Vaccine for the World

With Omicron on the horizon, Mozambique delivers Covid vaccines to the last mile

Most Mozambicans are yet to have the vaccine and health workers are trying to get doses to all corners of the country

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On a sunny morning in November, Isabel Tatanula, 49, a teacher and farmer in Mozambique’s coastal district of Maganja, has missed a day of work to cycle to a mobile vaccination unit to get her first Covid-19 jab.

Each dose is crucial. With southern Africa the current epicentre of Covid fears, health officials in Mozambique are striving to distribute the country’s limited vaccine supplies across its vast territory.

Mozambique started its immunisation campaign against Covid-19 in March and since then more than 6 million people have had at least their first dose. Still, 89 per cent of Mozambicans are yet to be fully vaccinated.

Reaching the country’s most rural outposts with the vaccine is a challenge. Maganja da Costa in central Mozambique’s Zambézia province, for example, is a five-hour drive along a dusty road from the provincial capital, Quelimane. And in the northern province of Cabo Delgado, security forces are battling an Islamist insurgency.

After a third wave of coronavirus infections subsided in September, authorities are now bracing for the Omicron variant, first identified across the border in South Africa.

The Omicron variant is potentially more transmissible than previous strains of the virus, but it is unclear whether it is more deadly.

What is certain is that the first line of defence is the Covid-19 vaccine.

Isabel Tatanula, a teacher and farmer in Maganja da Costa, Mozambique
Emidio Jozine

Reaching communities

From the district medicine and vaccines warehouse in Maganja da Costa, health workers plan their vaccination goals and areas to cover.

A mobile vaccination team prepares to fan out around the local area by car and motorbike to distribute a new batch of vaccines delivered from the provincial warehouse the previous day.

“When the vaccines arrive we do the distribution to all the districts. We have an electronic system of vaccine distribution so everyone has to report what they have used and what they still have in stock… then we work out how to allocate the vaccines because we don’t have enough to give to everyone,” says Ana Colaço, a provincial warehouse manager in Zambézia province.

In Isabel Tatanula’s home village of Diba, a young health activist walks around the village of thatched houses in an orange high-vis vest, shouting through his megaphone.

“Good day, good day!” he calls out. “The people with the vaccine are here! Come to the school to get your vaccination!”

The young health volunteers are key to spreading the word among communities and dispelling misinformation and mistrust around the vaccine, says Giusti Magiardo Pessuro, Maganja da Costa’s head physician.

“They are selected among their communities, we reach out to leaders and ask them for people who are respected and well-known, we pick our (volunteers) there and train them,” adds Pessuro.

“My job is to let people know about this Covid vaccine and mobilise them to come get it. This is the first time we’re vaccinating people in this community of Diba,” says volunteer Argentina Armando José, 26.

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Do no harm

Mozambique’s vaccination campaign is now in its third phase. After priority groups such as health workers, teachers and the elderly, inoculations are now available to those over 50 in rural areas and over 30 in the cities.

“The strategy we used in the beginning was to start with the health officials like doctors and nurses, people on the frontline, so this gave conviction to the community that the vaccine had come to benefit us and not do any harm,” says Dr Pessuro.

In the village of Tariua, traditional healer Aurélio Martins Soares, 36, is queuing for a vaccine after hearing about the rollout on the radio.

“Even though I’m from traditional medicine I came here to get the vaccine. Everyone can get infected by this disease, children, men, women,” he says.

His faith in the vaccine is still high after he receives his jab. “I feel good now, this vaccine is for Mozambique and the world. I will be back later this month to get my second dose.”

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The last mile

“When we talk about vaccines, people talk about training but they don’t really talk about logistics - and logistics can make or break the vaccine distribution,” says Rotafina Donco, Country Director for VillageReach, an organization working with the Ministry of Health on vaccine distribution.

VillageReach is a partner in the Last Mile Supply Chain program with Mozambique’s government and the U.S. Agency for International Development (USAID) to ensure everyone has access to essential medicines and vaccines no matter where they live.

“We have provided a platform for restock management with real-time data and VillageReach has played a key role in helping the Ministry of Health to manage the coordination of the emergency operations centre for Covid-19,” Donco adds.

Across Zambézia province’s river deltas and small islands, accessing remote areas with the vaccine has been a challenge.

“We face difficulties in terms of reaching our users. Some hospitals are located in islands, we use small boats to send vaccines,” says Dr Pessuro.

“We are doing our best to make sure we reach those who need to be vaccinated.”

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Lack of supply

However, for developing nations like Mozambique, it is the supply of doses, not just issues of distribution, that has held back the nationwide rollout.

"At the moment we’re vaccinating with what we receive and focusing on our target groups," said Colaço, the warehouse manager.

Beside those received via the COVAX  mechanism Mozambique’s government has purchased some vaccines, and through bilateral agreements has received donations from European countries, China and other donors. But it is still dangerously undersupplied.

Due to the threat of the new strain, Mozambique was added to the UK’s red list of countries to and from which travel is banned.

“Our wish is that everybody in Mozambique is vaccinated against Covid-19 but supply has been a concern not only in Mozambique but also in other developing countries. What we’re rooting for, campaigning and advocating for is equity, to ensure that developed countries do not hoard vaccines,” says Donco of VillageReach.

A shortage of vaccines in the world’s poorest nations gives the virus more chances to mutate, and for new variants like Omicron to emerge, say experts.

According to the Africa Union’s Vaccine Delivery Alliance co-chair, Dr Ayoade Olatunbosun-Alakija: “What is going on right now is inevitable: it’s a result of the world’s failure to vaccinate in an equitable, urgent and speedy manner.”

In Maganja da Costa, seated near her small cassava farm, Isabel Tatanula is thankful that she has received her shot as one of the priority groups. “We all need to get the vaccine, even if sometimes it means not going to farm in the morning.”

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