© Fadel Dawod/NurPhoto via Getty Images

Egypt: Haphazard and flawed Covid-19 vaccine rollout fails to prioritize most at-risk

The Egyptian authorities’ haphazard handling of the country’s Covid-19 vaccine rollout and failure to outline a clear national strategy has meant that at risk and marginalized people have not been prioritized for vaccination and continue to face barriers undermining their right to health, said Amnesty International today. Among those affected are people living in informal urban settlements or remote rural areas, prisoners, refugees and migrants,

The organization is calling on the authorities to rectify ongoing flaws and eliminate all practical barriers hampering at-risk people and those in vulnerable situations from accessing the vaccine.

“Egypt’s vaccine rollout has been blighted by the authorities’ lack of clear strategy and transparency leading to delays and backlog, as well as failure to reach out to those most in need or to tackle vaccine hesitancy through targeted awareness campaigns,” said Philip Luther, Middle East and North Africa Research and Advocacy Director at Amnesty International.

“We call on the government to ensure that priority groups are, in fact, prioritized, and that the distribution plan is inclusive, accessible and non-discriminatory.”

Egypt’s vaccine rollout has been blighted by the authorities’ lack of clear strategy and transparency leading to delays and backlog, as well as failure to reach out to those most in need or to tackle vaccine hesitancy through targeted awareness campaigns

Philip Luther, Amnesty International

Given the lack of a national campaign to disseminate information about access to vaccines, with hardly any billboard or radio or TV ads, people with limited or no access to the internet face practical barriers to register for the vaccine, particularly as registration at hospitals is fraught with the lack of clear and consistent procedures. People’s experience with hotline registration varied with some experiencing difficulties and delays.

Amnesty International spoke to health workers, journalists and human rights researchers and activists who work closely with at-risk and vulnerable individuals or communities. The organization also examined social media posts where people shared their personal and/or relatives’ experiences, as well as statements by officials and NGOs and media reports.

“The Egyptian authorities have a responsibility to ensure that the country’s lifesaving vaccine programme is rolled out fairly through the entire population: from those in urban informal settlements to those in hard-to-reach rural areas, those at liberty to those in detention, to Egyptian nationals as well as refugees and migrants,” said Philip Luther.

Lack of a clear national vaccination plan

The government’s vaccine rollout was announced on 24 January, and its distribution was deeply flawed. Online registration opened for health workers, older people and people with pre-existing health conditions on 28 February with over 150,000 people registering within the first four days. Registration opened to the general public on 6 March, before millions of older and chronically ill people had been vaccinated. In parallel with opening registration to the general public, the government increased the number of vaccination centers, but individuals from priority groups who registered earlier in the process experienced long waiting times and were unable to get appointments in the newly opened centers. 

Amnesty International is aware of at least 11 cases in April where young people without pre-existing medical conditions were contacted for vaccine appointments before their older relatives and other at-risk people. While this flawed distribution was partially rectified since May, the problem remains. One person told Amnesty International in May his 72-year-old chronically ill mother was registered for the vaccine on 20 March and has not yet been contacted for an appointment.

On 24 June, the health minister reported that  4 million people received the first jab, but failed to provide a breakdown of the profiles of those vaccinated.

The government’s mixed messaging over the vaccine rollout and lack of public awareness campaigning, both around access to the vaccine and vaccine hesitancy, has led to the exclusion of socio-economically marginalized groups and irregular legal statuses.

There has been no adequate government-sponsored targeted outreach to urban low income and rural remote areas, including those badly hit by Covid-19, as reflected in emptier vaccine centres. For instance, doctors, activists and residents in the impoverished governorates in Upper Egypt and in informal settlements in Greater Cairo, as well as communities of refugees and migrants, told Amnesty International that many residents were unaware of the vaccine rollout, and that in some cases local health workers were spreading awareness in the absence of a government drive.

In April, independent online media platform Mada Masr reported that parliamentarians and their families were given preferential treatment to choose between AstraZeneca and Sinopharm and received their first dose within days, despite the fact that none of them has been officially identified as being part of any priority group.

In the same month, the government also targeted tourism workers by establishing vaccination centers in hotels across touristic areas. On 3 June, officials declared that one million of tourism workers have been vaccinated so far. To date, authorities have yet to proactively reach essential workers at high risk, including transportation and food workers.

In January, the health ministry said it was prioritizing medical teams that treat Covid-19 patients in public, police and military hospitals first. Other health workers, including those who routinely deal with Covid-19 patients were excluded from early allocation. In April, the Doctors Syndicate also expressed concern about the low number of doctors vaccinated. The doctors’ syndicate declared that at 578 doctors have died of Covid-19. However, the health ministry continues to downplay health workers’ unsafe working conditions, claiming that only 115 of the deceased doctors contracted the virus at work, with the remainder due to community transmission.

Egyptian authorities must publish their vaccine allocation plans; and meaningfully consult with independent civil society groups, including the Doctors’ syndicate, to integrate human rights standards, ensuring that at high-risk and marginalized groups are prioritized and safeguards against discrimination and exclusion are introduced.

Prioritize at-risk and vulnerable groups

In line with the WHO SAGE Roadmap for prioritizing uses of Covid-19 vaccines in the context of limited supply, the authorities must abide by their human rights obligations and ensure vaccination of people systematically marginalized in their access to health care. This includes prisoners and detainees, refugees, asylum seekers and migrants, and low-income residents of informal settlements or remote rural areas.

Although Egyptian officials confirmed that a vaccination campaign inside prisons began on 17 May with the inoculation of 5,000 older or chronically ill prisoners, they have not shared the vaccination process, timeline, and criteria for eligibility. As a result, human rights lawyers and defenders took legal action against the ministries of interior and health for failing to vaccinate several prisoners and detainees held in relation to political cases. Eight people with direct knowledge of the situation in nine prisons across Egypt, including relatives and lawyers, told Amnesty International that many of those detained in politically-motivated cases have yet to be given access to a Covid-19 vaccine.

On 14 April, the lawyer of 69-year-old detainee Abdelmonim Aboulfotoh, a former presidential candidate and founder of the Misr AlQawia opposition, submitted a request to the public prosecutor to allow his client to receive a Covid-19 vaccine in prison given his age and pre-existing health conditions. Abdelmonim Aboulfotoh has been arbitrarily detained since February 2018 without trial in inhuman and cruel conditions and he has been deliberately denied health care. To date, he has not received a dose. 

In light of the pattern documented by Amnesty International of Egyptian authorities deliberately denying perceived dissidents’ access to health care, the organization calls on the authorities to ensure that prisoners of conscience, and others detained on political grounds, are not excluded or discriminated against. The organization is further concerned that lack of appropriate medical facilities and staff in police stations and in central prisons, which are designated for those sentenced to short prison terms or for failure to pay debt.

Access to health care is a human right. All detainees should have access to Covid-19 vaccines.

Philip Luther, Amnesty International

“While we welcome promises to vaccinate prisoners, the authorities must provide further information on the process, timeline and criteria for eligibility to ensure that all detainees in custodial settings can access a Covid-19  vaccine in a timely, transparent manner and on the basis of objective criteria starting with those at highest risk,” said Philip Luther.

“Access to health care is a human right. All detainees should have access to Covid-19 vaccines. Moreover, withholding vaccinations as means of punishing political dissidents or those arbitrarily detained for exercising their right to freedom of expression would be a flagrant human rights violation.”

Various practical barriers hamper the access of refugees, asylum seekers and migrants to vaccines. Non-Egyptian nationals can register online with their passports, residency documents and ID numbers provided by the United Nations High Commissioner for Refugees (UNHCR), but those undocumented or struggling to formalize their status are excluded. It also remains unclear whether dozens of those detained arbitrarily in police stations in upper Egypt simply on the basis of their irregular migration status would be included.

The Egyptian authorities must also proactively target refugees, asylum seekers and migrants in languages that they can understand, regardless of their legal status.

To date, Egypt has reported more than 280,394 confirmed Covid-19 cases since the beginning of the pandemic, including 16,092 deaths. According to the national committee to combat coronavirus in Egypt, the actual numbers are likely to be 10 times higher than officially recorded. Journalists, health workers and others questioning the government’s handling of the pandemic or official statistics have faced threats, prosecutions and detention, and other intimidation