Four people turned up at a health clinic tucked in a sprawl of commercial maize farms on a recent morning, looking for Covid-19 vaccines. The staff had some vaccine in the fridge. The staff members were apologetic and suggested that they try again.
The staff was under orders not to waste a single vaccine dose, because there was only five available.
Ida Musonda, the nurse who supervises the vaccination effort, suspected that her team might have found more people if they packed the vaccine in Styrofoam coolers and went to markets and churches. She said that there was no fuel for the vehicle to take the vaccines.
The records from the last trip to a farm were sitting in a paper heap in the clinic because the data manager had no internet connection.
The biggest challenge to protecting the world from Covid has been the lack of vaccine on the African continent, which has only received 404 million doses.
Obstacles are coming into focus as supply has begun to trickle into a more reliable flow. They are all on view.
Weak health care systems with limited infrastructure and technology are trying to get shots into the arms of people who have more pressing priorities. The global flow of information and deliberate misinformation on social media is creating the same skepticism that has stymied vaccination efforts in the United States and other countries.
Some people in the country are hesitant, but others have an attitude that could be described as vaccine indifference. The economy of this country has contracted sharply during the Pandemic and many people are notvaccinated.
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Simon Phiri walked three kilometers on his day off to get a Covid vaccine at a clinic in Chongwe, outside of Lusaka.
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The New York Times reported that the woman was skeptical of the fearmongering around Covid vaccines, but said she had more urgent health worries than the coronaviruses.
"I would like to get it, but I work Monday to Saturday and I don't know if they give it on Sunday," said Bernadette, who supports a large extended family with her wages from an auto-parts store in a low-income neighborhood on the edge of Lusaka. She has heard that the vaccine is part of a plan by Europeans to kill Africans and take their land, that Bill Gates is trying to reduce the world population, and that people who receive the vaccine will die in two years.
She rolls her eyes at the stories. Covid isn't on her list of health care worries. She said that there is H.I.V. and Tuberculosis in this season. She doesn't know anyone who has been diagnosed with Covid.
Two major problems are created by all these challenges. The pace of vaccination is too slow to prevent unnecessary deaths in a fourth wave, which is already beginning in southern Africa, or to prevent the emergence of new variant such as Omicron, which was first identified in South Africa last month. The vaccines in stock may not be used before they are destroyed.
The push to vaccine against Covid is drawing resources from health systems that can't spare them, which could lead to disastrous consequences for the fight against other devastating health problems.
The usual bustle and screeching at the mother-and-child health area, where babies are monitored for signs of malnutrition and given childhood immunizations, was absent because everyone on that staff had been re-designated as Covid vaccinators.
It is important that we protect the investments that have been made in H.I.V., maternal and child health, and Tuberculosis and Malaria, because every time we have a wave here it really threatens the investments.
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Women wait to see a nurse at a rural clinic.
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The technician at the clinic had no internet connection to make an electronic record and Charity Machika's vaccination data was registered on a paper card.
The director of public health for the health ministry in Zambia said that there was evidence that there had been a decline in infant growth monitoring and childhood immunizations. He is worried that infections will increase.
Some five million people have been vaccined against Covid. The president has set a goal of 70 percent of the population being vaccined by the third quarter of 2022, a goal that looks very ambitious.
Covax, the global vaccine-sharing initiative, is the main source of vaccines for Zambia. The fact that Zambia is dependent on donations means that it must adapt its program to whatever comes in, like making a meal with whatever arrives in a farm subscription box. The country is managing the distribution of five different vaccines.
The administrative burden has been created by that. The effect can be seen in the charts on the wall, which show the number of people who came back for a follow-up shot after receiving a first dose.
The coverage of the deaths of people in the parking lots of hospitals that ran out of oxygen made people think that the Covid was only for white or rich people. There were lines outside vaccination sites that couldn't keep up with demand.
When the wave abated, so did the demand.
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The health clinic has basic infrastructure.
Many people here remember the time when Western pharmaceutical companies refused to produce affordable drugs that could save lives. The companies that have come up with free solutions are being questioned.
In evangelical churches, the vaccine misinformation spreads because the shot contains the mark of the beast.
Dr. Zuze said that if a pastor said they didn't trust the vaccine, people wouldn't trust it.
There are false rumors that the vaccine causes female infertility in the United States. There are reports of blood clot in a very small number of people who received the shot, which has led to the fact that it is not being used in many countries. Everyone can switch on CNN.
Small children are usually the only ones who are protected by the vaccine, and it has no primary care practices. When pregnant or receiving H.I.V. treatment, an adult must go to a clinic.
Dr. Lawrence Mwananyanda, an assistant professor with the Boston University School of Public Health and a special adviser to President Hichilema, said that the government must balance between trying to create vaccine demand and not creating too much, when it can't be sure if it will have
He said that sometimes people go to a health facility and there is no vaccine, because they don't have cars. They are only told that if there are five or six people, they can't bevaccinated. How likely are you to come back?
Charity Machika received a vaccine at a rural health center. She was encouraged to go to the H.I.V. treatment center after going to the clinic for a checkup. She said she was scared because people said she would die and she would not be able to walk. I took the risk to protect myself and my baby.
She is the only person in her family who has not been shot. She said that it was difficult for her husband to make the four- kilometer walk to try and get the vaccine he was looking for.
The government has yet to tap into the vast network of H.I.V. and Tuberculosis treatment activists in the country, according to a veteran H.I.V. activist. He said that testing and treatment for H.I.V. only reached critical mass when care was delivered in bars, at schools and on doorsteps.
If they don't use the structures we already have, donors will keep sending the vaccines and they'll pile up here and expire and then they won't send us anymore
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Joo Silva of The New York Times received treatment at a clinic.
Dr. Mwananyanda said the key strategy for the planned rapid scale-up in vaccination was to take the vaccine to people in malls and bus stops.
No one is thinking about what will happen next. The C.D.C. says that they don't have a system for the long run. We need to start from zero and give people more vaccines if there are some new versions that escape the vaccine altogether.
Dr. Agolory said that it will need help procuring more and funding to bring on temporary health care workers to administer vaccines so that existing programs, like the Ngwerere mother-and-child clinic, are not abandoned.
Even with a huge boost in vaccination rates, the country won't have enough coverage to stop the coming wave.
The health ministry wants to keep getting vaccines so that people don't have to get them. We don't have enough demand for vaccines and they go to waste, which is something that I would really hate to see happen. These vaccines cost a lot. It would sting so badly.
