Where a vaccination campaign faces skepticism, war and corruption

KABUL, Afghanistan – Afghanistan, whose citizens have widely dismissed the coronavirus pandemic by calling it exaggerated or pure deception, is now preparing to distribute its first batch of vaccines.

Half a million doses of the AstraZeneca-Oxford vaccine, produced by an Indian manufacturer, were delivered to the capital, Kabul, by India on February 7. But the arrival was greeted with indifference by many Afghans, who rebuffed government warnings that the virus is a deadly threat to public health.

The inexpensive, easy-to-store AstraZeneca-Oxford vaccine is delivered as part of the Covax program, a global initiative to purchase and distribute vaccines to poor countries for free or at reduced cost. On February 15, the World Health Organization authorized the use of the vaccine, which requires two doses per person, clearing the way for Afghanistan to begin its vaccination campaign.

Global trials have shown the vaccine to provide complete protection against serious illness and death. But its effectiveness against the variant of the virus first seen in South Africa is in question, after the vaccine failed in a small trial to prevent study participants from contracting mild or moderate Covid cases .

Vaccine arrives as Afghanistan battles deadly second wave, even as most Afghans go about their daily lives as if the virus never existed. Many people refuse to wear masks and congregate in dense crowds inside bazaars, supermarkets, restaurants and mosques, oblivious to the ubiquitous public health posters.

In an impoverished country plagued by war, hunger, poverty and drought, an invisible virus is seen as a fake, or an afterthought.

“Of course, I won’t take the vaccine because I don’t believe in the existence of the coronavirus,” said Muhibullah Armani, 30, a taxi driver in the southern city of Kandahar.

Expressing a sentiment shared by many Afghans, Mr Armani added: “When I see people covering their mouths and noses, scared of Covid, it makes me laugh at them.

And even among Afghans who believe the virus is real and want to be vaccinated, there is little belief that the government, mired in widespread corruption, will fairly distribute limited stocks of vaccine.

“This vaccine will only be available to people of high status,” said Khalil Jan Gurbazwal, a civil society activist in Khost province, eastern Afghanistan.

Nizamuddin, a tribal elder in a Taliban-controlled district in northern Afghanistan’s Faryab province, said he was concerned the vaccine might be appropriated by well-connected politicians and warlords .

“It is common in Afghanistan that even food aid is stolen by corrupt people,” said Mr. Nizamuddin, who, like many Afghans, has only one name.

The attorney general’s office said on Thursday that 74 government officials from five provinces had been charged with embezzling coronavirus response funds. Among the accused were former provincial governors and deputy governors.

In Kunduz province in northern Afghanistan, a hospital administrator told authorities that hospital officials were collecting medical bills for Covid-19 treatments for 50 beds in a hospital of just 25 beds, pocketing fees “Ghost workers”, the Special Inspector General for the Reconstruction of Afghanistan recently reported.

“These harms are costing Afghan citizens not only financially, but also delayed access to potentially life-saving medical care,” the US Embassy said in a statement. But for many Afghans, the vaccine is a solution to a problem that does not exist.

As the vaccination program began on Tuesday, the first dose was administered at the presidential palace in Kabul to Anisa Shaheed, a television journalist who covered the pandemic.

Distributing any vaccine to a desperately poor country in turmoil is a daunting logistical challenge. In addition to overcoming public suspicion and traversing dangerous territories, the Department of Public Health must also lead the delivery of vaccines to remote provinces with poor roads and primitive infrastructure.

The pandemic has caused an increase in polio cases in Afghanistan as it has made it more difficult for polio teams to reach outlying areas, said Dr Osman Tahiri, public affairs adviser at the Ministry of Health. , who reported 56 cases of polio in 2020, up from 29 in 2019.

But equally worrying are the 305 cases of a polio variant in Afghanistan in 2020, up from zero cases reported in 2019, said Merjan Rasekh, public outreach officer for the ministry’s polio eradication program.

Mr Rasekh attributed much of the increase in variant polio cases to Afghan refugees returning from neighboring Pakistan, which has also struggled to eradicate polio. WHO should grant emergency approval at the end of the year for a vaccine against the variant.

While facing an increase in polio cases, Dr Tahiri said health workers would try to distribute the coronavirus vaccine even in areas controlled by the Taliban where activists have allowed government-run clinics. The Taliban have set up public health programs to warn of the pandemic and have distributed personal protective equipment while allowing government health workers to enter their areas.

But Dr Tahiri admitted that vaccination teams will not be able to reach large swathes of the country where fighting is most intense between the Taliban and government forces.

A thousand vaccination teams were formed last week, Dr Tahiri said. The ministry hopes to receive more donated vaccines; Afghanistan, he said, has the capacity to store 20 million doses.

The first doses will go to health workers and security officials “who are at risk and work in crowded places,” Dr Tahiri said, although there is not yet enough vaccine for everyone. world in this category. Journalists could also request to receive the vaccine, he added.

Afghanistan has recorded more than 55,000 coronavirus cases and nearly 2,500 Covid-related deaths, according to the Ministry of Public Health.

But due to limited testing and an inadequate public health system, experts say the actual number of cases and deaths is exponentially higher. A WHO model estimated in May that more than half of Afghanistan’s estimated 34 million could be infected. The Ministry of Public Health estimated last fall that more than 10 million Afghans may have contracted the virus.

Regardless of whether Afghans believe the virus is real, there is constant faith that Allah determines the fate of a believer.

Ahmad Shah Ahmadi, a resident of Khost province, said it was not necessary to get the vaccine. “Infidels do not believe in God, and that is why they fear the coronavirus. For Muslims, there is little danger, ”he said.

But Imam Nazar, 46, a farmer in Kunduz province, said most people in his village believed the virus was real because several villagers died from Covid-19. He said he and other villagers were eager to get the vaccine but doubted it would reach their remote town.

“This government is not keeping its promises,” Nazar said.

Fatima Faizi and Fahim Abed contributed reporting from Kabul; Farooq Jan Mangal from the province of Khost; and Taimoor Shah from Kandahar Province.

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