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Both Government and International Community Are Failing Tunisia Amid COVID Spike

The inequality between the Global North and the Global South remains the major factor of having late access to vaccines.

People queue up to receive a COVID-19 vaccine at Oued Ellil high school in Manouba, Tunisia, on August 8, 2021.

Tunis, Tunisia — Thus far, the Global North collectively has fully vaccinated more than half its population against COVID-19, with 57.7 percent for the EU and 52.9 percent for the U.S. In Africa, only 2.7 percent of the population received two doses of vaccine, while the rate in Asia is 29 percent. The pandemic has laid bare disparities between the Global South and Global North — and with the advent of vaccination, it has also accentuated them, as rich countries bought more doses than they needed and poor countries struggled (and continue to struggle) to get access to vaccines.

Although the huge gaps between the Global North and South are eminently clear, there are also imbalances within the Global South itself. In the Middle East, the wealthier Arab Gulf countries like the United Arab Emirates, and Qatar have more than 75 percent of their population fully vaccinated, followed by Bahrein with 66.4 percent. However, other countries like Jordan (29.04 percent), Lebanon (16.32 percent) and Palestine (8.85 percent), have much lower vaccination rates. In North Africa, there are also major disparities when it comes to vaccination rates between the countries. While Morocco vaccinated 41.37 percent of its population, followed by Tunisia with 19.56 percent (since August 30), neighbors Libya (16.42 percent) and Algeria (9.93 percent since August 26) were much slower in the vaccination process.

To understand the reasons behind the huge gaps in vaccination rates in the Global South, we can look to Tunisia — which currently has the highest COVID mortality rate per capita in Africa — as an example.

Tunisia’s first pandemic wave from March 2, 2020 to July 24, 2020, which ended with 50 deaths, was successfully contained with a strict lockdown of two months. Zakaria Bouguira, an anesthesiologist in Tunisia, has been advocating for more than a year for a “0 COVID” strategy based on three pillars: a lockdown with a minimum of two months, mandatory quarantine for people coming from outside the country and a 95 percent vaccination rate of the population. Now in its fifth and deadliest wave, peaking in July 2021 at 300 COVID deaths per day, the country is now seeing more than 100 COVID deaths per day.

Moreover, Bouguira questioned the government’s official death toll, asserting that the real number is much higher. “As of August 2, the Tunisian government declared 20,000 deaths, which isn’t the real number,” Bouguira told Truthout. “According to a study conducted by the University of Washington, there are 60,000 deaths, which is a huge number for a country of 10 million inhabitants.”

According to Bouguira, the Tunisian government failed to act in time, with a lack of prompt international aid playing a role. “When governments started buying vaccines last November, ours waited for international aids (financial aid as well as medical equipment and personal protective equipment). Contrary to what some people believe, this failure isn’t due to a lack of financial resources, since Tunisia has received financial aid from international organizations like the World Health Organization, European countries (especially France and Germany), the U.S. and Arab countries since the beginning of the pandemic.”

Boutheina Louhichi, a generalist doctor working in educational institutions and activist with the Tunisian League of Human Rights (LTDH), hosted awareness campaigns and information sessions during COVID’s first wave in Tunisia. In recent months, she has criticized the slowness of the vaccination pace in the country. “It was so slow that it seemed illogical for me as a doctor,” Louhichi told Truthout. “The results of our failed vaccination strategy were clear; whereas the sanitary conditions improved in many countries, we were living the peak of our crisis.”

Not only did the Tunisian government receive the vaccine late, but its vaccination strategy also wasn’t efficient. Both doctors agree on the absurdity of having vaccination posts only in big cities, far away from a large part of the rural population. Louhichi, who participated in vaccination campaigns, said that 2,176 basic health care centers throughout rural territory would have been more appropriate for reaching these populations.

For Bouguira, this bad strategy also contributed to the virus’s spread. “The government opted for a strategy where the people come to get vaccinated, not the other way around. This mistake delayed vaccination [rates].”

Witnessing such chaos in the vaccination process, Tunisian civil society mobilized and demanded the government improve the logistical management system of the vaccination. “As activists in the LTDH, we complained to the government about the slow pace and the bad management of vaccination,” says Louhichi. “They told us that that’s how things are, and they can’t change anything about it.”

However, their activism seems to have had an effect: On August 8, Tunisia organized an open day for vaccination for people over the age of 40. Doctors (both active and retired), nurses and youth organizations volunteered, and the Health Ministry reported that 551,000 people received a vaccination that day.

Aside from the failing vaccination strategy, the Tunisian government’s plan to prevent the spread of the virus during the second wave leaves much to be desired.

Since the beginning of the pandemic, many experts and civilians were against lockdown as a preventive measure; they feared economic recession and heavy costs for the government (aid funds to companies, financial support for underprivileged families and unemployed people). However, for Bouguira, those possibilities should be weighed against the loss of human life and the cost of widespread illness.

According to a study conducted by the International Monetary Fund last October, countries that chose lockdown had better economic results than those that opted for “herd immunity.” Among the measured economic outcomes that were measured in this study, are retail sales, gross domestic product, consumption and unemployment rate.

“What costs more: a person in an emergency room who costs 1,000 dinars ($360) per day, or buy one shot of vaccine for 30 dinars ($11)?” says Bouguira.

A February study conducted by Honoris United Universities et Eshmoun Clinical Research showed that only 41 percent of Tunisians were willing to get vaccinated. Bouguira says this low rate can be explained by the lack of trust between the citizens and their government.

“After successfully containing the virus, the government opened the borders for tourists who brought the virus along with money,” says Bouguira. “So there wasn’t any trust between the government and the citizens who felt betrayed by these risky decisions. As a psychological defense mechanism, the citizens denied even the existence of the virus, believed conspiracy theories and didn’t want to get vaccinated.”

Honesty and consistency in government messaging are also important, says Louhichi.

“The government’s communication strategy should reassure people and not make them have second thoughts about getting vaccinated,” Louhichi says. “However, people are told that the vaccine is good, and another day they’re told, by representatives of the Ministry of Health that it’s dangerous.”

Louhichi adds that awareness campaigns should be more regular and officials shouldn’t take inadequate measures like changing the curfew hour every two weeks. According to her, it’s important to inform the public about the potential side effects of the vaccine, while insisting that it’s the only way to defeat the virus. “There’s no vaccine or drug without any side effects. Some complications are better than thousands of deaths,” she says.

Seeing the number of deaths, especially during the peak in July, Tunisians are now largely convinced more than ever of the urgency of getting vaccinated.

“After every family lost at least one of their members, people are scared and want to get vaccinated,” says Louhichi.

However, despite the logistical mistakes that contributed to delaying the beginning of the vaccination process, the inequality between the Global North and the Global South remains the major factor in having late access to vaccines, and insufficient quantities.

With children returning to school, the Tunisian government’s vaccination efforts should get even more serious. “The suspension of classes is an efficient preventive measure since although children are asymptomatic, they’re 10 to 100 times [more likely to get infected] than adults,” says Bouguira. If the school year resumes without vaccinating children, “we’ll have a disastrous sixth wave, with many infections and deaths among children.”

Bouguira said that during the fifth wave, he has witnessed 2-month-old babies with more than 70 percent of lung damage, and 4-day-old babies dead from COVID. “The vaccination would cushion the impact of the sixth wave,” he said.

Bouguira is still demanding the government pursue a strict “0 COVID” strategy.

“We can’t wait ‘til the sixth wave hits us, because it’d be fatal; and we can’t count on international solidarity, since countries would be too busy dealing with their own situation,” he says.

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