The Last Mile:
Uganda’s Covid-19 vaccine struggle

NBC followed a team bringing vaccine doses to remote regions of Uganda. This landlocked East African nation has only enough vaccines to protect just 1 percent of its population.

UNICEF team arriving on Buvuma Island to begin Covid-19 vaccinations. Video: Kasiita Abu and Bill Angelucci / NBC News

UNICEF team arriving on Buvuma Island to begin Covid-19 vaccinations. Video: Kasiita Abu and Bill Angelucci / NBC News

NAMATALE, Uganda — Dr. Eva Kabwongera’s job is to make sure life-saving Covid-19 vaccines reach Uganda’s 45 million people. On a recent morning, that journey took her to a tiny island that is home to less than 2,000 people. 

The 40 doses Kabwongera brought with her to Namatale had traveled more than 3,000 miles via plane, truck, ferry and boat from Pune, India, to get to the outcrop in Africa’s vast Lake Victoria.

“We are delivering hope,” said Kabwongera, who is UNICEF’s immunization chief for Uganda, as she stepped into shallow water and walked to shore soaking wet. Dozens of small, smiling children greeted her. 

“The people there are waiting for it,” she added. 

Dr. Eva Kabwongera

Dr. Eva Kabwongera says the country is struggling to finance deliveries to remote locations, such as Namatale. Photo: Christine Romo / NBC News

Dr. Eva Kabwongera says the country is struggling to finance deliveries to remote locations, such as Namatale. Photo: Christine Romo / NBC News

But hope does not defeat a pandemicvaccines do. And Uganda doesn’t have enough to vaccinate even a tiny portion of its population. With the severe international shortage, Uganda and countries like it look set to have to wait to inoculate even its front-line health workers and most vulnerable groups to help stop Covid-19 and prevent the development of dangerous vaccine-resistant variants.

The result has been an extreme gap in vaccine distribution, with almost 1 in 4 people receiving a vaccine in high-income countries and a staggering 1 in more than 500 in low-income ones, according to the World Health Organization. Uganda, for example, has so far received only 864,000 vaccine doses — enough to fully vaccinate 400,000 people with two doses, or less than 1 percent of the country’s 45 million population. 

It wasn’t supposed to be like this.

Children laugh and cheer as vaccines are distributed

Children laugh and cheer as vaccines are distributed on Namatale Island. Photo: Christine Romo / NBC News

Children laugh and cheer as vaccines are distributed on Namatale Island. Photo: Christine Romo / NBC News

One year ago as Covid-19 marched across the globe, claiming lives and upending economies, the WHO and global vaccine charities kick-started a global initiative called COVAX. It’s the largest vaccine procurement in history, meant to guarantee equitable access to Covid-19 vaccines around the world. 

Today, developing countries like Uganda have been left behind in the vaccination race. In fact, they’ve barely started. 

Nurse Natalie Victa prepares to administer the Covid-19 vaccine on Namatale Island, distributed by UNICEF. Photo: Christine Romo / NBC News

Nurse Natalie Victa prepares to administer the Covid-19 vaccine on Namatale Island, distributed by UNICEF. Photo: Christine Romo / NBC News

Of more than 1 billion Covid-19 vaccine doses administered globally so far, 82 percent have been in high or upper middle-income countries, while just 0.3 percent have been administered in low-income countries, the WHO chief, Tedros Adhanom Ghebreyesus, said on April 29. 

Even with rich countries buying up most of the global supply, COVAX had been hoping to put 2 billion shots in arms by the year’s end. Many experts have always said this goal was far too optimistic, but COVAX is already way behind. That's partly because of export controls imposed by India, where almost all of COVAX's vaccines are made, as the country keeps doses made on its soil to deal with its own crisis.

“That is painful, very painful,” Uganda’s health minister Dr. Jane Ruth Aceng told NBC News as she sat outside her office in Kampala, Uganda’s bustling capital. 

“This pandemic has affected the entire globe,” Aceng said. “We have to hold hands together if we are going to win this war.” 

Namatale is one of the smallest and most remote islands on Lake Victoria. Video: Kasiita Abu and Bill Angelucci / NBC News

Namatale is one of the smallest and most remote islands on Lake Victoria. Video: Kasiita Abu and Bill Angelucci / NBC News

The country is set to receive 3 million vaccine doses from COVAX through May — a fraction of what is needed to stop the virus with herd immunity — but with global supply constraints growing, even that could be in danger, Aceng, 52, said.  

“We are not getting vaccines as quickly as we should,” she added. 

Since COVAX began its global rollout in late February, more than 59 million doses have been delivered to 122 countries, according to data from UNICEF, which helps procure and distribute Covid-19 vaccines. That's just over one fifth of the 250 million doses it had wanted to deliver by the end of May.

And despite vaccine manufacturers trying to scale up and optimize their production, the global supply of Covid-19 vaccines is still far from matching the demand. Current models predict that there will not be enough vaccines to cover the world's population until as late as 2024, according to research by Duke University.

Epidemiologists have cautioned that low levels of vaccinations in developing countries, like Uganda, could undermine vaccination efforts around the world and could prolong the pandemic, allowing the virus to spread and mutate. And even if richer countries reach some level of herd immunity, everyone will remain vulnerable as long as there are pockets of Covid-19 anywhere in the world.

The Biden administration has struck a far more internationalist tone than that of former President Donald Trump. It has pledged $4 billion toward COVAX — the most of any country — and said it will donate surplus shots abroad as part of its international fightback against the virus.

But Biden's focus has still been domestic, making sure Americans are not impacted by any global goodwill and only offering to give away its stockpile of 60 million Oxford University-AstraZeneca vaccines — which it wasn't using anyway.

“If any country thinks after vaccinating its population they are safe, it is a lie”

— Uganda’s health minister Dr. Jane Ruth Aceng speaks to NBC News.

‘It feels good’

In Namatale, a wooden desk covered with green tablecloth sits in front of the island’s health clinic — a hand-written sign reading “vaccination table” hanging from it. Registration forms, a hand sanitizer bottle and disposable gloves sit next to a gray cooler box with a blue UNICEF sticker — that’s where the vaccines are.

Breeze blows from the lake and music plays from the loudspeakers in the background as the recipients, mostly health workers, get their shots one by one.  

Dr. Katende Jimmy

Dr. Katende Jimmy shows his vaccination card. Christine Romo / NBC News

Dr. Katende Jimmy shows his vaccination card. Christine Romo / NBC News

A clutch of curious children watch as Dr. Katende Jimmy rolls up his sleeve for the injections. 

“It feels good,” he said. “We want to do away with this pandemic.”

He’s one of the lucky ones; other health workers will have to wait for their vaccine. 

The 52 islands that comprise the Buvuma Islands, of which Namatale is one, had received 1,070 doses when NBC News visited in late March. About 130,000 people live there, 200 of them health workers. 

Kabwongera, who works round-the-clock managing UNICEF’s immunization program in Uganda, said only 320 people across the islands have been vaccinated since NBC News left and as the country struggles to finance deliveries to remote locations. 

With COVAX sending vaccines in small batches — instead of by the millions — going back to places as remote as Namatale to vaccinate new groups of people as doses trickle in is expensive, according to Kabwongera.

At the moment, she and her team have to go to each and every island to vaccine health workers alone. 

Whenever the next shipment arrives from COVAX, she said, they will have to go back to Namatale and the other 51 remote Buvuma Islands on Lake Victoria to start targeting the next key group — teachers. That means more money is needed for fuel and other transportation costs. 

“This is gold to us.”

—  Dr. Yayi Alfred

Twahf Sedi Olega, a cold-chain specialist responsible for keeping the vaccines at the correct temperature, is flanked by two armed security guards who keep watch over the site 24 hours a day. Photo: Christine Romo / NBC News

Twahf Sedi Olega, a cold-chain specialist responsible for keeping the vaccines at the correct temperature, is flanked by two armed security guards who keep watch over the site 24 hours a day. Photo: Christine Romo / NBC News

Around the same time as Kabwongera arrived in Namatale, COVAX-supplied vaccines landed some 260 miles north of the island in Bidibidi, a vast refugee camp on the border with South Sudan. 

Uganda is the largest refugee host in Africa, with the refugee population of around 1.4 million.

Bidibidi alone is home to 230,000 people. 

Refugees in Uganda live alongside citizens and enjoy many of the same services, including vaccinations.

When NBC News visited the camp on March 23, health officials were distributing just over 10,000 Covid-19 vaccine doses allotted to its residents and the town of Yumbe next to it. Most went to health care workers, some of whom are also refugees. 

Wearing a suit and tie, Dr. Yayi Alfred pointed to two blue refrigerators holding vaccine doses.

He stood in a stuffy storeroom that was barely big enough to fit five people. Two armed guards stood outside. Its wooden doors were heavily padlocked. 

“This is gold to us,” Alfred said. “It’s very important that we keep it well and put it to right use.”

Johnson Macore, 20, a refugee from South Sudan, got his vaccine shot alongside Ugandans. 

He told NBC News he works as a health interpreter in the Bidibidi settlement and dreams of becoming a doctor one day. He said that at 15, he escaped civil war in South Sudan by walking for 14 days to reach Bidibidi. 

“Refugees are not being given a different vaccine,” the soft-spoken Macore said as he sat in the shade of a giant tree and a nurse monitored him for side effects of the vaccine. 

“Ugandans are receiving the same vaccine that refugees from South Sudan are receiving,” he added.

Johnson Macore and Alinda Lumarri

Johnson Macore and Alinda Lumarri, refugees from South Sudan, fill out paperwork before receiving the first dose of the Covid 19 vaccine. Photo: Christine Romo / NBC News

Johnson Macore and Alinda Lumarri, refugees from South Sudan, fill out paperwork before receiving the first dose of the Covid 19 vaccine. Photo: Christine Romo / NBC News

Johnson Macore
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Johnson Macore and Alinda Lumarri

Johnson Macore and Alinda Lumarri, refugees from South Sudan, fill out paperwork before receiving the first dose of the Covid 19 vaccine. Photo: Christine Romo / NBC News

Johnson Macore and Alinda Lumarri, refugees from South Sudan, fill out paperwork before receiving the first dose of the Covid 19 vaccine. Photo: Christine Romo / NBC News

Johnson Macore

‘Americans are not safe’ 

In Kampala, Aceng, the Ugandan health minister, said the country was aiming to vaccinate at least 50 percent of the population. 

Experts estimate that 70 percent or more need to be vaccinated for a country to achieve herd immunity. But Uganda is a nation of young people, with nearly 50 percent of its population below 15, so targeting the other half is the real goal in battling a disease that generally affects older people, Aceng said. 

However, the first COVAX shipment will be enough to fully vaccinate only 1 percent of its population. 

How to make up that gap in a timely manner is something Aceng said she can’t answer. 

“It would take nearly the entire international community to answer that question,” she said. “Production is low. The vaccines are in high demand by every country in the world. We all want to get vaccinated.” 

So far, Norway and New Zealand have pledged to transfer the doses they have purchased through COVAX to low-income participants of the program, a spokesperson for Gavi, the alliance that helps run COVAX, told NBC News. Last month, France became the first country to donate doses from its domestic supply to COVAX. Sweden followed suit on May 3, raising hope more developed countries will pitch in. 

Covax shipments in Copenhagen, Denmark

Covax shipments are prepared along a conveyor belt at UNICEF's 20,000 square foot distribution center in Copenhagen, Denmark. Photo Christine Romo / NBC News

Covax shipments are prepared along a conveyor belt at UNICEF's 20,000 square foot distribution center in Copenhagen, Denmark. Photo Christine Romo / NBC News

On April 26, the U.S. announced plans to ship its stockpile of millions of AstraZeneca vaccine doses overseas as it ramps up vaccination efforts at home. It has yet to say if it will be sharing those doses through COVAX or sending them directly to receiving countries. 

With more than 100 million people in the U.S. now fully vaccinated and everyone 16 and older now eligible to be vaccinated, it’s easy to get complacent and think that the pandemic is over, Aceng said. 

“Americans are not safe,” she said. “It takes a few hours to reach the United States, it takes a few hours to reach China, it takes a few hours to get anywhere in the world, so the virus will continue to move.”

“If any country thinks after vaccinating its population they are safe, it is a lie,” she added. 

Christine Romo and Cynthia McFadden reported from Uganda, Yuliya Talmazan reported from London, and Kit Ramgopal reported from New York. 

Kit Ramgopal contributed.