Phionah Atuhebwe, WHO's head of new vaccines in Africa: "The West failed us in the covid pandemic"

Phionah Atuhebwe, World Health Organization head of new vaccines in Africa.

In a hotel on the beach of Dar Es Salaam, last Friday, 59 experts in vaccination against covid hugged each other euphoric – and without masks. It was the first time they had seen each other in person, after three years of video calls and emails, working together through the worst of the pandemic, an emergency that officially just came to an end. They did it, curiously, in Tanzania, a country that denied the existence of covid-19 to the last consequences. The reason, the conclusion of a program with which the European Commission has invested 16.6 million euros, through the World Health Organization (WHO), to vaccinate against the coronavirus in 16 African countries suffering humanitarian crises.

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Phionah Atuhebwe (Mbarara, Uganda, 40 years old), responsible for new WHO vaccines in Africa, had to be evacuated from the Republic of Congo to Europe after contracting covid. Despite being healthy, she says, she suffered from hypotension and depression for months after passing the disease. Now Atuhebe, who experienced on the front lines the initial failure ofCovax to get immunization to poor countries, criticizes how rich countries hoarded vaccines, buying them at prices with which Africa could not compete. And he warns against the credits that some poor countries asked for "desperately" in the middle of the pandemic: "Some are going to be paying for a long time for vaccines that they are not going to use." Atuhebwe gives this interview on the verge of leaving office to take charge of immunizations at UNICEF.

Question. What lessons does the pandemic leave?

Answer. That the African continent has never been prepared for one pandemic and that we must be ready for the next one. With covid, we depended on the West for screening, for medicines, for masks, for personal protective equipment... At the time of the big waves of infections, with many hospitalizations and deaths, we did not have vaccines. When the pandemic started to slow down is when they arrived. And by then it was hard to convince people that it was necessary to get vaccinated. Another lesson we have learned is that countries in dire straits should not have borrowed. They're going to be paying for a long time for vaccines that they're not going to use. We have also learned to vaccinate massively in a very short period of time, and we have acquired the ability to immunize adults, something in which we did not have as much experience. In addition, we now have real-time data, which we can leverage to make decisions.

Countries in dire straits should not have borrowed. They're going to be paying for a long time for vaccines they're not going to use.

Q. The role of Covax, the ambitious global platform created to give equal access to vaccination to rich and poor countries, is questioned.

A. Covax had ups and downs. It would have delivered the vaccines on time to Africa were it not for the delta variant in India, on which production depended. On the other hand, rich countries bought the vaccines, at higher prices. Overall, Covax worked on behalf of resource-poor countries, without them it would have been even more difficult.

Q. Did Africa lose confidence in rich countries in this pandemic?

A. Yes. The West failed us. Canada, for example, ordered nine times as many vaccines as it needed. When they were finally sent to Africa, we no longer needed them – part of the population felt that there was no need to be vaccinated anymore. And they also had a very close expiration.

Q. Is Africa unprotected against covid? The average population that received at least one vaccine on the continent is around 38%, compared to 72% of the world average.

A. Science says that almost 85% of the world's population today can be immunized against covid, naturally, or through the vaccine, or both. That's why we're now focusing on high-priority population.

Q. The European Union Humanitarian Aid Office (ECHO) has invested 16.6 million euros in this project, which ends now, to assist in the vaccination against covid of 16 countries suffering humanitarian crises. Has it served any purpose?

A. In 2021, when this started, there were still very few vaccines in Africa. We were not prepared. With this European aid we managed to go from less than 5% coverage on average in 2021 to the current 31% in these 16 countries with humanitarian crises. Some countries, such as Liberia, managed to reach 80 per cent. In Tanzania, a country that was late to vaccination against covid, coverage today is 52%.

Q. How have the systems improved?

A. Creating, for example, cold chains for vaccines that need them — we didn't have them, except in some countries that, having been affected by Ebola, had needed them in the past. Also training health workers in rural areas, investing in engaging communities, monitoring the infodemic (spread of hoaxes) and responding to those rumors...

Q. What problems were encountered?

A. Countries like South Sudan have experienced many difficulties due to the conflicts in the country and how impossible it is to reach some territories. There were also countries with very little political involvement, which suffered as a result. This pandemic required a political response, from state leaders, not exclusively a health response. In Tanzania we noticed a radical change with the new leadership [the president, John Magufuli, who denied covid, died in March 2021 of unclear causes, although the opposition claimed that it was due to the coronavirus. With his replacement, Vice President Samia Suluhu, this country began its vaccination campaigns.]

This pandemic required a political response, from state leaders, not exclusively a health response.

Q. And what issues are pending?

A. Among others, it is still difficult to identify people with comorbidities. For example, in many places in Africa, someone often doesn't know if they have hypertension, or even if they're diabetic – and therefore you're more at risk for COVID.

Q. There are striking success stories, such as Liberia: it managed to vaccinate 80% of the population.

A. Liberia had very, very strong political leadership, at the national, regional, local level... We see that in Africa, if the population does not have confidence in the Government, it is very difficult to carry out any government initiative. An example is Burundi, where the percentage of the population vaccinated against the coronavirus is around 0% due to low political involvement. In the case of Liberia, we must not forget that it was hit hard by Ebola, so the population is aware of the importance of getting vaccinated. There was also good funding (they received a good amount from the World Bank, the United States and the global vaccine alliance, Gavi).

Q. With the end of the pandemic, is covid vaccination taking a back seat to health priorities in Africa?

A. It was foreseeable at this point. There are so many emergencies and so many competing priorities in Africa! It's like always putting out fires. We had foreseen this and that is why we have changed the strategy. The plan since the beginning of this year is to focus on vaccinating only high-priority groups — which, if infected, have a high chance of being hospitalized or dying. And we're trying to get countries to integrate covid vaccination into systems that already exist, rather than focusing on specific campaigns.

Q. Where will the funding come from?

A. Funding has fallen, although funds are being announced from institutions such as the Government of Canada, and also from Gavi, the World Bank, Unicef ...

Q. In this forum there has been a lot of talk about infodemic, the spread of rumors, such as that the vaccine harmed fertility. How do you fight health misinformation?

A. Many of the hoaxes spread through social networks, so we tried to combat them with the same tool, publishing explanatory videos, for example. But we also saw major media outlets, government officials or health experts spreading misinformation.

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