Nurses greeted patients at the front of the clinic to take their temperature and asked if they had been exposed. There was a hand-washing station. Patients were safely distanced in the waiting room. Hand sanitizer and masks were readily available.
Sanford Health’s clinics in Ghana looked and operated like those in the U.S. But the surrounding communities lacked reliable internet service, a consistent vaccine supply and adequate distribution channels, said Tracy Bieber, clinical services for Sanford World Clinics, who just returned from Ghana Sunday.
“Telemedicine hasn’t taken off like in New Zealand or the States because when you get into rural areas, they don’t have very reliable internet,” she said, adding that some of the clinics experience “down time” when connections intermittently drop. “That’s been a big hindrance.”
Sioux Falls, S.D.-based Sanford can still connect to the centralized communication system in Ghana to relay how to best store and distribute COVID-19 vaccines, Bieber said. But the connectivity issues illustrate how difficult it is to coordinate a global response to COVID-19 as many countries grapple with outbreaks.
Health systems across the U.S., including Sanford, Cleveland Clinic, UPMC and Mass General, have tried to help their counterparts around the world secure and distribute vaccines, source personal protective equipment, find testing supplies and guide public health safety measures. But they have been restricted by each countries’ respective ministry of health and red tape that slows or stops exports.
Without a coordinated, holistic, global response to COVID-19, outbreaks in places like India and Nepal could soon become everyone’s problem, and should be treated as such, experts said.
“It can be needle-moving for us to engage our own leaders, whether it’s here in the U.S., Europe or other rich countries where we have hoarded the global vaccine supply and are not really stepping forward, and say we have a global movement in solidarity here,” Louise Ivers, executive director of the Massachusetts General Hospital Center for Global Health, said on a recent webinar coordinated by the Harvard T.H. Chan School of Public Health. “For us to look over there and say that is someone else’s problem—it’s not, this is all of our problem.”
Only about 800,000 of Ghana’s some 31 million residents have been vaccinated. About 11% are reportedly vaccinated in Costa Rica, where Sanford helped implement the first drive-through vaccination site in the country. But positivity rates are still very high, executives said.
“They’ve had some issues of government nurses pretending to give out vaccines and selling them in the black market. People are so desperate they are willing to pay quite a bit,” said Karoliina Slack, senior director of operations for Sanford World Clinics, who has been traveling frequently to Costa Rica. There is a lot of concern about that—we have no way of knowing how many people were actually vaccinated.”
Costa Rica, which relies heavily on tourism, has been wary to implement strict public health guidelines, Slack said, adding that the unemployment rate is around 25%. The Biden administration is trying to get vaccines to some countries, although India’s around 1 billion people overshadows countries like Costa Rica, she said.
“If they do get the vaccine, we have the protocol in place to help them quickly operationalize,” Slack said. “But that’s if they can get it.”
Even if vaccines were readily available, only 82% of Indian residents said they would take a vaccine if it was available at no cost to them, according to a recent Gallup poll. More than 1 billion of people around the world said they were unwilling to take the vaccine.
“The more people who don’t take the necessary precautions, the more and more the virus will evolve,” said Julie Ray, managing editor for world news at Gallup. “That is the worst-case scenario.”
After India overcame its first wave, there was a false narrative that India had overcome COVID-19, said Dr. Krutika Kuppalli, a fellow at the Infectious Diseases Society of America.
“When you have the relaxing of public health measures with the population density and socioeconomic issues, it really was ripe for the development of the spread of these infections and development of these variants, which is now driving the high cases we’re seeing in urban areas,” she said on a May 12 webinar. “We’re now seeing that spread to rural areas, which is really challenging.”
Mass General has partnered with the Indian organization Mission Oxygen, which helps hospitals procure oxygen concentrators. But there are also shortages of vaccines and testing supplies in India.
“Rich countries are 25-times faster at getting people vaccinated than poorer countries,” Ivers said, noting that less than 1% of the global vaccine supply has gone to Africa. “It’s a moral catastrophe, we have to do something about it.”
Cleveland Clinic Abu Dhabi is delivering vaccinations to caregivers and the general public, in coordination with Mubadala Health and the Abu Dhabi Department of Health. Cleveland Clinic’s caregivers have also volunteered with the National Health Service to help vaccinate the British public, a Cleveland Clinic spokesperson said.
University of Pittsburgh Medical Center’s clinical staff in Italy and Ireland have been vaccinated, a UPMC spokesperson said, adding that the UPMC-managed transplant hospital ISMETT in Palermo, Italy partnered with the government to boost vaccination efforts.
As of mid-April, 2,000 seniors and 600 transplant patients had been vaccinated at ISMETT, with another 800 patients scheduled.
“I took this opportunity immediately, and I was looking forward to it,” said Angela Zaffuto, 80, of Palermo, who was the first person to receive the vaccine at ISMETT. “Now, I feel safer.”
It has been hard for Sanford to help its international affiliates secure vaccine because each government has contracts with the pharmaceutical manufacturers, which take precedence, Bieber said.
But Sanford has been able to leverage its expertise and resources related to education, supply chain management, infection control, regulations and human resources, she said.
“There are so many resources at our fingertips. Sometimes we take that for granted,” Bieber said. “But that’s something most health systems can offer to our smaller partners in different countries.”