Akanksha Chowdhury
Rwanda, officially the Republic of Rwanda, a landlocked republic lying south of the Equator in east-central Africa became the first country to roll out COVID-19 vaccines for its refugees in the first week of March of 2021.
Almost a year since the nation’s first registered COVID-19 patient and as entailed in Rwanda’s national vaccination drive, the Rwandan Ministry of Health inoculated vaccines to its refugees. This included 224 refugees residing in the Emergency Transit Mechanism (ETM) centre in Gashora and 192 refugees in six refugee settlements who work on the front lines as community health workers and cleaners or security guards at health clinics in the refugee settlements. Ever since the campaign made a jumpstart, nearly 230,000 Rwandan citizens have been vaccinated against COVID-19.
BACKGROUND
The novel coronavirus (COVID-19) outbreak, originated in Wuhan, China was declared a global pandemic by the World Health Organization (WHO) on March 11, 2020, post its detection as a highly contagious strain of the virus in December of 2020.[1]
Gradually more than 100 countries came into the vicious grip of this viral strain and caused enormous casualties all around the world. The disease became a matter of serious concern for every government, national and international organisations. Nationwide Lockdown was declared in several countries to contain the spread of the virus, while every pharmaceutical associations and companies took to inventing a vaccine which intended to provide acquired immunity against Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS‑CoV‑2), which is the organism causing Coronavirus disease 2019 (COVID-19).
In Phase III trials, several COVID-19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID-19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer).[2]
RWANDA AND ITS FIGHT AGAINST COVID-19
When COVID-19 began engulfing the world in its vicious grip in the early months of 2020, several developed countries struggled to keep the virus at bay. Many worried about the ability of African countries to withstand the pandemic owing to the limitation in their means and health resources. Experts from across the world predicted dire consequences, warning that the region’s weak health systems would be decimated. However, the roadmap to the containment of the disease, set by the African countries, especially Rwanda, has rather set an example for the entire world to tread on.
Post the 1994 genocide against the Tutsi wherein one million people were murdered, Rwanda’s health system was depleted and had to be rebuilt from the scratch. Twenty-six years after the Genocide, Rwanda was faced with the challenge of the Pandemic which brought worry in the minds of several. Contrary to the much-contemplated deterioration, Rwanda’s measures in containing the virus were appreciated as an exemplary response to the Pandemic. According to statistics on 1 January 2021, the COVID-19 death toll in the United States has surpassed 330,000 (out of a population of around 330 million), while Rwanda’s death toll stands at just 62 (out of a population of 12.3 million).[3]
Rwanda implemented complete lockdown a week after its first Covid-19 patient was reported in mid-March. A week later, it set up a contact tracing system and simultaneously executed testing for all personnel policing borders, as well as those working in public spaces. By the end of April, a total of 29,395 citizens had been tested for COVID-19 (prevalence was 0.7%). With considerable assistance from the private sector, the nation’s community health network has enabled the government to identify populations in need of extra support.[4]
To minimize contact time with confirmed cases and thereby reducing the risk of contamination of health experts in COVID-19 treatment centres, robots were deployed. At Gatenga and Kanyinya treatment centres in Kigali City, visits by pharmaceutical staff to patients went down considerably since May 2020. The five human-sized robots are programmed to perform temperature screening, take readings of vitals, deliver video messages and detect people not wearing masks and, accordingly instruct them to wear masks as per protocol.[5]
The five robots were launched in May 2020 at the Kanyinya COVID-19 Treatment Centre, by the Ministry of Health. The robots were coined in Kinyarwanda, Akazuba, Ikirezi, Mwiza, Ngabo, and Urumuri. These robots were manufactured by Zora Bots, a Belgian company that specialised in robotics. They were acquired through a partnership between the Ministry of ICT and Innovation and the UNDP Rwanda Accelerator Lab (AccLab).[6]
The government of Rwanda has enforced the administration of two vaccines: the Pfizer–BioNTech vaccine and the Oxford–AstraZeneca vaccine.
Agnes Binagwaho, the key architect of the Rwandan Health System, said “While some of the world’s richest and most technologically advanced countries have struggled to contain the spread and morbidity of COVID-19, Rwanda has set a shining example on how to manage a pandemic and safeguard public health. Chief among its advantages is a healthcare system based on equity, access, and public trust.”[7]
Upon being asked regarding the reintegration of the Rwandan Health system, she said, “The Rwandan health sector is quite bold, concerning equity. When I returned to the country in 1996, structural violence against the vulnerable was widespread. The distrust of the government remained, even after the genocide had ended. And the poorest were left to fend for themselves. I saw those as injustices, beyond simply risk factors for disease. When you construct a system, you are deciding whether or not you pit them against these structural biases depending on whether you design it in a way that intentionally alleviates these risk factors. So, sure, universal coverage helps, extensive primary care helps, intense attention to health access helps, but they’re not enough. The human bits matter too.”[8]
IMPLICATIONS ON RIGHTS OF REFUGEES
UNHCR, which has urged all countries to include forcibly displaced and stateless people in their vaccination programs, praised the Rwandan government’s efforts. Of the 151 countries currently developing COVID-19 vaccination programs, 106 have explicitly included refugees and 33 are in the process of doing so.[9] “COVID-19 has affected everyone in our country, whether they be Rwandans, foreigners, refugees, or asylum-seekers,” said Olivier Kayumba, Permanent Secretary in the Ministry of Emergency Management. “Vaccines are for everyone, and they are being distributed as they become available.”[10]
The exhibit of humanitarian values in its health policies by the Ministry of Health of Rwanda has opened new fold dynamics to the rights of refugees. This has been believed to have a positive impact on a global scale as regards the condition of refugees in an era of a health crisis.
Despite being a third-world country and having its health system restructured and rebuilt, Rwanda has shown exemplary steadiness in its fight against COVID-19. It has proved that curbing a disease needs more solidarity and resources next. Instillation of faith and assurance in the hearts of citizens is the initiation of cure and aids in panic control, thereby, facilitating able administration. The citizens of a country need to have faith in its government. It is equally imperative for the government of sovereignty to treat every individual on its land as equal and promote brotherhood and solidarity among its people.
Having the refugees, homeless and asylum seekers included in its vaccination drive has convinced them towards the right to health care and good living. “Including refugees in the vaccine rollout is key to ending the pandemic”, Mike Woodman of UNHCR’s Public Health Section explained.
UNHCR reiterates that refugees, internally displaced and stateless people, and their local host communities must be included on an equal footing with state citizens in all national responses concerning the Pandemic, including that which entails public health access, vaccination, and social safety boundaries. National authorities are responsible for the same. It was stated that safeguarding the health conditions of refugees also protects the health of the host communities and societies at large since it breaks the chain. It should be in the interest of all communities, States, and the world at large to not have their people falling through the cracks, marginalized, exposed, and unprotected.
As per public health analysis, it is impractical to break or sustainably slow down the transmission of the virus unless a minimum of 70% of the population has acquired resistance against the same. Guaranteeing the inclusion of refugees in the vaccine rollout is key to bringing the Pandemic to an end. If the refugees, other displaced people, or no-nationals are excluded from the vaccination schemes, there could be risks of ongoing transmission among the people, with spill-over into the national population. There are concrete safety risks associated with the exclusion of refugees, ranging from health consequences, and access to services, work, livelihoods, education, and freedom of movement, against discrimination.[11]
“We commend Rwanda’s inclusion of refugees in its response to the pandemic,” said Clementine Nkweta-Salami, UNHCR’s Regional Bureau Director Bureau for the East, Horn of Africa, and the Great Lakes. He also appealed to all countries to include refugees in their vaccination drives at par with nationals to ensure that everyone is protected.
The first dose of the COVID-19 vaccine is being given to high-risk groups such as health workers, teachers, elderly people with chronic health issues, those aged over 65 years, and other frontline workers. Refugees who meet these criteria are included in the first stage of Rwanda’s vaccination campaign as well.[12]
The ETM centre was set up after negotiations in mid-2019 by the Rwandan Government, UNHCR, and the African Union, collectively, to evacuate refugees and asylum seekers trapped in Libya, and to provide them with a vital lifeline and a protected and systematic roadmap to long term solutions. At present, 303 refugees and asylum seekers are residing under the shelter of the ETM.
A 2019 study from the Wellcome Trust found that 97% of Rwandans have confidence in the health authority.[13] This has instilled in them a sense of confidence and faith that their government wouldn’t leave them alone in their plight and fight. They feel assured that the “system is not against them” and that as and when the need arises, they will be taken care of and wouldn’t be made to suffer in terms of finance or employment. They know that public health guidance is not politically motivated, rather driven by humanitarian sentiments and equity towards the welfare and well being of people.
Rwanda’s reliable and trustworthy health care system has positively contributed to its response to COVID-19. Rwandan citizens feel assured that every health measure is being taken in the public interest. So, when the government closes the borders and sends everyone home when it deploys health workers to people’s homes, robots to their treatment centres, and drones to their skies[14] the people already know that these actions are not against them but in their favour.
This feeling of assurance has promoted compliance to guidelines issued by the government, facilitating better administration and able panic control. The government has been able to make enforcements that have helped curb the Pandemic in the country.
CONCLUSION
Rwanda’s success in fighting COVID-19 has led every government to rethink many assumptions about what it takes to build a strong and capable health system. Rwanda’s health facilities are devoid of several amenities. For example, Rwanda does not have a surplus of ventilators or Intensive Care Unit beds. But the values of equity, trust, community participation, and patient-centrism vested in its system have enabled the Rwandan government to carry out its fight against COVID-19 ably. By making evidence-based decisions, taking lessons from its mistakes in the past, and treading in the footsteps of other successful countries, Rwanda has defied expectations and proved that the right strategies and good leadership can help any country to keep its citizens safe.
The inclusion of refugees in the vaccination drives has set the Rwandan government as an exemplary figure towards the promotion of humanitarian values in the world. It has opened the doors for refugees to be treated on equal footing as nationals and be given equal opportunities as regards health and lifestyle. This has been an endorsement of UNHRC’s appeal to the world to work towards the betterment of the homeless and refugees and facilitate their needs.
Rwanda’s strong healthcare system and strictly coordinated preventive measures against COVID-19 has helped the country to combat the pandemic in the country. As the Pandemic threatens to gather momentum in different countries, other governments could largely benefit from the lessons imparted by Rwanda through its capable administration. Rwandan health system and measures taken to fight against COVID-19 have taught the western world that a lot is still left to be inspired from smaller countries with limited resources. The culture of individuality does not quite promote the wellbeing of communities and solidarity and good conscience alone can revive the world.
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[1] WHO Director-General’s opening remarks at the media briefing on COVID-19 in March 2020.
[2] Shrotri, Swinnen, Kampmann, Parker, Lancet Glob Health, Vaccine Centre, London School of Hygiene and Tropical Medicine, last updated on 18 March, 2021, https://vac-lshtm.shinyapps.io/ncov_vaccine_landscape/
[3] World Health Organisation, WHO Coronavirus (COVID-19) dashboard, 18 March 2021, 4:53 PM CET, https://covid19.who.int/
[4] Jeanine Condo, Jean Paul Uwizihiwe & Sabin Nsanzimana, Learn from Rwanda’s success in tackling COVID-19, 26 May 2020, https://www.nature.com/articles/d41586-020-01563-7
[5] World Health Organisation, Robots use in Rwanda to fight against COVID-19, 31 July 2020, https://www.afro.who.int/news/robots-use-rwanda-fight-against-covid-19
[6] Supra note 5.
[7]Agnes Binagwaho, Lessons from Rwanda’s fight against COVID-19, 31 December 2020, https://www.project-syndicate.org/onpoint/rwanda-model-of-public-health-lessons-from-covid-by-agnes-binagwaho-2020-12?barrier=accesspaylog
[8] Eli M Cahan, Rwanda’s secret weapon against COVID-19: Trust, 11 December 2020, https://www.bmj.com/content/371/bmj.m4720
[9] Tim Gaynor, UNHCR, The UN Refugee Agency, 14 January 2021, https://www.unhcr.org/news/latest/2021/1/5fff1afe4/qa-including-refugees-vaccine-rollout-key-ending-pandemic.html
[10] Eugene Sibomana, First Refugees receive COVID-19 vaccinations in Rwanda, UNHCR, The UN Refugee Agency, 12 March, 2021, https://www.unhcr.org/news/latest/2021/3/604b7a4f4/first-refugees-receive-covid-19-vaccinations-rwanda.html
[11] Supra note 10.
[12] APO Group, Coronavirus Rwanda vaccinates refugees and asylum seekers against COVID-19, Africa News, 12 March 2021, https://www.africanews.com/2021/03/12/coronavirus-rwanda-vaccinates-refugees-and-asylum-seekers-against-covid-19//
[13] Farrar J, The most important healthcare tool is trust. Welcome Trust, 13 Aug 2019, https://wellcome.org/news/most-important-healthcare-tool-trust
[14] Bariyo N, Rwanda’s aggressive approach to covid wins plaudits and warnings, Wall Street Journal, 29 Sep 2020, https://www.wsj.com/articles/rwandas-aggressive-approach-to-covid-wins-plauditsand-warnings-11601372482
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