaccine administration in March 2021, always been 39,000.

As at now, over 22,619 have been vaccinated, with over 8,354 people getting the first and second doses of Oxford- AstraZeneca vaccine and over 5, 854 people getting Johnson & Johnson vaccine.

While vaccines are there, however, the district’s efforts to vaccinate more people are being frustrated by shortage of staff, with 169 people trained in Covid-19 vaccine administration.

Chitipa is a unique case because it has been managing to administer all Covid-19 vaccines allocated to it, with no dose ever destroyed.

“There is equity in the distribution of vaccines,” Chirwa says.

In Karonga District, however, people like Jonathan Lackison, who is originally from Mpata Village, T/A Kyungu, has vowed not to go for Covid-19 vaccination until Pfizer— which Malawi started administering in January this year— is made available to people like him.

“I prefer Pfizer to any other vaccine. I know we have Oxford- AstraZeneca and Johnson & Johnson but all I need is Pfizer because I like German cars and I understand that Germans are using the vaccine more than any other vaccine,” the 50-year-old father of five says.

However, Ministry of Health spokesperson Adrian Chikumbe says Malawi is administering Pfizer vaccine to children only.

“Adults have a choice; they have Oxford-AstraZeneca and Johnson & Johnson. As such, we felt that, this being the first time we are administering Covid-19 vaccines to children, we must spare Pfizer for them.

“We are grateful to people who are giving us the vaccines. You know that the vaccines are from our partners. We are not buying any of the vaccines,” he says.

Ironically, at some point this year, Oxford-AstraZeneca vaccine doses— which are administered twice— run out.

In fact, there were fears that a long period would elapse before those who got their first dose of the vaccine would get a second one.

However, Ministry of Health officials were quick to point out that, in case six months elapsed without more doses of Oxford- AstraZeneca arriving, those who got the first dose would be free to get a dose of Johnson & Johnson, which is administered once.

Malawi’s dilemma right now is that it is depending on its development partners for its Covid-19 vaccine supplies, meaning that, in case there are lapses in-between dates of vaccine depletion and arrival, the population would be left with no choice but to bear the brunt of the pandemic.

In Karonga District, for example, people were once known for their zeal to get vaccinated, with Karonga District Director of Health Services David Sibale indicating that, in the early days of vaccination, the number of people getting inoculated for Covid-19 could reach 200 per day.

Then 200 turned to 100, then 60 then far lower figures.

Chikumbe admits that the country has a long way to go in achieving Covid vaccination targets by December 2022.

“We want to vaccinate as many people as possible now, but we are having a lot of disinformation and then we are having lower numbers of new cases may be people think we are done,” he says.

The situation is worrisome, says Medical Doctors Society of Malawi President Victor Mithi, who fears that laxity in Covid-19 vaccination efforts could create a situation where Covid-19 statistics take the shape of an exponential curve; rising every now and then.

Kamuzu University of Health Sciences epidemiologist Professor Adamson Muula says equity in Covid-19 vaccine administration should extend to all diseases in Malawi.

“This is because, if we are not careful, we may put a burden on the health care system. As such, it is important to strengthen the whole pipeline,” Muula says.

Muula has been a voice of reason as Malawi battles the scourge and maintains that it is not too late for Malawi to conduct an immunology study on the coronavirus pandemic.

He says, even before people can start debating on issues such as equity, there is an urgent need to know the proportion of people that have developed Covid-19 antibodies.

“What we needed now is to do a quick study nationally to check how many people have antibodies against Covid-19. It is possible that many of our people have gotten Covid-19 at some point but they never became sick or never showed up and because they never died we did not even know them.

“If, for instance, the study finds that around 70 percent of Malawians have had coronavirus, it will mean, in some ways because we say reception is also vaccination, that these people will unlikely die; that is, if they get infected again,” Muula says.

It would be unfortunate if such calls were ignored in the reverberations of low figures of Covid-19 vaccination.