Long Covid: A hidden pandemic

Appearing before Parliament’s Health Committee on Tuesday, a day after Health Ministry announced that the country’s last two hospitalised patients had been discharged, Dr Aceng said: “These resources (Shs652b) are needed to procure vaccines and related supplies, storage and distribution [of] vaccines and logistics and other operational costs.”
She did not disclose the number or type of the vaccine they intend to buy, or why they want to procure more when some of the unused stock in the country is nearing expiry date as early as next month.

Lawmakers on the Committee chaired by Koboko Municipality Member of Parliament, Dr Charles Ayume, didn’t scrutinise this cash proposal which minister Aceng retailed as necessary to “prepare” the country for the pandemic.
Latest Health Ministry statistics indicate that only 19.9 million out of 44.7 million, or less than half of Covid vaccine doses in stock, have been used despite the loud complaints by Uganda’s leaders in the early months of global vaccination that rich nations were hoarding vaccines.

Officials have been at pains to explain the less-than-satisfactory update of the jabs, with some blaming it on anti-vaxxer culture and Covid deniers, poor grassroot mobilisation and demand by some political leaders for cash as a pre-condition to rally the population for the inoculation.

Our investigations show that Health Ministry only used about Shs128b of the Shs560b that it received to buy 5 million doses, leaving much of the Treasury disbursement unaccounted for. Donors, bilaterally and through multilateral mechanisms, brought into the country nearly 40m doses of vaccines.
Uganda targeted to inoculate 22 million people, but to-date only 68 percent have got either a single or full dose. This means up to 7 million target citizens have not received any dose.

Fully vaccinating the 7 million would require 14 million doses of double-jab vaccines, meaning about 10 million out of the unutilised 24.8 million doses will still remain, begging the question why the rush to get Shs562b to ostensibly buy more vaccines.

Whereas officials did not explain the reason, the government has previously unveiled plans --- much contested by parents --- to administer Covid jabs to children aged 12-17, who number about 6.8 million. It also wants particularly the elderly, and most at risk population, to get booster shots.
These are outside the original plan to procure vaccines to inoculate 21.9 million. Vaccinating these children with the recommended double jab Pfizer vaccine, which Uganda has approved for use in children, will require around 13.6m doses.

More than half of the 13.5 million doses of Pfizer vaccines in the country are yet to be deployed, according to official statistics.
Of these, 5.7 million doses are at the National Medical Stores, which could cover 2.8 million children if all the doses were ringfenced for them.
Dr Timothy Lusala, the shadow minister for Health, in his alternative Ministerial policy statement, dated March 2022, said the country already has enough vaccines and there is no need for huge sums of tax payers’ money to be spent on vaccine procurement as Health Ministry intends.

He said Dr Aceng’s policy statement for Health sector is silent on more important issues.
“Notable is an allocation of Shs652b for what is termed as the ‘Covid-19 resurgence plan’… The health sub-programme has nineteen intervention areas as per the National Development Plan III. The budget framework paper and ministerial policy statement do not show what exactly will be done to operationalise each intervention area,” he noted.

According to the shadow minister, going by the World Health Organisation (WHO) guidelines, all the available vaccines should be for those 18 years or older, with priority to the elderly and those with comorbidities.
“We note that the country has already procured and, or received in donations, sufficient Covid-19 vaccines to administer to the categories of people indicated by the WHO guidelines. We, therefore, propose that the colossal sums of money being requested for mass vaccination campaign be invested in the establishment of a minimum care and monitoring package that will ensure early and timely detection of any Covid-19 cases at the community level, including schools,” Dr Lusala noted.

The alternative proposals from the shadow minister include amplifying the role of community-based health care through the empowerment of community health extension workers, village health teams and the role out of integrated community case management.
It also captures the need to invest in health promotion and disease prevention, increase funding towards the prevention of non-communicable diseases and equip health facilities.
Dr Aceng on the other hand told this newspaper yesterday that the Shs652 billion they are asking for is needed to prepare and fight any imminent Covid-19 pandemic cases.

“We need to be prepared as a country and that is why we are asking for the money,” she said during an interview yesterday at Parliament.
She added: “We cannot stop taking action simply because cases have gone away. There are [Covid-19] variants still out there and other countries are doing everything possible in pooling resources in continuing to fight them.”

Without providing specifics, it is difficult to know what exactly is involved in the planned preparation package which is different from the various interventions since Covid outbreak to build the country’s capacity to respond to the pandemic.
Parliament Health Committee Ayume, himself a medical officer, sided with minister Aceng, reasoning that the significant decline in Covid infections, and deaths, does not mean planning stops.

“We have previously had waves [of Coronavirus] and believe we are not yet out of the woods,” he said.
Among the duties of lawmakers such as Dr Ayume is scrutinising the use of public resources, but he said much less about accountability in regard to Covid funds despite the Auditor-General John Muwanga raising red flags in his January 2022’s Special Audit report on related expenditure.
For instance, he reported serious mismanagement of part of the Shs2.3t that the government released for Covid-19 response in the 2020/2021 Financial Year.

Funds unaccounted for
Our investigations show that Health Ministry only used about Shs128b of the Shs560b that it received to buy 5 million doses, leaving much of the Treasury disbursement unaccounted for. Donors, bilaterally and through multilateral mechanisms, brought into the country nearly 40m doses of vaccines.