* African countries struggle with mass rollouts
* Many lack vaccine storage, training and equipment
* Ghana alone faces almost $44 million funding gap
* Conflict-weary Mali, South Sudan have a hard road
By Edward McAllister
DAKAR, April 21 (Reuters) - When Ghana received 50,000
COVID-19 vaccine doses from India last month, it hit a
frustrating roadblock: it had not trained enough staff to
distribute them.
The country was still rolling out shots received in late
February from the global vaccine-sharing scheme COVAX, and
didn't have the capacity to expand that operation, according to
the head of Ghana's immunisation programme.
Rather than going straight into the arms of health workers,
the additional doses were put in cold storage in the capital
Accra, Kwame Amponsa-Achiano told Reuters, adding that his team
had received two days' notice about the shipment.
"We were in the middle of the first campaign,"
Amponsa-Achiano said. "How do you plan for 50,000 when you
already are doing another campaign?"
The problems faced by Ghana, one of sub-Saharan Africa's
more economically developed nations, illustrate how a continent
with experience in battling deadly infectious diseases has found
itself ill-prepared to inoculate people against this pandemic.
Many African countries, already facing a shortage of
affordable vaccines, are being stunned by the unprecedented
scale of the distribution challenge when doses do arrive.
Authorities do not have enough equipment like masks and
cotton wool because of funding shortfalls that could total
billions of dollars, according to more than a dozen health
experts and some internal government documents seen by Reuters.
They also lack sufficient personnel and training to
distribute vaccines at short notice.
While Africa has thus far been relatively unscathed by
COVID-19, some experts fear stuttering rollouts could draw out
the outbreak in the region, potentially leading to more deaths
and economically damaging restrictions in a continent that is
already the poorest in the world.
Benjamin Schreiber, COVAX coordinator at the U.N. children's
agency UNICEF, said logistical problems could mount in the
coming weeks and months as countries tried to get vaccines to
their general populations.
"As we start rolling out bigger quantities, we are going to
start seeing more issues," Schreiber said.
"The gaps in the healthcare systems will be the gaps that
hinder the rollouts," he added. "My worry is that we miss
complete communities."
NEEDED: MILLIONS OF DOLLARS
Ghana, where the novel coronavirus has infected more than
91,000 and killed over 750, is considered one of the
better-prepared countries in Africa to carry out a mass
vaccination drive because of its political stability and
economic development.
The government aims to initially inoculate 17.6 million
people - about half of its population - at a cost of $51.7
million, according to a national plan seen by Reuters.
It hopes to cover $7.9 million of that money with a World
Bank loan but is short of $43.8 million, described as a "funding
gap" in the internal government document.
Immunisation chief Amponsa-Achiano said he was not aware
that the situation had changed since the plan was formulated in
February.
The Ghanaian finance and health ministries did not respond
to requests for comment.
Ghana was the first country in the world to receive a
shipment from COVAX, taking delivery of 600,000 doses of the
AstraZeneca/Oxford University vaccine, manufactured in India, on
Feb. 24. It started its vaccine drive on March 1, and had vaccinated
599,000 people by April 7.
While that vaccination rate is better than many of its
African peers - Ivory Coast vaccinated just over 53,000 people
between March 1 and April 6 - it is far behind the fastest
countries globally. Britain, for example, administered doses to
about 2 million people in roughly the first month of its drive.
NEEDED: FRIDGES, COTTON WOOL
The Ghanaian national plan shows how even relatively
prosperous African nations lack vital equipment.
Money is needed across the board, including $1.5 million for
11 walk-in cold rooms and over 650 fridges to keep vaccines at
between 2 and 8 degrees Celsius.
About $25 million is needed for supplies and waste
management, including 33,600 boxes of face masks, 240,000
bottles of hand sanitizer, and nearly 55,000 rolls of cotton
wool, the plan says. About $21 million is needed to train over
171,000 health workers and volunteers.
To add to Ghana's challenge, its next COVAX shipments,
expected in April and May, have been delayed until June, because
India suspended major exports of vaccines manufactured there.
In its 2021 budget, outlined in mid-March, the Ghanaian
government allotted 929,296,610 cedis ($160 million) for vaccine
acquisition and deployment.
Amponsa-Achiano said, though, it was not clear how much
would go towards distribution, or when the funds would
materialise.
It is a common problem in Africa, UNICEF's Schreiber said.
"The question is at what point will this funding hit the
ground? Will it be in time?"
CONGO EBOLA OUTBREAKS
Some African authorities are familiar with deadly
contagions. Since 2018, Congo has contained four Ebola outbreaks
with a vaccine which must be stored at between -60 and -80
degrees Celsius. But the scale of the COVID-19 vaccination drive is new.
COVAX - the donor scheme co-led by the World Health
Organisation (WHO) - has delivered over 18 million doses to 41
African countries, according to Reuters data.
That's the first wave in a drive expected to deliver 600
million doses to Africa this year, enough to vaccinate 20% of
their populations. Russia, China and India have also donated
some of their vaccines.
Funding is only one issue delaying vaccine rollouts.
Another is patchy record-keeping in many public health
systems, which experts say make it difficult to identify people
who should be prioritised because of age or co-morbidities.
Demand for shots is also weak in some countries due to
mistrust of health authorities, lack of education about the
vaccines and worries about potential side effects.
Spotty electricity and poor transport links in some places
add to the challenge, while medical teams will have to negotiate
safe passage across parts of Democratic Republic of Congo, Mali,
Somalia and other places where insurgencies rage.
VACCINATING UNTIL END-2022?
John Nkengasong, who heads the Africa Centres for Disease
Control and Prevention, says it could take until the end of 2022
to vaccinate 60% of the continent's 1.3 billion people.
Take the task facing Mali, an impoverished country fighting
an Islamist insurgency. It needs $14.7 million to deploy
vaccines, including for gasoline, vaccine storage and training,
according to an internal government vaccination plan seen by
Reuters.
The government will need funding support from the WHO,
UNICEF, the GAVI vaccine alliance and the World Bank, the plan
says. Those organisations are all looking to provide funding to
African nations facing shortfalls.
South Sudan, still racked by violence after a civil war
ended in 2018, has seen COVID-19 infect at least 10,300 people
and kill more than 100.
It began distributing 132,000 vaccine doses from COVAX on
April 7. However, authorities won't start administering shots
outside the capital Juba and its surrounding county until May at
the earliest, said Kawa Tong, a member of a COVID-19 steering
committee that advises the government.
"The key reason is the lack of funds for a rollout outside
Juba. The transport of vaccines, training of health workers,
community outreach - all these are tied to funding," Tong told
Reuters.
Adding to the difficulties, by May the rainy season will be
well underway, cutting off transport links to large parts of the
country, she said. The vast majority of the 11 million-strong
population live outside Juba county.
Atem Riek Anyom, director general for primary healthcare at
South Sudan's health ministry, said the government had requested
World Bank funding, adding that vaccines would soon be deployed
across the country.
"There's no challenge in regards to the vaccine rollout," he
added.
The World Bank, which has a $12 billion fund to help
developing countries around the world buy and distribute
vaccines, said it was reviewing requests from Mali and South
Sudan.
The bank said it has approved $2 billion to 17 countries,
including seven in Africa: Ethiopia, Cape Verde, Ivory Coast,
Eswatini, Tunisia, Rwanda and Gambia.