COVAX mechanism injects new energy into COVID-19 vaccination of refugees

Uganda’s central location in the heart of Africa makes in a perpetual destination for refugees streaming in from all directions on the continent. The over 1.5million refugees constitute 3.3 percent of Uganda’s population, so vaccinating them is essential for everyone’s safety.

Faced with the resurging COVID-19 infections, Uganda’s Ministry of Health and its partners led by UNICEF with funding from the Swiss Government and European Commission have gone the extra mile to ensure timely vaccination of the people in the refugee hosting areas. UNHCR supported the exercise in the various refugee hosting districts.

Kyegegwa District Health Officer Dr. Tedson Kandole recalls how the first COVID-19 outbreak affected health service delivery, to the extent that overzealous police officers enforcing the lockdown were barring women in labor from going to hospital. He laments that after the lockdown, it was back to business as usual and COVID-19 vaccination was virtually abandoned despite availability of vaccines.

Kyegegwa District which hosts Kyaka II Refugee Settlement, set a target to vaccinate 56,612 adults and 17,369 of the 12–17-year-olds under the Humanitarian Buffer programme.  The Humanitarian Buffer is a mechanism established within the COVAX Facility to act as a measure of ‘last resort’ to ensure access to COVID-19 vaccines for high-risk and vulnerable populations in humanitarian settings.

Senior Nursing Officer Daphne Namusoke, who is the Kyegegwa District Immunization Focal Person says getting people to respond has its challenges and cites the sticky point of vaccine side effects, explaining how they dealt with it:

“To simplify and compress the science of vaccination for our people, I devised an illustration of a stranger suddenly entering your house and you react by fighting him, until you realize he came to train you how to fight a big real enemy who is coming to your village,” Namusoke says. “Then you become friends and learn how to fight off the real enemy – by building antibodies. The Village Health Teams used the example.”

The VHTs also registered all persons eligible for the jab and kept reminding them to turn up. So, the vaccination exercise which spanned the third week of June was close hitting the target at most vaccination centres.

According to Dr Eva Kabwongera, the Team Leader for Immunization at UNICEF Uganda, the humanitarian buffer programme was conceived to ensure that the whole country benefits from the accelerated COVID-19 mass vaccination exercise.

Because of the refugees’ mobile nature, experts prefer giving the single dose Johnson& Johnson to first timers.

Many refugees want to do what it takes to preserve life. In Itambabiniga Refugee Settlement, Neema Kabirigi, a 31-year-old pregnant refugee mother of four has just taken her second jab.

Community leaders too have been effectively used. Congolese refugee Nginari Kahiro is volunteer who uses a megaphone to mobilize in the Kakoni Outreach.

“People were suspicious because of myths and anti-vaccine propaganda,” Kahiro says. “I show them photos of top leaders taking the jab, so they know it is safe.”

In settlements where different nationalities don’t mix, vaccination compliance was particularly hard. In the sprawling Nakivale Refugee Settlement that occupies a large chunk of Isingiro District, there are large communities of Somalis, Ethiopians, Congolese, Rwandese, Burundians, Eritreans and Sudanese – all leading their separate lives. They would dutifully listen to health workers but didn’t comply. Nakivale Public Health Officer Bernard Amuga says religious leaders here misled many by quoting holy books out of context. Targeting cultural leaders has helped make inroads in the communities. The Somalis are top performers, with 99 percent vaccinated.

But non-Somali Muslim refugees were hard to convince, having been influenced by anti-vaccination clerics. Preacher Ibrahim Bigirimana used mosques to convince the faithful that whites were inserting microchips in blacks through vaccination to control them like robots. The now reformed cleric confesses:

“I had believed that stuff having been misled by what I saw on social media.”
He attributes his conversion to a health worker called Abraham who engaged him patiently for weeks and debunked the anti-vaccination fallacies. Ibrahim now campaigns for vaccination, and even invites VHTs to talk at the mosque.

Some Born-Again Christian preachers also opposed vaccination. Jean Paul Karimunzira who leads a large Pentecostal fathers’ union in the Nakivale refugee settlement used to preach that the government of Uganda and Congo wanted to kill refugees who don’t return home. He also confesses he got the ideas from social media and was converted by a health worker who showed him photos of Uganda’s president taking the jab. From an opponent, he transformed into a promoter of vaccination.

While convincing the people to be vaccinated is one thing, ensuring that the vaccines are available and safe everywhere in the country is another. A team of supply chain officers and cold chain technicians ensures that 136 cold storage district units are supplied and working, supplying vaccines to health units and outreach posts all the time.

We found Christine Lanyero, a supply chain officer from Ministry of Health headquarters conducting a maintenance support and inspection tour in Isingiro. The District Cold Chain Technician, Deus Asiimwe was showing Christine his array of ten refrigerators, their contents of different vaccines and his distribution records.  Asiimwe also manages the dry supplies which include liquefied gas, injection materials, cold boxes and data tools. He also runs the small fleet of motorcycles.

Lanyero explains that their biggest challenge is unstable electricity supply. But she says UNICEF with Japanese Government funding is working steadily to ensure that all district units have solar power to protect different vaccines from the electricity grid issues