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Where a vaccination campaign faces skepticism, war and corruption

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KABUL, Afghanistan Afghanistan, whose citizens have largely given up on the coronavirus pandemic as an exaggeration or a complete hoax, is now preparing to distribute the first batch of vaccines.

Half a million doses of the AstraZeneca-Oxford vaccine, manufactured by an Indian manufacturer, were shipped to the capital, Kabul, from India on 7 February. But the arrival was greeted with indifference by many Afghans, who have opposed government warnings that the virus is a deadly threat to public health.

Cheap, easy-to-maintain vaccine AstraZeneca-Oxford is being distributed as part of the Covax program, a worldwide initiative to buy and distribute vaccines in poor countries for free or at a reduced cost. On February 15, the World Health Organization authorized the use of the vaccine, which requires two doses per person, paving the way for Afghanistan to begin its inoculation campaign.

Global evidence has shown that the vaccine provided complete protection against serious illness and death. But its effectiveness against the first variant of the virus in South Africa is in question, as the vaccine failed a small test to prevent study participants from getting mild or moderate cases of Covid.

The vaccine arrives as Afghanistan battles a deadly second wave, even though most Afghans go about their daily lives as if the virus never existed. Many people refuse to wear masks and piles in dense crowds inside bazaars, supermarkets, restaurants and mosques, oblivious to the ubiquitous public health posters.

In a poor nation hit by war, famine, poverty and drought, an invisible virus is considered false, or a later thought.

I certainly do not get the vaccine because I do not believe in the existence of the coronavirus, said Muhibullah Armani, 30, a taxi driver in the southern city of Kandahar.

Expressing a common feeling from many Afghans, Mr. Armani added, When I see people covering their mouths and noses, scared of Covid, it makes me laugh with them.

Even among Afghans who believe the virus is real and want to be inoculated, there is little confidence that the government, steeped in widespread corruption, will evenly distribute limited supplies of vaccines.

The vaccine will only be available to people of high status, said Khalil Jan Gurbazwal, a civil society activist in Khost Province in eastern Afghanistan.

Nizamuddin, a tribal elder in a Taliban-controlled district in northern Afghanistan’s Faryab Province, said he feared the vaccine would be appropriated by politicians and well-connected warlords.

“It is common in Afghanistan for food aid to be stolen by corrupt people,” he said. Nizamuddin, who like many Afghans goes by a name.

The Attorney General’s Office said Thursday that 74 government officials from five provinces had been charged with embezzling coronavirus response funds. Among the accused were former provincial governors and deputy governors.

In Kunduz province in northern Afghanistan, a hospital administrator told authorities that hospital officials collected medical costs for Covid-19 treatments for 50 beds in a hospital with only 25 beds, pocket charges for ghost workers, recently announced the special inspector general for the reconstruction of Afghanistan.

This abuse costs Afghan citizens not only financially but in delayed access to potentially life-saving medical care, the US Embassy said in a statement. But for many Afghans, the vaccine is a solution to a problem that does not exist.

As the vaccination program began on Tuesday, the first dose was administered at the presidential palace in Kabul for Anisa Shaheed, a television reporter who has covered the pandemic.

Delivering any vaccine to a desperately poor country consumed by the unrest is a daunting logistical challenge. In addition to overcoming public suspicions and traversing dangerous territories, the Ministry of Public Health must also navigate the delivery of vaccines to remote provinces with poor roads and primitive infrastructure.

The pandemic has spurred an increase in polio cases in Afghanistan because it has made it more difficult for polio teams to reach peripheral areas, said Dr. Osman Tahiri, public affairs adviser to the health ministry, who reported 56 cases of polio in 2020, up from 29 in 2019.

But equally worrying are the 305 cases of polio variant in Afghanistan in 2020, versus zero such cases reported in 2019, said Marjan Rasekh, chief of public awareness for the polio eradication ministries program.

Mr Rasekh attributed most of the polio cases to variants of Afghan refugees returning from neighboring Pakistan, who have also fought to eradicate polio. WHO is expected to provide emergency approval from years running out for a vaccine against the variant.

While struggling with an increase in polio cases, Dr. Tahiri said health workers would try to distribute the coronavirus vaccine even in Taliban-controlled areas where militants have allowed government-run clinics. The Taliban have set up public health programs warning of the pandemic and have distributed personal protective equipment while allowing government health workers in their areas.

By Dr. Tahiri acknowledged that vaccination teams would not be able to reach large areas of the country where fighting is heaviest between the Taliban and government forces.

One thousand vaccination teams were trained last week, said Dr. Tahiri. The ministry hopes to receive more donated vaccines; Afghanistan, he said, has a capacity to store 20 million doses.

The first doses will go to health workers and security officials who are at risk and working in crowded places, said Dr. Tahiri, although there is still not enough vaccine for everyone in this category. Journalists would be eligible to apply for the vaccine, he added.

Afghanistan has registered more than 55,000 cases of coronavirus and nearly 2,500 Covid-related deaths, according to the Ministry of Public Health.

But due to limited testing and an inadequate public health system, experts say the current number of cases and deaths is exponentially higher. A WHO model estimated in May that more than half of Afghans estimated that 34 million people could be infected. The Ministry of Public Health estimated last fall that more than 10 million Afghans may have contracted the virus.

Regardless of whether Afghans believe the virus is real, there is a firm belief that Allah determines the fate of believers.

Ahmad Shah Ahmadi, a resident of Khost Province, said there was no need to get the vaccine. The wicked do not believe in God, and that is why they fear the coronavirus. For Muslims, there is little risk, he said.

But Imam Nazar, 46, a farmer in Kunduz Province, said most residents of his village believe the virus is real because some villagers have died from Covid-19. He said he and other villagers were eager to get the vaccine but doubted it would reach their distant town.

This government does not keep its promises, said Mr. Nazar.

Fatima Faizi and Fahim Abed contributed with reporting from Kabul; Farooq Jan Mangal from Khost Province; and Taimoor Shah from Kandahar Province.

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