Swift end to pandemic threatened by unvaccinated faraway locales

After losing her son who got infected with COVID-19 last year, 79-year-old Tomasa Valdez was desperate to get vaccinated. But on the remote Philippine island of San Salvador, where she lives, there were no shots to be had.

Getting to the mainland, where the vaccinations were available, meant a boat ride that was arduous at her age and expensive for her meager income from drying sea grass which she sells for less than 100 pesos ($1.95) a sack. Help only arrived in December 2021 — 10 months after the Philippines began its national program and about a year after Western nations like the U.S. and U.K. started theirs.

The health workers had to travel via a wooden motorized boat, ferrying heavy vaccine storage equipment across the choppy South China Sea.

“Vaccines really have to be brought closer to the people, not the other way around,” said Noel Bueno, the doctor who inoculated Valdez.

After addressing the shortages that initially hampered their vaccination programs, emerging nations like the Philippines are now struggling to get the shots into the arms of their citizens, millions of whom can live on distant archipelagos or far-flung mountain tops. Developed places with much higher vaccination rates are getting to the point where they are choosing to live with COVID-19 and treat it as endemic. But logistical issues are relentlessly hounding the rollouts in poorer countries, becoming one of the world’s biggest public health challenges as the pandemic enters into its third year.

The Philippines has one of Asia’s lowest vaccination rates, with only about half of its population receiving both shots, according to the Bloomberg Vaccine Tracker. Its limited and costly testing, fragmented tracing and fragile health system have made it hard to stamp out outbreaks despite several economically devastating lockdowns. In recent days, it’s posted record high numbers of daily cases, potentially due to the spread of the ultracontagious omicron variant.

The hurdles that developing nations face in widening the reach of their inoculation programs — which can extend from logistical issues to vaccine hesitancy and social media rumors — are likely to stymie global efforts to contain the virus. New strains can proliferate in under vaccinated populations and lengthen the pandemic as the emergence and spread of the highly contagious delta and omicron variants in India and Africa have shown.

Developing nations face a “combination of challenges in hard infrastructure in the form of trucks, freezers but also soft infrastructure in the form of logistics staff, vaccine administrators and adequate planning,” said Prashant Yadav, a senior fellow at the Washington and London-based Center for Global Development, who specializes in supply chains. “But these are all surmountable barriers and we have managed to overcome them for the Ebola vaccine, and many other outbreak vaccines.”

While the U.S. government and international agencies have begun efforts to support emerging countries, more high-income countries need to step in, he said. “Remote regions have poorer health-care infrastructure in terms of oxygen, ICU beds so if someone does get severe COVID the ability to treat them is weaker,” Yadav said. “From that standpoint it becomes important to reach remote areas early.”

To help address logistics woes, the U.S., through its Agency for International Development, pledged $315 million for mobile vaccination sites for hard-to-reach rural areas, and to invest in cold-storage facilities.

For much of last year, developing nations faced difficulty getting access to the best vaccines, which were initially hoarded by Western countries for their own use. The Philippines first relied on shots from China’s Sinovac Biotech Ltd., which have been shown to be less effective than the more potent mRNA shots being used in the U.S., particularly against the omicron variant.

But in recent months many of its supply problems have eased and the Philippines now has a stockpile of shots. More mRNA shots from Pfizer Inc. and Moderna Inc. are now being administered in the Southeast Asian country, particularly to minors. But its logistical challenges have lingered.

Other low- and middle-income nations are grappling with challenges of their own. In Asia, India is pushing to get shots to its vast, impoverished countryside, while Indonesia’s vaccine drive is hampered by the difficulty of reaching people spread across its thousands of islands.

In sub-Saharan Africa, poor trade and logistics quality could destroy vaccines, and further derail the region’s slow inoculation, the African Development Bank’s chief research economist Eugene Bempong Nyantakyi and Professor Jonathan Munemo from Salisbury University in Maryland have said. Only around 8% of Africans were fully vaccinated as of late last year.

“No journey is more critical to determining the fate of a pandemic than the distance a vaccine must travel from the production line to a person’s arm,” the researchers said in a piece published on the International Monetary Fund’s website late last year. “In sub-Saharan Africa, the last mile of this important race is all-important.”

Nations from Asia to Africa are attempting to get creative and stretch their limited budgets to bring vaccines to isolated areas. The government in Ghana partnered with a startup to use drones to ferry tens of thousands of Pfizer-BioNTech shots to its remote countryside.

In Malawi, where less than 5% of the population is fully vaccinated, health workers drive vans from UNICEF to bring shots to remote rural areas.

In the Philippines, local officials in the central city of Tacloban are now dangling 100 pesos as transportation fare for those from remote areas who had to travel to get vaccinated, Vice Mayor Jerry Yaokasin said over the phone.

Despite delays, residents from isolated areas like Valdez from the Philippine island are thankful for these efforts.

“I can finally walk along the shore to collect sea grass, without having to worry about getting very sick from COVID,” she said, smiling as she finally held her vaccine card, more than two months after her son’s death.