The place a Vaccination Marketing campaign Faces Skepticism, Battle and Corruption

KABUL, Afghanistan – Afghanistan, whose citizens have pushed the coronavirus pandemic aside as an exaggeration or largely a joke, is now preparing to distribute its first batch of vaccines.

Half a million doses of the AstraZeneca-Oxford vaccine, made by an Indian manufacturer, were shipped from India to the capital, Kabul, on February 7th. Many Afghans, who rejected government warnings, greeted the arrival indifferently, but the virus poses a deadly public health threat.

The cheap and easy-to-store AstraZeneca Oxford vaccine is supplied as part of the Covax program, a worldwide initiative to buy and sell vaccines to poor countries free of charge and at reduced prices. On February 15, the World Health Organization approved the use of the vaccine, which requires two doses per person, and paved the way for Afghanistan to begin its vaccination campaign.

Global studies have shown that the vaccine offers complete protection against serious illness and death. However, the effectiveness against the virus variant first observed in South Africa is questionable after the vaccine failed in a small study to prevent study participants from getting mild or moderate Covid cases.

The vaccine arrives as Afghanistan fends off a second deadly wave, even though most Afghans organize their daily lives as if the virus never existed. Many people refuse to wear masks and to gather in dense crowds in bazaars, supermarkets, restaurants and mosques without paying attention to ubiquitous public health posters.

In an impoverished nation ravaged by war, hunger, poverty and drought, an invisible virus is considered a fake or an afterthought.

“Of course I won’t take the vaccine because I don’t believe in the existence of the coronavirus,” said Muhibullah Armani, 30, a taxi driver in the southern city of Kandahar.

Mr Armani expressed a sentiment shared by many Afghans and added: “When I see people covering their mouths and noses and being scared of Covid, it makes me laugh.”

And even among Afghans who believe the virus is real and want to be vaccinated, there is little confidence that the government, embroiled in ubiquitous corruption, will fairly distribute limited vaccine supplies.

“This vaccine will only be available to high-profile people,” said Khalil Jan Gurbazwal, a civil society activist in Khost province in eastern Afghanistan.

Nizamuddin, a tribal elder in a Taliban-controlled district in Faryab province in northern Afghanistan, feared the vaccine would be appropriated by well-connected politicians and warlords.

“In Afghanistan it is common for even food aid to be stolen from corrupt people,” said Nizamuddin, who, like many Afghans, has a name.

The attorney general’s office said Thursday that 74 government officials from five provinces had been charged with embezzling coronavirus response funds. Former provincial governors and deputy governors were among the defendants.

Updated

Apr. 23, 2021, 9:27 p.m. ET

In Kunduz province, northern Afghanistan, a hospital administrator told authorities that hospital officials were charging medical costs for Covid-19 treatments for 50 beds in a hospital with only 25 beds and fees for “ghost workers”, the special inspector general for the reconstruction of Afghanistan recently raised reported.

“This misconduct costs Afghan citizens not only financially, but also from delayed access to potentially life-saving medical care,” the US embassy said in a statement. For many Afghans, however, the vaccine is a solution to a problem that doesn’t exist.

When the vaccination program began on Tuesday, the first dose was given to Anisa Shaheed, a television reporter who covered the pandemic, at the Presidential Palace in Kabul.

Distributing vaccines in a riot-consumed, desperately poor nation is a daunting logistical challenge. In addition to overcoming public suspicion and traversing dangerous areas, the Ministry of Health must also manage vaccine delivery in remote provinces with poor roads and primitive infrastructure.

The pandemic has led to an increase in polio cases in Afghanistan as it has become more difficult for polio teams to reach remote areas, said Dr. Osman Tahiri, the public affairs advisor for the Ministry of Health, who reported 56 polio cases in 2020, up from 29 in 2019.

But equally worrying are the 305 cases of a polio variant in Afghanistan in 2020 versus zero in 2019, said Merjan Rasekh, head of public awareness for the ministry’s polio eradication program.

Mr Rasekh attributed much of the surge in variant polio cases to Afghan refugees returning from neighboring Pakistan, which was also struggling to eradicate polio. The WHO is expected to issue an emergency approval for a vaccine against the variant by the end of the year.

While Dr. Tahiri had to contend with an increase in polio cases, he said health workers would try to distribute the coronavirus vaccine even in Taliban-controlled areas where militants have allowed government-run clinics. The Taliban have run public health programs to warn of the pandemic, distribute personal protective equipment, while allowing state health workers to enter their areas.

Dr. However, Tahiri acknowledged that vaccination teams will not be able to reach much of the country, where fighting between the Taliban and government forces is strongest.

A thousand vaccination teams were trained last week, said Dr. Tahiri. The Ministry is hoping for more vaccines to be donated; Afghanistan has a capacity of 20 million cans.

The first doses are going to health workers and security officials “who are at risk and work in crowded places,” said Dr. Tahiri, although there aren’t enough vaccines for everyone in this category yet. Journalists could also apply to have the vaccine, he added.

Afghanistan has registered more than 55,000 coronavirus cases and nearly 2,500 deaths related to Covid, according to the Ministry of Health.

Due to limited testing and an inadequate public health system, the real number of cases and deaths is exponentially higher, according to experts. A WHO model estimated in May that more than half of the estimated 34 million people in Afghanistan could become infected. The Ministry of Health estimated last fall that more than 10 million Afghans could be infected with the virus.

Regardless of whether Afghans believe the virus is real, there is an abiding belief that Allah will determine the fate of a believer.

Ahmad Shah Ahmadi, a resident of Khost province, said there was no need to take the vaccine. “Unbelievers do not believe in God, and so they fear the coronavirus. There is little danger for Muslims, ”he said.

But Imam Nazar, 46, a farmer in Kunduz province, said most of his village residents believe the virus is real because several villagers have died from Covid-19. He said he and other villagers were desperate to get the vaccine but doubted it would reach their remote town.

“This government is not keeping its promises,” said Nazar.

Fatima Faizi and Fahim Abed reported from Kabul; Farooq Jan Mangal from Khost Province; and Taimoor Shah from Kandahar Province.

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