How do you vaccinate a small African nation? Rwanda’s health minister explains

·5-min read
 (WHO/Andre Rugema)
(WHO/Andre Rugema)

When the first Covid-19 vaccines landed in the Rwandan capital Kigali on March 3rd, the country was ready.

Within an hour, the vaccines reached the health ministry’s central warehouse, where vehicles from the country’s 47 district hospitals were waiting with fridges on board. In a deployment that had already been tested and tweaked, the trucks fanned out across Rwanda’s green hills and valleys, and army helicopters lifted off to deliver the vaccines to the most remote pockets.

“It was all about preparation. Our experience of preparing for outbreaks of contagious diseases in the past has helped us develop detailed crisis plans, which we were able to put into effect as soon as Covid-19 was identified,” says Dr Daniel Ngamije, Rwanda’s Minister of Health.

“Planning the logistical elements of our vaccine rollout, similarly, was set in motion shortly after a state of emergency was declared.”

Rwanda’s Health Minister Dr Daniel Ngamije (right)  as vaccines arrive in Kigali in March (WHO/Andre Rugema)
Rwanda’s Health Minister Dr Daniel Ngamije (right) as vaccines arrive in Kigali in March (WHO/Andre Rugema)

On a continent where fewer than 5 per cent of people are fully vaccinated, Rwanda’s vaccine rollout stands out as a success, not just in Africa but by any global comparison. In a Covid Performance Index compiled by the Lowy Institute, Rwanda ranked 7th in the world.

It’s not a competition, Dr Ngamije insists. “We are all part of the same fight to defeat this pandemic, and given the interconnectedness of our continent, we are not safe until everyone in Africa is safe.”

Nevertheless, Rwanda’s experience could provide lessons for other African nations, both in their response to Covid-19 and to future pandemics.

“One of the important things is that our vaccine programme was not born in the time of Covid. From the central planning, the warehousing, logistics and transport to the communities - the whole supply chain - the foundations were already there,” says Dr Sabin Nsanzimana, Director General of the Rwanda Biomedical Center, which coordinates the rollout.

“We just had to strengthen them because not only were Covid vaccines coming in big numbers, we also had other vaccination programmes for children that were continuing,” he explains.

As well as preparing regular refrigerators used for other vaccines, Rwanda also purchased ultra-low temperature freezers able to store the Pfizer vaccine at -70 degrees Celsius, becoming the first African country to use Pfizer’s doses that require ultra-cold storage.

 (WHO/Andre Rugema)
(WHO/Andre Rugema)

Without the resources to front up funds to make large pre-orders, many African countries had to stand by last year as the world’s richest countries reserved doses to vaccinate their populations against Covid-19 several times over.

Rwanda, like most African nations, has received supplies from the vaccine-sharing facility COVAX. But when those supplies dried up in April – as vaccines were diverted to combat India’s massive infection wave - Rwanda cut deals directly with manufacturers Pfizer and AstraZenca to secure 4 million doses, says Health Minister Dr Ngamije.

Once on the tarmac, the shots reached people’s arms within hours. In power for 27 years since the 1994 genocide, the administration of President Paul Kagame prides itself on efficiency and technological expertise.

“We have a saying here that we don’t store vaccines in fridges or warehouses, we store vaccines in people’s arms,” says Dr Nsanzimana.

 (WHO/Andre Rugema)
(WHO/Andre Rugema)

Known as The Land of a Thousand Hills for its lush, mountainous terrain, Rwanda deployed “helicopters from day one and we had purchased vehicles for each of the district hospitals, so they could transport vaccines overland to the health centres,” he says.

First in line were the elderly and most vulnerable, followed by jabs for those most exposed to infection – key workers, moto-taxi drivers and hospitality staff. Next came a mass campaign across the capital city.

“Kigali has been the most significant hub for transmission,” says Dr Ngamije. “By vaccinating over 90 per cent of adults in the city, we can reduce transmissions and protect the entire nation.”

On a continent where misinformation and hesitancy around the Covid-19 vaccine is rife, again Rwanda has trodden its own path.

Building on trust built over years of routine vaccinations for children, Rwanda mobilised everyone from heads of households and village elders to district and provincial leaders to disseminate accurate information on the Covid jab, says Dr Ndoungou Salla Ba, the World Health Organisation’s Representative in Rwanda.

Radio and TV channels hosted interviews and answered questions about the vaccine in local languages and daily updates are posted on social media.

“Our top leaders, the president himself, religious leaders, teachers, scientists and celebrities have also come forward to take the vaccine in public,” says Dr Nsanzimana of the RBC. “So in Rwanda we have not had the issue of vaccine hesitancy. Actually, it’s more about the pressure on us to bring in more vaccines.”

 (WHO/Andre Rugema)
(WHO/Andre Rugema)

Rwanda’s target now is to vaccinate at least a third of its population by the end of the year, rising to 60 per cent next year. And it is laying the foundations for a longer term solution by positioning itself as Africa’s vaccine manufacturing centre.

“We hope that before long, and with support from the international community, we can become a hub for the home-grown vaccines that Africa needs in order to be self-sufficient in the fight against future pandemics and outbreaks of infectious diseases,” says Dr Ngamije.

The country is in talks to establish the first mRNA vaccine plant in Africa, with Rwanda, Senegal and South Africa on the shortlist for U.S. drugmaker Moderna’s planned factory.

“When the Rwandan government commits, it makes it happen,” concludes WHO’s Dr Salla. And the government is really committed to ending this pandemic.”

Watch: Moderna considers Senegal, Rwanda, and S.Africa

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