Baluka Winfred Viola, a Nursing Officer at Kisenyi Health Center IV, receives a shot of the AstraZeneca COVID-19 vaccine at Mulago National Referral Hospital during the official launch of  COVID-19 vaccination in Uganda.

Fighting COVID-19 in Uganda

A look at some of the challenges faced in the distribution of vaccines to stop the spread of the novel coronavirus in Uganda.

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Since February 24, 2021, the COVAX Facility has shipped lifesaving COVID-19 vaccines to more than 100 countries, with UNICEF leading on procurement and deliveryOn March 5, Uganda received its first COVAX consignment of 864,000 vaccine doses. Cynthia McFadden and her NBC News crew traveled to Uganda to see what it takes to get those vaccines to remote areas via boats, small planes and on foot. She met with Dr. Eva Kabwongera, who manages UNICEF Uganda's immunization program, and together they traveled from the Buvuma Islands to Bidi Bidi refugee settlement. Below, Kabwongera shares some of the logistical hurdles faced by vaccinators in Uganda, and how UNICEF is working to meet those challenges.

We are facing challenging times for Uganda’s 27.5 million children, young people and their families. As a Health Specialist for UNICEF Uganda I have seen the consequences of COVID-19 in my work as well as in my personal life.

Uganda, also called the Pearl of Africa, was hard-hit by the COVID-19 pandemic, like other countries in the world. Uganda's first COVID-19 case was confirmed on  March 21, 2020; by April 10, the country had recorded 41,174 confirmed cases among Ugandan nationals, including 420 children. Although fewer children got sick or died due to COVID-19 disease compared to adults, they were significantly affected by the secondary socio-economic impacts of the coronavirus pandemic, and the potential longer-term effects of delayed attainment of the Sustainable Development Goals (SDGs).

UNICEF Uganda's Dr. Eva Kabwongera discusses the rollout of COVID-19 vaccines with NBC's Cynthia McFadden in Bidi Bidi refugee settlement.

In Uganda's Bidi Bidi refugee settlement, UNICEF Health Specialist Dr. Eva Kabwongera (left) and NBC's Cynthia McFadden discuss the challenges of reaching remote areas of the country with COVID-19 vaccines. 

Building on its extensive experience with managing health outbreaks, the Ugandan Government responded early and decisively by closing borders, imposing a national lockdown, curfew and school closure; and rolling out critical public health measures, including physical distancing, masking and handwashing with soap. The National Taskforce on Outbreaks for COVID-19 was activated by the Ministry of Health in January 2020 and, as the pandemic evolved, leadership and coordination responsibilities were appropriately elevated to the Office of Prime Minister (OPM) and the President.

The prompt and stringent containment measures were instrumental in slowing the spread of the epidemic in the country. As of August 2020, the Lancet ranked Uganda among top 10 countries in the world in terms of suppressing the spread of COVID-19.

Refugee health workers receive COVID-19 vaccinations in Uganda's Bidi Bidi refugee settlement.

Refugee health workers receive COVID-19 vaccinations in Uganda's Bidi Bidi refugee settlement. 

In the health sector, the COVID-19 crisis led to reversals in earlier achievements in several areas including immunization (DPT3) and vitamin A coverage, as well as intermittent preventative treatment for malaria in pregnancy and deliveries in health facilities declined compared to the previous year. The COVID-19 crisis also uncovered areas that require further strengthening, such as infection prevention and control (IPC), laboratory capacity, specialized hospital care and oxygen therapy.

On March 5, Uganda received the first wave of 864,000 doses of AstraZeneca COVID-19 vaccine through COVAX. On March 10, the MoH launched the COVID-19 vaccination deployment and as of March 26, the National Medical Services (NMS) had distributed 663,000 vaccine and materials to all 135 districts in the country, including hard-to-reach areas like the Island communities in Buvuma. The delivery strategies involve a combination of fixed site, vaccination outreaches and mobile teams, using different means of transport, including boats.

UNICEF Uganda Health Specialist Dr. Eva Kabwongera

Health Specialist Dr. Eva Kabwongera manages UNICEF Uganda's immunization program and emergency health response. 

As of April 12, 189,409 individuals across the country including 19,958 health workers have been vaccinated. This is 13.3 percent of the targeted 150,000 health workers. Uganda has expanded its scope to the next phase targets including security personnel, 550,000 teachers, people over age 50 and those with comorbidities who are 18 or older.

Key challenges to COVID-19 vaccine deployment in Uganda include vaccine hesitancy, lack of operational funding for readiness activities (e.g. training, communication, community engagement), last-mile distribution and uncertainties in the timelines for vaccine delivery. Additional funding will be required to overcome these challenges.

In Uganda's Buvuma District, vaccinators must travel by boat to reach people living on 52 scattered islands in northern Lake Victoria. 

I have seen firsthand the logistical hurdles one has to manage to vaccinate the population in Buvuma District, which is made up of 52 scattered islands in the northern part of Lake Victoria. Buvuma is among the most economically disadvantaged districts in Uganda, with only nine health facilities serving a population of over 120,000 residents, including 65,500 children under 18. Boat taxis provide transport between the islands, but due to rising water levels, some of the islands are not easily accessible by small boats.

The Ministry of Health owns a small boat, but the COVID-19 immunization has been slow because of lack of adequate transport, budget for fuel and limited operational financial support to take services to the different islands. Presently, 70 people have received the COVID-19 vaccine, 30 from the mainland and 20 from Namatale, one of the smaller islands I visited recently with the NBC TV crew.

The Government of Uganda aims to vaccinate up to 60 percent of the country's total population of 45 million in the acute phase of the pandemic in order to attain   population immunity. Despite challenges and lack of funding for the operational costs, the government and partners are working around the clock to roll out the COVID-19 vaccination plan. Despite the logistical challenges, 10 districts have used more than 40 percent of the allocated vaccines.

A view of one corner of Uganda's vast Bidi Bidi refugee settlement.  

The recent deployment of COVID-19 vaccines will reduce severe disease and death. It is unlikely, however, that vaccines will have a significant impact on the pandemic trajectory in the first half of 2021 given the relatively low number of available doses.

Ensuring equitable and fair access to safe and affordable COVID-19 vaccines for all countries, including Uganda, should be a priority for governments across the globe. If we are serious about controlling this pandemic, we must look beyond our borders and help those countries in dire need. Let us not forget that no one is safe until everyone is safe!

You can help end the pandemic by supporting UNICEF's efforts to equitably deliver COVID-19 vaccines around the world through COVAX. Please donate.

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Watch the NBC report on what it takes to get COVID-19 vaccines to remote Uganda.

Top photo: Baluka Winfred Viola, a nursing officer at Kisenyi Health Center IV, receives her first dose of the AstraZeneca COVID-19 vaccine at Mulago National Referral Hospital during the official launch of Uganda's COVID-19 vaccination campaign. The country received its first consignment of 864,000 doses of COVID-19 vaccines from the COVAX Facility on March 5, 2021. © UNICEF/UN0428581/Bongyereirwe; All other photos © Erica Vogel for UNICEF