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Tanzania’s health minister said earlier this month that the country has no plans to procure COVID-19 vaccines. Moina Spooner, editor of The Conversation Africa, asked Catherine Kyobutungi to explain Tanzania’s response to COVID-19 and why it is problematic.
Why was the decision not to vaccinate?
Tanzania has had a unique approach to controlling COVID-19. Just a few months after the pandemic last year, the country’s President John Magufuli declared Tanzania COVID-free after three days of national prayers.
Since then it has refused to impose a closure, reopened schools, allowed large sporting events, continued religious gatherings, stopped testing and stopped public communication campaigns about the virus. The country also stopped reporting cases and deaths.
The argument was that people should stop living in fear and that they should trust God and rely on traditional African remedies to avoid contracting the virus. It may be the only country in the world that has taken this approach. It goes against everything recommended by scientists, other national health agencies and the World Health Organization (WHO).
Therefore, it is not surprising that the authorities have said that they have no plans to vaccinate the population against COVID-19, at least for now.
Will people still be able to access vaccines?
No and yes.
No, because a vaccine cannot be used in the country without being registered and authorized for use. The normal process is for the country’s experts, along with regulatory bodies, to review the data on the vaccine and approve its use if they are satisfied with its efficacy and safety.
For the COVID-19 vaccine, this is done through the WHO Emergency Use Listing procedure. The review is carried out by an international team of experts with the participation of experts from national authorities.
If Tanzania refuses to register the vaccine for use in the country, no one will be able to access it.
However, the country could register the vaccine but refuse to import it. This would allow the private sector to import something, but it will not be enough. The COVID-19 vaccination programs of any country are a huge undertaking. If driven by the private sector, many may not be able to access or pay for vaccines.
Meanwhile, those who could be vaccinated are the Tanzanian elites (or people with means) who could fly out of the country and get vaccinated elsewhere.
Other Tanzanians who may be able to access vaccines are border communities that have crossed into neighboring countries in the past and benefited from vaccination programs. This may be the case as long as widespread vaccination begins in Kenya, Uganda, Rwanda, and Malawi.
But that’s in a couple of years.
There is still the possibility that Tanzania may register and import the vaccines in the future. Magufuli has been sending mixed messages. For one thing, the government has said it does not plan to order vaccines through COVAX, a global initiative aimed at equitable access to COVID-19 vaccines, or any other mechanism. In fact, the recently published COVAX allocation has zero doses for Tanzania.
On the other hand, he has said that Tanzanians should only trust those vaccines that have been reviewed by Tanzanian experts and found to be safe.
Does Tanzania have a history of resistance to vaccination?
Not that I know.
Tanzania, like other countries, has implemented routine vaccination programs. These mainly target children under the age of five against diseases such as tuberculosis, polio, whooping cough, measles, rubella, and diphtheria. In recent years, these have expanded to include vaccines again against bacterial pneumonia, diarrhea, and hepatitis B.
Vaccination coverage (the percentage of people who receive the vaccine outside of the target population) in Tanzania is very high: around 80% -90%. This means there is no history of vaccine resistance.
What is different in the country compared to neighbors like Kenya and Uganda?
Kenya, Uganda, Rwanda, and Malawi have been desperately trying to get their hands on COVID-19 vaccines for their citizens. Everyone participated in the COVAX facility and developed vaccine implementation plans, calculated costs, and shipped them. Rwanda has even gone ahead and obtained vaccines outside of COVAX facilities.
All four countries have also started informing the public about these plans. For example, they have said that the first round of awards will be prioritized for healthcare workers and members of the high-risk population.
The biggest problem facing African countries at the moment is the lack of vaccines on the world market to vaccinate a significant part of the population. Many rich countries will have vaccinated all those due to be vaccinated by the end of this year. But African countries will only have a widely available vaccine by the end of next year or even in 2023.
If the countries that have been aggressively seeking vaccines are so far behind, imagine a country like Tanzania that hasn’t even started right now.
What is the risk for the country and the region?
The risk to the country is already evident. The approach taken by Tanzania has allowed the virus to spread uncontrollably in the population. Suddenly, people are dying from what has been labeled “pneumonia” and “breathing difficulties.”
People living in Tanzania are not sufficiently prepared or protected: there are no protocols on what lay people should do if someone falls ill to prevent the spread of the virus. Most of the information is about steaming, to prevent COVID-19, but that doesn’t stop the virus from spreading from person to person.
The second biggest problem is the impact on healthcare workers. Even in countries where strict measures have been implemented, health workers have fallen ill and many have died. Misinformation in Tanzania could mean that healthcare workers don’t take sufficient precautions in outpatient clinics, emergency rooms and even wards when treating patients. With the illness of healthcare workers, other healthcare services are likely to be affected.
The greatest danger for the region and the world is twofold.
First, as long as there are COVID-19 cases in Tanzania, it is impossible for neighboring countries, with which it shares porous borders, to be free of COVID.
Second, and perhaps more important, is the risk of new variants developing in the country when no one is following the trail. New variants emerge due to uncontrolled spread.
If, in the future, a new variant emerges in Tanzania, the danger is that it could spread across the region and invalidate the vaccines that may have taken place if they are not effective against that variant.
The pandemic will not end for anyone, anywhere until it is controlled in all countries. Tanzania’s approach will make it much more difficult for normalcy to return.
Catherine Kyobutungi receives funding from Sida, BMGF, Carnegie Corporation in New York, the African Academy of Sciences, and the Hewlett Foundation.
By Catherine Kyobutungi, Executive Director, African Center for Population and Health Research
