After leaving the airport, the cube vans carrying vaccine plunge onto the chaotic roadways that knit Luanda’s urban centre together, becoming a couple of white blips in the speeding, honking, swerving late afternoon traffic.
The noise drops away as they pass through a high gate into a yard of neatly manicured gardens surrounding a nondescript white building.
The sign above the door has the gleam of a recent addition: Depósito Central de Vacinas.
Angola’s Health Minister Dr. Silvia Lutucuta says the country has had to seek out opportunities for vaccine procurement. Carlos Cesar for the Toronto Star
This is Angola’s vaccine depository, a crucial lynchpin in its distribution system.
The health minister says the country started ordering fridges and planning a distribution network last year. A country must show it can store vaccines before it can receive them under the global vaccine-sharing program COVAX, and Angolan officials tried to prepare for anything — including a host of different vaccines with different storage requirements.
“All over the country, we can vaccinate with Pfizer, we can vaccinate with Sinopharm, we can vaccinate with AstraZeneca, we can vaccinate with Johnson and Johnson,” she said, speaking through a translator.
“We can vaccinate with any other vaccine.”
Given that some countries struggle to pay for and distribute typical childhood vaccines, the challenge of distributing COVID vaccine has pushed some health-care systems to the brink.
COVAX has tasked UNICEF, a branch of the United Nations that already provides aid to children around the world, with delivering donated vaccines as far as the local airport, at which point it’s largely the recipient country’s problem. (That said, UNICEF is also doing its own work in dozens of middle- and low-income countries, including things such as training and providing personal protective equipment to health workers and combating vaccine hesitancy.)
The challenge has been complicated by the fact that the size of shipments has varied and they have arrived on nothing resembling a set schedule. Wealthy countries have also used COVAX as a defacto clearing house for vaccines they can no longer use, some of which have been redistributed, as one observer put it, with all the organization and planning of someone regifting last year’s Christmas present.
In an email, a COVAX spokesperson said that vaccines are “ideally” allocated three months ahead to account for things such as expiry dates and how many vaccines a country can reasonably expect to use.
Before a donation ships out, countries must grant national regulatory approval for the vaccine, and complete “readiness checklists” to show they can store and transport the doses. They must also sign a “manufacturer-specific indemnity and liability agreement,” which limits the vaccine makers' responsibility for things like adverse effects.
While this isn’t unheard of during a pandemic, some countries have accused the makers of COVID vaccines of taking it too far — according to the U.K.-based Bureau of Investigative Journalism, Argentina accused Pfizer of asking for indemnity for, among other things, its own negligence. Pfizer was quoted in the story as saying it had allocated doses to low- and middle-income countries for a not-for-profit price and was “committed” to supporting efforts to promote global vaccine access.
Ultimately a recipient country can choose to take a donation or not. Poor nations rejected more than 100 million vaccine doses in December alone, mostly because they were too close to their expiry date, a UNICEF official told Reuters. Other countries have struggled to string together enough refrigeration capacity to keep the vaccines chilled to manufacturers' specifications.
In an interview with the Star, Harjit Sajjan, the newly minted federal minister of international development, says officials are currently moving “as quickly as possible” to assist the global community.
Sajjan, who did three tours in Afghanistan as a military reserve officer, says it’s important that donations and other supports are tailored to the needs on the ground, and that broader issues around a country’s ability to accept and use vaccines are addressed. Maybe some countries aren’t ready to transport vaccines, or don’t have enough refrigerators standing by, he says.
He points to countries that donated excess doses to low-income countries, only to see them tossed because they were too close to expiry: “It sounds all great from a political perspective. But we just wasted all those doses,” he said.
An official with UNICEF involved in shipments to this part of the world says that when he emails Angolan leadership to ask if they can handle another arrival, their only question is — how soon can it get here?
Angola was the first country in southern Africa to welcome a COVAX shipment, in March 2021.
The country has a population roughly the same size as Canada’s, but with not quite four per cent of the gross domestic product. That number papers over a stark divide between the haves and have notes — Luanda ranks among the world’s priciest cities for foreigners who pay $400 a night in high-end hotels and lounge at beach clubs while en route to offshore oil rigs.
Angola's vaccine deliveries
Vaccines received
27,062,952
From donations
24,022,952
Sources: Unicef Covid-19 Vaccine Market Dashboard
Meanwhile, almost half of the population lives on less than $2.50 a day. While Canada called in the army to make sure regular shipments of three vaccines were shuttled across the country, Angola has handled half a dozen different vaccines on a shoestring budget.
Angola is one of 92 countries classified as “low” or “low-middle” income by COVAX, and it has been mostly dependent on donations, despite managing to pay for some vaccines. The country has received donations well known in the West, including Pfizer, Moderna and Janssen, but also shots less familiar to a Western audience, including Sinopharm from China.
Roughly a dozen countries have chipped in donations, according to UNICEF’s vaccine tracker. Portugal, Angola’s former colonial ruler, has sent at least three types of vaccine, including more than 700,00 AstraZeneca doses from its own supply. Even Alrosa, a Russian mining company that owns almost a third of a massive open-pit diamond mine known as the Catoca mine, announced it was sending 50,000 doses of Russia’s Sputnik V shot.