Vaccination against Covid widens differences in Africa and Portuguese-speaking people on the continent

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​A little more than a year after the start of vaccination against Covid, the distribution of doses in Africa continues to be a topic of debate in international forums. After all, with doses donated to the continent mostly in the last five months — many with a short shelf life — and storage problems, only 15% of the African population completed the first vaccination schedule.

Among the 54 countries on the continent, however, there are differences, and one of them is in the PALOP (Portuguese-speaking African Countries). Angola, Cape Verde, Guinea-Bissau, Equatorial Guinea, Mozambique and São Tomé and Príncipe have immunization rates above the regional level and are among the most vaccinated, although they have a tangle of domestic challenges in combating the disease.

There are several reasons behind this, and some of them call for a visit to local history. Starting with the diplomatic success enjoyed by Portuguese-speaking Africans.

A good part of the doses applied in these nations came from China, Russia and Portugal, says the Angolan Filomeno Fortes, director of the Institute of Hygiene and Tropical Medicine, at Universidade Nova de Lisboa. “Denialism also didn’t have much weight, and it was possible to have a great social mobilization on the part of governments”, he explains.

THE sheet, the Portuguese Ministry of State and Foreign Affairs reported that 2.7 million vaccines had been donated to the Palop by the end of February, either through bilateral agreements or through the international consortium Covax. The main destination was Angola, the largest Portuguese-speaking African in terms of population — at least 1.8 million vaccines from Lisbon landed in the country.

The figures, however, were not able to stop the vaccine delay. Fortes says that even the Palop will struggle to reach the global target of more than 70% vaccinated. Cape Verde could reach 70% coverage, while Mozambique and São Tomé and Príncipe should stagnate at around 45%, and Angola could reach 30%, he estimates. “The expectation is that Covid will become another endemic with small outbreaks until natural immunity comes.”

The causes for the problem go beyond the difficulty of acquiring vaccines. Added to this is the fact that many of the donated doses —at least 1 million, according to Fortes— have a very short shelf life; the poor storage capacity of the immunizer at low temperatures; the great migratory flows in these nations; and health systems with reduced coverage capacity.

These obstacles are also reported by Joana de Morais, director general of the National Institute of Public Health in Angola, a country with 17.6% of vaccinated people. She mentions numerous cases of international donations whose vaccines had an expiration date of one or two months – which made it almost impossible to get the immunizer to reach areas that were difficult to access. “Nobody looked at this. There was a lack of solidarity and understanding of the Angolan context.”

In the list of challenges, biomedicine also includes the low health literacy of the population — which would have corroborated the spread of conspiracy theories — the difficulties in the logistics chain and the insufficient communication campaign promoted by the authorities.

There was also the perception that Covid was not the most latent problem, which is due to the existence of communicable diseases, such as malaria and tuberculosis, in many of the Palop. “The pandemic has reduced the capacity for testing, diagnosis and treatment of these diseases; with the exception of Cape Verde, there has been a decrease in vaccination coverage against polio, measles, tetanus, diphtheria, whooping cough, BCG and yellow fever in the Palop”, reports Filomeno Fortes .

Point outside the curve in this sense, the archipelago of Cape Verde consolidated itself as the most vaccinated Palop and the fifth most immunized African country, behind Seychelles, Mauritius, Morocco and Rwanda. At least 54.6% of the population received two doses, a percentage that, in large part, is due to the historical differences that mark the country in comparison with other Lusophones.

Considered a good example in the fight against the pandemic, the country saw the number of cases explode at the end of December, just when the tourism sector, responsible for a quarter of GDP, was reheating.

The president of the Cape Verde National Institute of Public Health, Maria da Luz Lima, however, attributes the recent outbreak to the interruption of the mandatory use of masks and the large influx of Cape Verdeans who live in other countries, not to tourist activities. According to her, many family members took to their relatives false theories about the immunizer, something that never took root in the archipelago.

Lima says that the new wave could be controlled — now the country records an average of 20 fewer Covid cases per day — due to the history of what was already being done in the health area. And he mentions what he describes as “institutional isolation” still in the first phase of the disease, when those infected were isolated in hotels and schools, away from their families, which made it possible to flatten the Covid figures at the beginning.

There are reasons for Cape Verde’s most successful vaccination campaign, and they reflect the fact that even the Palop are marked by structural differences among themselves. With a differentiated colonization and post-independence process, the country of 550,000 inhabitants has already started the pandemic with a more structured health system, the result of a robust public administration.

“Cape Verde has always been seen by the metropolis [Portugal] as a creator of administrative staff who were co-opted and took part in the administration of countries like Angola and Guinea-Bissau”, explains Leila Leite Hernandez, professor of African history at USP.

“During independence, there was no breakdown of the administrative apparatus, marked by the Portuguese colonial bureaucracy, as there was in other former colonies, so that Cape Verde was the only country with an administrative framework”, he continues.

Thus, explains Hernandez, author of books on the archipelago, a favorable terrain was created so that, in the post-independence period, there would be an accelerated modernization of the administrative part, with special commitment in the education and health sectors, the latter fundamental in the face of the health crisis. observed in the last three years.

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