Uganda: Covid Jab Breakthrough Exposes Health Officials


By TABU BUTAGIRA

Uganda has made a major breakthrough in its hunt for Covid-19 vaccines, snapping up a generous offer by Covax on behalf of the Global Alliance for Vaccines and Immunisation (Gavi), but not without controversy.

Sources told this newspaper that emotions ran high at a meeting on Monday of the nine-member Vaccine Acquisition Committee (VAC), a steering committee that Cabinet established in July to coordinate vaccine access, before Health officials caved in to a demand to book 18 million doses of Covax-offered jabs.

In an earlier sitting last Friday, Health officials informed members that 10 private companies had expressed interest – unsolicited – to supply vaccines to Uganda.

They informed the committee that eight had failed preliminary assessment on the basis of “defective submissions or proposed to supply vaccines that were not listed by World Health Organisation as such couldn’t be considered for importation into Uganda”.

In the meeting which happened two days after Covax made the offer to Uganda, the Health team presented two of the 10 companies — M/S Beyler PVT Ltd and M/S Rhart Solutions — it said it had vetted so that VAC members could recommend them to the government for issuance of letters of intent.

Without assurance that the preliminary selection process of the private firms complied with procurement rules, and polarised over committing the government to such a deal, members remained divided until State House reined in on Health ministry to book vaccines with speed from Covax.

Covax is a World Health Organisation-established facility to help poor countries such as Uganda, crowded out by the purchasing power of wealthier nations, to get vaccines.

VAC is chaired by Dr Henry Mwebesa, the director general of Health Services, with other members being Prof David Serwadda, the chair of the government scientific advisory committee; Amb Adonia Ayebare, Uganda’s permanent representative to the United Nations; Prof William Bazeyo of Makerere University; Dr Alfred Driwale, the manager for immunisation at the Ministry of Health; and Mr Moses Droma Onzima, the deputy director of Operations at External Security Organisation.

Others include Mr William Musubire representing the National Medical Stores, the statutory agency responsible for procuring medicines and health commodities; Mr Jimmy Ameny, who handles procurement at the Health ministry as well as Solicitor General Francis Atoke, who replaced his deputy Christopher Garibashake.

Dr Diana Atwine, the Permanent Secretary in the Ministry of Health, last night corroborated information earlier obtained by this newspaper that Uganda three days ago booked 18 million doses of Sinopharm and Sinovac dangled by Covax.

In an August 11 letter on behalf of Gavi, the Covax Country Engagement Director, Mr Santiago Cornejo, informed Health Minister Ruth Aceng that they had on offer and under cost-sharing arrangement — 30 million and 75 million doses of Sinopharm and Sinovac, respectively.

The vaccines are planned to be delivered anywhere between October and December, this year, and at the lowest market prices, $5.5 (Shs19,000) per dose.

In an August 5, 2021 statement prepared for Parliament by the State minster in-charge of Health for General Duties, Ms Anifa Kawooya, officials placed the cost of a dose of Sinopharm at $19 (Shs68,400) and that of Sinovac at $13 (Shs46,800) — at the very least double the new price offered by Covax.

To-date, Uganda has vaccinated 1.7 million, or 8 per cent, of the targeted 21.9 million citizens, excluding the 7 million-plus students aged 12 to 17 years added to the inoculation-eligible category only three weeks ago.

The country has not bought a single jab using its own money, and benefitted from bilateral and multilateral donations, citing vaccine shortage and hoarding by rich and powerful nations.

Strained in search of vaccines and terrified by resurgence of Covid infections and deaths from late May until a 42-day lockdown dampened the wave, Uganda accelerated the hunt for jabs by empowering its embassies abroad to scout for any supplier.

Cabinet then created VAC to coordinate and harmonise the search for the vaccines across the western world and from China to Russia to Cuba.

Citing a July 1, 2021 framework agreement between the government of Uganda and Covax, Covax Country Engagement Director Cornejo gave Uganda up to Tuesday, this week, to submit an AMC cost-sharing participant supply offering selection “or it will be deemed that you do not wish to purchase any doses of the approved vaccines set out in the letter [to Minister Aceng].”

Dr Mwebesa, the chair of VAC, to whom PS Atwine referred our inquiries about consideration of the private companies for vaccine supply, did not answer or respond to this newspaper’s repeated telephone calls.

Health ministry spokesperson Emmanuel Ainebyoona said he was not aware of the details of the Covax vaccine offer and hinted at the possibility of the Health Minister, Dr Aceng, addressing the country as early as tomorrow about it and the Covid situation.

In last night’s interview, PS Atwine said they ordered for only 18 million of the available 105 million doses of vaccines from Covax because they have parallel pipeline through which they expect to get 9 million doses of Johnson&Johnson vaccines and another combined 10 million doses of Pfizer, Moderna and Oxford-AstraZeneca.

“We are also looking at other opportunities to get vaccines that are affordable. There are many people pushing to get for us vaccines. But we have committed to Covax, which is more affordable and reliable, with preference for Sinopharm [vaccines],” she said.

The government is yet to deploy 300,000 doses of Sinovac donated by the Chinese government last month amid reports that the National Drug Authority had not approved its use in Uganda, but PS Atwine attributed the delay to pending “documentation”.

Top scientists in the country earlier said they did not have enough data on efficacy and safety to recommend a person to be given different vaccines.

Uganda initially made a $3 million down payment to acquire 2 million doses of Johnson&Johnson vaccine, but the order was varied to 9 million doses following an August 3, 2021 Zoom meeting between government bureaucrats and officials of the American pharmaceutical organised by Ambassador Adonia Ayebare.

“I can confirm that I arranged the meeting which resulted in the increase of the doses of Johnson&Johnson vaccines for Uganda by 7 million,” he said when contacted last night.

This was the first ever direct interface between Ugandan officials and vaccine manufacturers, with Uganda represented by Dr Alfred Driwale of the Ministry of Health and Amb Ayebare while Johnson&Joshnson was represented by its Head of Africa Programme, Ms Lynda Arthur, and Mr Alan Tennenberg, the chief medical officer of Global Public Health.

The Johnson&Johnson vaccines, combined with the 10 million in the pipeline and 18 million doses booked with Covax, means Uganda expects 37 million doses soon in the country.

Highly-placed sources told this newspaper that the United States is set to deliver Moderna doses anytime once Uganda provides assurances of cold chain to the last mile to keep the vaccine’s recommended storage temperate of 70 degrees Celsius.

Back to last Friday’s meeting of VAC, members questioned why the Ministry of Health elected to recommend private companies when there was an offer on the table by Covax, through which Uganda has acquired all its 1.7 million doses of donated vaccines.

The committee members said they would not endorse issuance of letters of intent to private suppliers of vaccine and Health officials attempting to block the Covax offer.

The dissenting members were reportedly led Amb Ayebare and supported by Solicitor General Atoke and Professors Serwadda and Bazeyo, who strongly argued that dealing with private companies without vetting would lead Uganda to lose money and time.

Sources told this newspaper that Dr Atwine, who attended Monday’s VAC meeting, alongside other health officials, attempted to persuade members to consider private vaccine providers as well but their argument was defeated.

The committee ordered that Uganda buys 21 million doses from Covax, but it was later varied to 18 million.

Asked last night how the private firms knew of the opportunity to supply vaccines without a formal bid call, PS Atwine said representatives of the companies went “knocking on the door of the Ministry of Health because they have heard that there is a global shortage of vaccines… they came to present their proposals”.

The other companies that expressed interest to supply vaccines to Uganda, but which were dropped, included M/S Rahue Inversiones Y Asesorias, M/S Ruby Medical Center, M/S Broi Big Revolution India PVT Ltd, M/S Alfrend Swantex Group, M/S Vax Corp Biomedical, M/S Aquarius Global, M/S Suffolk Medical Supplies and M/S Rhart Solutions.