Africa finally has enough Covid shots. Is it too little, too late?

The staff in Worawora has expanded in the last few weeks in preparation for the country’s second vaccination campaign — propped up in large part by international funding, including funding from USAID. In normal times, his staff is minimal — the team sets up underneath a tree in the center of the Oti district, in hyper-local health centers or in local schools, hoping people will come to sign up for the shot. In those times, the door-to-door knocking is significantly reduced and vaccine uptake tends to slow.

“In all vaccination campaigns, we struggle with adults,” he says. “For Covid, we tell them about the benefits of the vaccine and why it is important to take as far as herd immunity is concerned. Some will accept. We have people who do not take anything at all — they have spiritual and religious reasons. For those, we cannot do anything.”

One of his volunteer staff, a young woman from the community, is sitting in one of the wooden pew-like benches, chiming in from the side.

“Some of the men in the region think the shot is going to give them erectile dysfunction,” she says, her room of peers, including Quaye-Appiah, erupting in laughter.

“Yea, and for some we have people who say it gives them too much function!” another male volunteer staff member says, joking. It’s a conspiracy theory not dissimilar to the ones currently held by large portions of the American population.

As the rain begins to fall from a tap-tap to a shhh, a drone flies through the dewy sky above the front of the hospital complex, dropping a medium-sized red box. Zipline, a California-based company, supported by Gavi, set up a hub in Ghana in 2019 to help deliver blood, vaccines and other kinds of medicines. It’s been crucial for helping deliver Covid shots in hard-to-reach areas in Ghana.

The red box slowly falls to the ground, suspended from a paper hood. It includes more Johnson & Johnson shots — a favorite in this area because it does not require the ultra-cold storage of some other vaccines. Unused J&J doses simply go into the normal containers in the front of the hospital alongside AstraZeneca doses. They sit in a small room off the main entrance. They’ve come from a large storage center in Accra where the government keeps giant freezers full of vaccines.

Right now, this district, like almost all of the others in Ghana, has too many vaccines — more than meets demand. And vaccination teams like Quaye-Appiah’s are struggling to move them out before they expire. A significant number of their current AstraZeneca doses — thousands in some districts — continue to arrive in the country with short shelf lives and will likely expire soon. Meanwhile, 2 million additional U.S. doses arrived in the country in late April.

Quaye-Appiah says at the beginning of vaccination distribution in August 2021, his staff was encouraged by the number of people they reached — sometimes over 100 a day. Now, though, his staff are at times only convincing 30 people a day to get vaccinated. That number has fallen to as low as seven.

“We are hearing in our consultations with African health counterparts, that there’s just not the same sense of urgency about it that there was last year,” Konyndyk says of vaccination campaigns in countries like Ghana. “It’s not to say those people can’t be convinced or won’t eventually be convinced. But this is one of the reasons why there is this need to really do a significant push on expanding that community engagement and combating misinformation. Because it is, it is going to be a barrier.”

Those barriers are also being met by community health workers in the Okere district, a four-hour drive southwest of Worawora on the way to Accra. The Okere district is the youngest and smallest district in the country, according to Augustine Ankuvie, the director of health services. This week, the second to last in April, community leaders across the district are desperately trying to ramp up their vaccination numbers before the national campaign comes to a close.

Ankuvie is sitting in one of the main rooms off the entrance of the district’s health office, just a few minutes drive from the senior high school. In this room, health care workers plot out how to ramp up vaccinations among both children and adults and track disease outbreaks. Binders line the bookshelf on the side of the room — just one of them is titled Covid. There are several for malaria, some for tuberculosis and HIV.

Ankuvie sits at a desk at the front of the room with his assistant who is pouring over the day’s vaccine numbers. Vaccinating people in this district is expensive, he says.

Okere launched its own district-wide vaccination campaign April 10 — a little less than two weeks before the national one started. During that push, Ankuvie said, the district spent about 44,000 cedis, or approximately $5,800 to pay vaccinators to knock on doors. USAID, in collaboration with the Ministry of Health, helped sponsor the campaign. But the money didn’t come in time and the district had to use money out of its own budget, which goes to help treat other illnesses, Ankuvie says. The district is still waiting for reimbursement. USAID officials say the money was transferred to the Ghanaian government April 21 — a few days after the campaign ended. Ankuvie suspects it has yet to trickle down to the regional government and on to the district for repayment.

The lack of quick reimbursement worries Ankuvie. In recent weeks, the rainy season has brought on a sharp uptick in malaria cases. The doctor at the local health center down the road says she treated several patients for malaria today, including a four-year-old girl. Before seeing the doctor, the young girl wearing a light pink dress squats next to a drainage ditch on the side of the health center building, vomiting excessively, crying out to her mother. She’s not the first child to seek treatment this week, the doctor says.

“For us, we aren’t seeing or focusing on Covid,” she says. “We are seeing a lot of malaria. We test to make sure and then give them tablets to take home. We will see how this girl feels after 24 hours of treatment. She may have to come back.”

The fact that Covid isn’t causing local hospital rooms to fill up has drained energy from the vaccination campaign, Ankuvie said.

With his assistant by his side crunching the numbers, he explains that the district is aiming to vaccinate about 49,200 people for Covid total. There are about 78,000 people who live here. This week, during the national campaign, Okere’s goal is to get 5,680 people vaccinated. So far, on the second to last day of the campaign, they’ve vaccinated just over 3,000 — only 544 doses were first doses, he said. Doses are expiring here, too. Ankuvie’s assistant, who tallies the vaccinations in a small notebook, estimates that the district has had 3,076 doses expire — almost all of them AstraZeneca.

“The shelf life is so short for those ones,” she says.

While the work of getting people vaccinated in northern Ghana is equally as difficult, one district near the border of Ghana — a 12-hour drive from Accra — is doing exceedingly well.

One can reach the Bongo district, a community of 120,000 people, by flying into Tamale from Accra. Tamale is the biggest city in the northern part of the country and home to some of the biggest health and humanitarian hubs in the country. To get to Bongo, you have to drive down a red-sand and dirt road about two hours from the Tamale airport. The land in this part of the country is significantly less developed. And there is so much of it — peppered with rows and rows of trees, often with large ant mounds underneath. Cattle graze the grass around it.

The communities on this road are further apart than those near Worawora and in Okere — and the houses lack reliable electricity. The roadside structures, where men and women sell food products and local goods, have just one light bulb for when the sun goes down — providing only enough light for someone standing in the doorway.