In the middle of a pandemic, Mavis Owureku-Asare is optimistic.
The reason? On February 24, her homeland, Ghana, became the first low-resource country to receive free COVID-19 vaccines through COVAX.
"I feel very hopeful," says Owureku-Asare, a food scientist with the Ghana Atomic Energy Commission and a 2020 Aspen New Voices fellow. "Ghana has become a role model for other countries."
She's not the only one encouraged by the shipment from COVAX, an initiative set up in partnership with the World Health Organization to ensure equitable access to the vaccine, especially in low income countries.
"This is a historic step toward our goal to ensure equitable distribution of COVID-19 vaccines globally, in what will be the largest vaccine procurement and supply operation in history" is how WHO phrased it in a statement.
But the reality on the ground is a bit more complicated. There are still potential stumbling blocks ahead for Ghana — and no doubt for other countries on the COVAX distribution list.
"We weren't expecting to get the vaccines so soon," says Owureku-Asare. "Having this at this time, I think shows that Ghana is doing what it needs to take this disease seriously."
Ghana, characterized as a lower middle-income country by the World Bank, received 600,000 doses of the AstraZeneca-Oxford vaccine — part of an initial 2.4 million doses to be shipped by COVAX in 2021.
But it's one thing to have a supply of vaccines; it's another to administer them.
Nana Kofi Quakyi, research fellow and doctoral candidate at NYU College of Global Public Health, thinks the country can draw from past experience. Ghana has been able to vaccinate up to 90% of its population for various other diseases, Quakyi says.
"We are talking measles, chickenpox, rubella, whooping cough, tetanus. And we do that through a cold storage and cold chain infrastructure that has over the years become very specialized. So in terms of actual storage and distribution, especially for the kind of vaccine we're getting from AstraZeneca, that fits perfectly into that whole chain."
But George Mwinnyaa, a research fellow at Johns Hopkins National Institute of Allergies and Infectious Diseases who grew up in Ghana, says that impressive success rate is a little misleading. Yes, the government may be able to get the COVID vaccine vials from point A to point B as it does with other vaccines, says Mwinnyaa. But he says that many people don't quite trust it.
"COVID vaccines are for adults, they are new and [Ghanaians] already have misconceptions and myths," says Mwinnyaa.
"The biggest rumor is that there's a big conspiracy theory that it [the vaccine] is coming for a tryout and the Ghanians are being used as guinea pigs," he says. "Of course this is not true. But the thought is the whites are coming to wipe us out with the vaccine."
Adding fuel to the rumor, says Mwinnyaa, is the brand of vaccine COVAX gave to Ghana: AstraZeneca.
"The biggest question I get asked [by friends in Ghana] is: Why didn't COVAX get us Pfizer or Moderna? Why did they give us AstraZeneca, which is not approved in the U.S.? In Ghana people really look up to the United States and believe in the FDA. And so when something is not approved in the U.S. In the eyes of Ghana, the U.S. is an ideal and the U.S. FDA did not approve it."
So like many countries — including the U.S. — Ghana needs to educate the public about vaccines, says Mwinnyaa: "Without strong public education these vaccines will be useless because the myths run deep. In my view what will be more challenging [than distribution] will be the public perception and debunking some of these conspiracy theories."
The government is trying to get the message out, says Dr. Elliot Koranteng Tannor, a senior specialist physician and consultant nephrologist at the Komfo Anokye Teaching Hospital. But he predicts it will be an uphill battle.
"Monday, the president and the vice president and parliamentarians, and all their families got the first shots on TV to show it is safe," he said. "But some will still say that wasn't the [real COVID] vaccine they got in their arm."
'A drop in the bucket'
Then there's the issue of numbers.
COVAX gave Ghana 600,000 vaccines. Rather than use these to provide the suggested two doses of AstraZeneca for 300,000 individuals, Ghana's health ministry plans to administer them as first doses for 600,000 citizens — and trust that COVAX or Ghana's government will find a way to supply the second doses, says Tannor.
At this time, UNICEF, which is part of the COVAX collaboration, is unable to give a specific timeline for the arrival of the next COVAX shipment — and whether it can ensure those doses will arrive within the recommended timeframe for the second dose (an interval of eight to 12 weeks, according to the World Health Organization website).
And even if Ghana is able to get the next dose in time for the first 600,000 vaccine recipients, there are still 30 million Ghanaians.
The government has said it plans to vaccinate 20 million people by the end of October, according to Dr. Kwame Amponsa-Achiano, senior public health specialist at the Ghana Health Service. "Which means, given the current regimen of two doses, we need to find about 40 million doses," says Quakyi.
The first COVAX supply, he says, is "a drop in the bucket."
Nonetheless, Mwinnyaa, for one, is encouraged. Just a few weeks ago, in mid-February, there were 130 countries that were "yet to administer a single dose," according to UNICEF.
That's 2.5 billion people who were shut out of the global vaccine campaign.
For Mwinnyaa, those 600,000 historic doses are definitely a "positive sign."