INSHASA, Congo — Amid a critical yellow fever vaccine shortage, more than 1 million doses sent by the United Nations, World Health Organization, and partners to Angola in February disappeared. Officials complained internally that they suspected the shots were appropriated by local politicians or wound up on the black market.
Months later, WHO and partners were still mystified by where the vaccines were being used in the country. In a series of internal calls, health officials complained that shots were sometimes used in areas that had no yellow fever cases, without any explanation. Experts complained that it was “pointless” to approve vaccine plans for Angola since the country was completely disregarding them.
An internal draft document sent from WHO’s Africa office to its Geneva headquarters in June cited a lack of senior leadership at WHO. It said the emergency outbreak response manager and team in Angola “are unable to lead or positively influence the operational direction and scale of containment efforts.”
As the outbreak raged, manufacturers sent vaccines that sometimes were not accompanied by syringes, due to poor UN management. In Congo, one WHO logistics officer questioned whether the vaccines were being kept cold enough and warned WHO could “hardly guarantee the quality of the vaccine.”
The sole laboratory in Congo for diagnosing yellow fever closed for weeks after running out of diagnostic materials, leaving officials unable to track the evolving outbreak. Pressured by aid groups to act quickly, WHO’s Director-General Dr. Margaret Chan emailed Dr. Joanne Liu, international president of Doctors Without Borders, to detail a number of steps taken to resolve the problem. To avoid bad publicity, Chan asked Liu not to share the email.
The continuing outbreak in Angola — and its increasing need for yellow fever vaccine — has left other countries unable to get requested stocks, compromising their preparedness for a potential outbreak. Faced with growing demands for limited vaccines and a proposal to dilute doses to stretch availability, a senior UNICEF staffer wrote in a June email: “WE HAVE A MAJOR PROBLEM ON OUR HANDS.”
Officials plan to offer weaker vaccines in Congo this month, despite limited evidence that diluted vaccines would provide sufficient protection in African populations. Instead of the normal vaccine, officials plan to use a version containing one-fifth the usual dose. A draft WHO document on the “fractional dosing” included a line that said the strategy should be “forgotten.” In a later version, that sentence was deleted.