Challenges Facing COVID-19 Vaccination

COVID-19 vaccine rollout in Somalia represents the country’s largest-ever vaccination drive and as in many countries in fragile contexts, the government faces operational and logistic challenges despite the limited doses of vaccine received. Besides the need to build up a stable and sufficient COVID-19 vaccine doses to immunize substantial proportion of the population to achieve herd immunity, the country also must secure funds to cover the operational cost of the rollout. The list of challenges to effective COVID-19 rollout is dauntingly long, but the main obstacles, summarized below, could be 7 Report of the SAGE Working Group on Vaccine Hesitancy, WHO, October 2014
8 The Guide to Tailoring Immunization Programmes (TIP), Increasing coverage of infant and child vaccination in the WHO European Region, WHO Regional Officer for Europe., 2013
9 Noni E. MacDonald, Vaccine hesitancy: Definition, scope and determinants, Vaccine, Volume 33, Issue 34, 2015, Pages 4161-4164, https://doi.org/10.1016/j.vaccine.2015.04.036. overcome with better planning, innovation and collaboration between all stakeholders.
Limited Vaccine Supply: Somalia was poised to receive around 6.2 million vaccine doses from COVAX facility to immunize 20% of its population. It has so far received 300,000 doses of COVID-19 Oxford/Astra Zeneca vaccine in mid- March 2021 and was expecting to receive a second shipment of 300,000 to be used as a second dose in April 2021. The export suspension on Oxford / Astra Zeneca vaccine by India has delayed the second shipment and forced Somalia health authorities to revise the country’s vaccine deployment plans and settle for using the remaining COVID-19 supplies for second dose only.
Limited Funds for Operational Costs: The second biggest challenge to COVID- 19 vaccine rollout in Somalia arose from lack of adequate funding for operational costs, which significantly affected not only the accessibility of the vaccines but, by and large, the ability of the health authorities to implement the vaccine deployment plans. The Federal MoH approached World Bank for assistance to cover the operational costs in December 2020 but once the vaccines were delivered through COVAX facility, no financial assistance was forthcoming from the World Bank and there were no financial contingency plans in place to fill the funding gaps. UNICEF and WHO stepped in to cover the operational costs of the first phase of vaccination rollout in Somalia.
Poor Health Infrastructure: It is a formidable operational and logistic challenge to Somalia’s weak health system to deliver a large-scale vaccination programme, which requires a well-functioning logistics system, sufficient supplies and trained medical personnel, among others. The use of the meagre resources of the health system for COVID-19 vaccination programme would stretch the essential health services, jeopardize the routine immunization programmes and pose serious long-term consequences for the health and economic development of Somalia.
Restricted Access to Vaccines: The current model – urban-based, fixed health center vaccination sites – has restricted the access to vaccines for vulnerable communities including people living in rural and hard to reach areas, Internally Displaced People (IDPs) and refugees. The prioritization of frontline health care workers, teachers, municipal officers, police and point of entry workers for vaccination excluded these marginalized and vulnerable communities from the opportunity to be vaccinated in the first phase as very few of them could meet these criteria. The vaccination data indicate that 72% of vaccinated people fell into these five categories.
Transport and Security Challenges: In the Federal Member States of Jubbaland and South West, a number of towns and villages are accessible only by air due to insecurity and poor transport infrastructure, complicating the existing distribution challenges and hampering the vaccine rollout. These States also contain big districts with sparse health facilities, which presents serious convenience barriers for these communities. Moreover, large areas in these States including towns are under the control of Alshabaab who released a statement banning the use of COVID-19 vaccine in their territories.
Short vaccination days: The 10 days vaccination programme without pre- listing of vaccine recipients and putting in place robust registration and monitoring system was very ambitious but too short to deliver the planned vaccination of 300,000 people.
Lack of adequate awareness and community mobilization: The vaccination programme was rolled out without significant prior exposure, awareness raising and community engagement mobilization. The vaccination programme was launched amid tense political wrangling over the Federal elections.
Misinformation and disinformation –
Misinformation and disinformation about COVID-19 vaccine safety and effectiveness is a global problem and ranges from false information about the side effects of the vaccines such as infertility to conspiracy theories about population control by implanting vaccine microchips into people. In Somalia, mistrust surrounding the rapid development and authorization of COVID-
19 vaccines and whether the vaccines contain any non-halal ingredients are compounded by genuine concerns about the side effects of Oxford/Astra Zeneca jab.

 CASE STUDY: BADHADHE Rejection of COVID-19 Vaccination Shots

Badhadhe administrative district is located in southern Lower Juba Region of Jubaland State of Somalia. Badhaadhe, the district’s main town and its administrative center, has been under Alshabab control since 2017 but the coastal towns, villages and islands are administered by the government of Jubaland. The marginalized ethnic Bajuni minority community, who primarily inhabit the coastal settlements and islands, do not get adequate access to social services i.e. education, health care and clean water. These are no mobile phone and internet services in these areas and the Bajuni community rely on the traditional media particularly BBC Somali & Swahili as the only and well-trusted source of information for daily news.
As part of the COVID-19 vaccination campaign, Jubaland MoH allocated four health facilities in the Badhaadhe district area and deployed the vaccine and other necessary supplies required to inoculate the people along the coastal settlements and islands but the vaccination campaign has met with strong resistance from the community. On top of the complex geographical, social, economic and cultural factors pertaining in the subgroup vaccine hesitancy, the roll-out of the COVID-19 vaccine in these coastal areas was impeded by vaccine safety concerns after the news broadcast by BBC Somali and Swahili about the emergence of the rare but severe blood clotting adverse effects possibly linked with Oxford/AstraZeneca vaccine and the limitation of its use in many European countries in March 2021. The news might have entrenched the community’s already distrust in authority, health professionals and vaccination programmes. Concurrently, Alshabab which control large swaths of inland of Badhadhe district issued a statement warning against the use of the COVID-19 vaccine due to reported side effects.