What Tanzania’s reluctance to COVID-19 vaccine means for its citizens and the world

Tanzania’s Minister of Health said earlier this month that the country has no plans to procure COVID-19 vaccines. Moina Spooner, an editor at The Conversation Africa, asked Catherine Kyobutungi to explain Tanzania’s response to COVID-19 and why it is problematic.

Why was it decided not to vaccinate?

Tanzania has had a unique approach to controlling COVID-19. Just months after the pandemic started last year, the country’s President John Magufuli declared Tanzania COVID-free after three days of national prayers.

He has since refused to impose a lockdown, reopened schools, allowed major sporting events, continued religious gatherings, stopped testing and stopped public communication campaigns on the virus. The country has also stopped reporting cases and deaths.

The argument was that people should stop living in fear and that they should trust God and rely on traditional African remedies to avoid contracting the virus. It is perhaps the only country in the world to have adopted this approach. This goes against everything that has been recommended by scientists, other national health agencies and the World Health Organization (WHO).

It is therefore not surprising that authorities have said they have no intention of vaccinating the population against COVID-19, at least for now.

Will people still be able to access vaccines?

No and yes.

No, because a vaccine cannot be used in the country without having been registered and authorized for use. The normal process is for experts in the country, working with regulatory agencies, to review the data on the vaccine and approve its use if they are satisfied with its effectiveness and safety.

For the COVID-19 vaccine, this is done according to the WHO emergency use list procedure. The review is carried out by an international team of experts with the participation of experts from national authorities.

If Tanzania refuses to register the vaccine for use in the country, it will not be available to anyone.

The country could, however, register the vaccine but refuse to import it. This would allow the private sector to import it, but it will not be enough. Any country’s COVID-19 vaccination programs are a massive undertaking. If it is driven by the private sector, many may not be able to access or afford vaccines.

In the meantime, those who could get vaccinated are the Tanzanian elites (or those with the means) who could fly out of the country and get vaccinated elsewhere.

Other Tanzanians who may have access to vaccines are border communities who in the past have passed through neighboring countries and benefited from vaccination programs. This may be the case if and when generalized immunization begins in Kenya, Uganda, Rwanda and Malawi.

But that’s in a few years.

It is still possible that Tanzania will register and import vaccines in the future. Magufuli has sent mixed messages. On the one hand, the government has said it does not plan to order vaccines through COVAX – a global initiative aimed at equitable access to COVID-19 vaccines – or any other mechanism. This is because the recently published COVAX allocation does not include any dose for Tanzania.

On the other hand, he said that Tanzanians should only trust vaccines that have been reviewed by Tanzanian experts and found to be safe.

Does Tanzania have a history of vaccine resistance?

Not that I know.

Tanzania, like other countries, has implemented routine immunization programs. These mainly target children under five against diseases such as tuberculosis, polio, whooping cough, measles, rubella and diphtheria. In recent years, they have expanded to once again include vaccines against bacterial pneumonia, diarrhea and hepatitis B.

Immunization coverage (the percentage of people who receive the vaccine compared to the target population) in Tanzania is very high: around 80% -90%. This means that there is no history of vaccine resistance.

What is different in the country compared to neighbors like Kenya and Uganda

Kenya, Uganda, Rwanda and Malawi have all tried desperately to get their hands on COVID-19 vaccines for their citizens. They all participated in the COVAX installation, drew up vaccine deployment plans, cost them and submitted them. Rwanda even went ahead and got vaccines outside the COVAX facility.

The four countries have also started to communicate with the public on these plans. For example, they said the first round of allowances would be a priority for healthcare workers and high-risk members of the population.

The biggest problem African countries are currently facing is the lack of vaccines in the global market to immunize a significant portion of the population. Many rich countries will have vaccinated everyone who needs to be vaccinated by the end of this year. But African countries won’t have a vaccine widely available until the end of next year or even 2023.

If countries that were actively researching vaccines are so far behind, imagine a country like Tanzania that didn’t even get started then.

What is the risk for the country and the region?

The risk for the country is already obvious. Tanzania’s approach allowed the virus to spread unchecked among the population. All of a sudden people are dying from what is called “pneumonia” and “difficulty breathing”.

People living in Tanzania are not adequately prepared or protected: There is no protocol on what laymen should do if someone becomes ill to prevent the spread of the virus. Most of the information is about steam – to prevent COVID-19 – but that doesn’t stop the virus from spreading from person to person.

The second biggest problem is the impact on healthcare workers. Even in countries where strict measures have been put in place, health workers have fallen ill and many have died. Misinformation in Tanzania could mean that health workers do not take sufficient precautions in outpatient clinics, emergency rooms and even wards when caring for patients. As health workers fall ill, other health services are bound to be affected.

The greatest danger for the region and the world is twofold.

First, as long as there are cases of COVID-19 in Tanzania, it is impossible for neighboring countries – with which it shares porous borders – to be COVID-free.

Second, and perhaps more importantly, there is the risk that new variants will develop in the country when no one is following them. New variants emerge due to uncontrolled spread.

If, in the end, a new variant emerges in Tanzania, the danger is that it could spread throughout the region and invalidate any vaccinations that might have taken place if they were not effective against that variant.

The pandemic will not end for anyone, anywhere until it is brought under control in all countries. Tanzania’s approach will make it even more difficult to return to normalcy.

Catherine Kyobutungi receives funding from Sida, BMGF, Carnegie Corporation in New York, the African Academy of Sciences and the Hewlett Foundation.

By Catherine Kyobutungi, Executive Director, Center for Population and Health Research in Africa