- Malawi's stock of Covid-19 vaccines is dangerously low, with only 540 doses left.
- The country seems to be headed for a third wave, with an increase in infections and instances of the Delta variant.
- Malawi earlier received part of the AstraZeneca vaccine batch from South Africa, but these were close to expiry.
With only 540 Covid-19 vaccine doses left, Malawi is entering a potentially perilous third wave of coronavirus infections.
Reliant on the Covax facility, Malawi was experiencing the connected effects of the devastating surge in India, which saw the Serum Institute of India redirect exports of the AstraZeneca vaccine for domestic use. The country announced stockouts at certain facilities last week, and the number dwindled to just more than 500, as of 23 June.
With 119 new cases, adding to a cumulative 35 115 cases, a third wave of infections is on the horizon. Although lower than many other countries, including South Africa, the actual figures may be higher due to low testing.
"Our figures may not be that alarming but we're not taking chances," said health ministry spokesperson Adrian Chikumbe.
It was "understandable" that India, a country of more than a billion people, was focusing on the safety of its own population, he added. For now, the country was reliant on non-pharmaceutical measures like mask wearing, social distancing and the use of hand sanitiser.
"We recognise the vaccine has not replaced the other preventative measures that we have promoted," Chikumbe told News24.
The country has recorded cases of the Delta variant, first discovered in India, but the extent was not yet clear as Malawi was largely reliant on South Africa for genomic sequencing, said the World Health Organisation (WHO).
Stalled rollout
Malawi's agreement with the Covax facility was meant to deliver 3.8 million vaccine doses to cover 20% of the population.
The country's vaccine rollout kicked off in March with 512 000 doses, said Dr Nonhlanhla Dlamini, WHO representative in Malawi. Most of these – 360 000 doses – were acquired via Covax, the global vaccine acquisition alliance. The Indian government also donated 50 000 doses.
Malawi also benefitted from South Africa's AstraZeneca doses. Ineffective against the Beta variant first discovered in South Africa in February, telecoms giant MTN purchased the stock and donated it to the African Union (AU). Malawi was one of nine countries that benefitted from this scheme, taking delivery of 102 000 doses in late March.
Dlamini said:
These vaccine doses also arrived at a time when vaccine hesitancy was high, particularly in rural areas, and many adopted a "wait-and-see" approach to the early rollout, explained Dlamini.
Malawi was also still in the process of training its vaccinators and had to make use of mobile units, further adding to the delay in the rollout programme.
Destroying vaccines
Last month, Malawi made global headlines when Health Minister Khumbize Chiponda personally oversaw the destruction of 19 610 vaccine doses that had reached their expiry date.
That exercise, said Dlamini, was to encourage already waning public trust in vaccines.
"The scepticism was coming from the healthcare workers themselves, and of course they talk out there within the communities," Dlamini said.
"If they had kept those vaccines, the negative effect would have been so bad because then the story that was spreading was that all of the vaccines had expired. All of them."
Dlamini said she had seen attitudes toward vaccines change, with greater uptake, including in rural areas.
Hope in dosage-sharing
Pledges from wealthy countries promising to share their vaccine doses with poorer nations has brought some hope to the country. Malawi hopes to receive its first batch of shared doses in July, said Dlamini.
The country is also moving towards the Johnson & Johnson vaccine, which like the AstraZeneca vaccine, does not require ultra-cold storage facilities.
When the new stock arrives, Malawi will also be better prepared to roll it out. The global health alliance Gavi has supported the country with training, cold rooms and transportation facilities, said Dlamini.
Last week, the World Bank also approved a $30-million grant to help the country acquire vaccines, potentially reducing its reliance on Covax.