After the establishment of COVID-19 Global Access (COVAX) to ensure equitable access to vaccines, much success has not been recorded due to paucity of vaccines [21]. The aim was to ensure that safe doses of COVID-19 are delivered to at least 2 billion people among committed countries and vaccination of a minimum of 20% of each of the vulnerable and high-risk populations of committed 92 low-income countries by the end of 2021 [21].
Records have shown that only 57.3% in high-income countries and 2.14% vaccination rates were achieved in low-income countries at the end of the third quarter of 2021, largely attributed to the lack of access to vaccines and the financial implication of having these vaccines [22, 6]. With just over 13% of people in low income countries receiving vaccinations, compared to nearly 70% of people in high income countries, Michelle Bachelet claimed that the failure to administer the vaccines in a fair and equitable manner was prolonging the [23]. This failure was incredibly unjust and immoral, as well as highly unacceptable [23].
Most African countries are struggling to have access to vaccines to administer their first doses [11]. For example, a study carried out by the Organization for Economic Cooperation and Development (OECD) in several member states showed that the risk of infection in refugees was twice as high as native-born individuals [24]. Data collected from three West African countries on access to health care services in refugee camps, especially COVID-19 services, remains very discouraging. For instance, information gathered from 1,396 in selected refugee camps on COVID-19 testing in Niger Republic, Burkina Faso and Mali shows that 90% in Niger Republic, 98% in Mali and 95% in Burkina Faso were never tested for COVID-19 [7].
The Exposure of Forced Migrants to the COVID-19 Pandemic
COVID-19 worsens the already precarious condition of refugees according to the UN High Commissioner for Refugees, Filippo Grandi [25]. Children in this vulnerable population are especially at risk for lack of access to safe spaces, water, nourishment, and medical care, making them more susceptible to viral illnesses such as (COVID-19) water borne illnesses, and respiratory tract infections [26]. It was estimated by WHO (2020) that 52% of the global refugee population was under the age of 18. There are an estimated number of 31 million child migrants, 13 million child refugees, 936,000 asylum-seekers, and 17 million child IDPs [27]. In West and Central Africa, over 30,000 migrants remain stranded at the borders while over 2,000 are overcrowded at transit points waiting for assistance [27]. It was also reported that, since the outbreak of the COVID-19 pandemic, many people have been abandoned in the desert by smugglers and traffickers, exposing their lives to a variety of health risks, including the transmission of COVID-19 [27].
In Nigeria, IOM situational study of COVID-19 in the North-East found that there were no operational hand-washing stations with soap and water on-site in 76% of the locations analysed [28]. Only 34% of the places surveyed had hand-washing stations with soap and water, according to a subsequent examination into the availability of soap and water in IDP camps, camp settings, and host communities [28]. The advent of COVID-19 has created a double emergence for forced migrants as the struggle to contain the virus and at the same time try to have access to basic needs [29]. In Africa for instance, displaced populations are more vulnerable to COVID-19 transmission because they are not in formally organized refugee camps and are more vulnerable as most of them are found in urban slums with no official support [30] It was also reported that 54% of refugees in Burkina Faso, 42% in Niger, and 39% in Mali do not have access to COVID-19 protective gear. Many people reported that they do not have adequate information or they lack where to have testing and treatment (47% in Niger, 42% in Burkina Faso and 37% in Mali) [7].
Public perception about COVID-19 has greatly affected the attitude of the public towards COVID-19 control in Nigeria and other West African countries [31]. These perceptions are influenced by many factors, including cultural belief systems, religion, and a lack of public trust in the policies and those saddled with the responsibility to handle the pandemic [32]. It is unfortunate that many people out there (in West Africa and others) still believe that the Corona Virus is not real in Africa [32]. These categories of people may not adhere to any guidelines or protocols set by the WHO or their national regulatory agencies, thereby endangering themselves and others. Based on religious beliefs, some people think that the COVID-19 pandemic is a disease for unbelievers, and that those who trust and believe in God will not be infected [32]. These different perceptions and beliefs are inimical to the fight against the pandemic. Also, face masks are misused, even by highly placed government officials, by wearing them on their chin or neck without necessarily paying attention to covering their mouths when talking [33]. It is unfortunate that most people who wear face masks do so only when they are involved in public activities where it is required.
COVID-19 National Response Strategies in West Africa
The global strategies for COVID-19 Preparedness and Response stress the necessity to ensure that considerable attention is given to vulnerable populations and hard-to-reach populations [34]. Any effective public health and recovery response to COVID-19 must take into account everyone, along with all migrants irrespective of their nationality or migration status [23]. Following the establishment of National Deployment Vaccination Plans (NDVP) by many countries, the performance of such plans has been called into question on the progress in the NDVPs, but there is still a huge challenge of accommodating the undocumented displaced persons across many countries [28]. Most countries have included refugees in their national vaccination plans, more is needed to ensure that these services get to the vulnerable populations [8]. According to Professor Stanley Okolo, the Director General of the sub-regional body, the West African Health Organization (WAHO), a unit of ECOWAS, said that the organization had distributed over 100,000 medical materials and over one million personal protective equipment [35].
West African governments have taken a variety of measures to combat the pandemic since its inception, including the formation of task forces and other action committees to prevent and contain the disease. It is a matter of concern how well these committees are working in their countries. However, it was warned that COVID-19 nationalist measures that could further put vulnerable people at risk or worsen the spread of the virus should be avoided by governments in Africa [30].
National COVID-19 Response Strategy in Mali
Mali recorded its first two confirmed cases of COVID-19 on March 25th, 2020. These cases rose to 56 by April 7th of the same year, with at least six confirmed deaths cutting across the regions of Bamako, Kayes, Koulikoro, and Mopti. The Mali government quickly formed the Central Coordination Cell and Crisis Committee for Epidemic Management COVID-19, coordinated by the National Institute of Public Health, to handle the national response, among other things. Afterwards, thousands of cases were confirmed after that period. As a response to the pandemic, the country has put in place a plan of action to ensure the prevention, communication, capacity building, prevention and case management, and other related issues of the pandemic. The sum of $57 million was set aside to achieve these objectives [36]. As it was common practice globally, the government of Mali on March 25th declared a state of emergency in the health sector to tackle the disease. Among the notable measures were the prohibition on all public gatherings, the suspension of all commercial flights, and the closure of schools. Interestingly, a gathering of more than 50 people was restricted, but it is unfortunate that at that very time there were more than one million IDPs in Mali interacting freely in these camps-a place and condition that made any physical distancing very difficult to maintain. It is quite disturbing that the efforts of all these response frameworks could not address the needs of forced migrants, which is evident in the [7].
A Response Strategy in Burkina Faso
In Burkina Faso, the first case of the Corona Virus was discovered on March 9, 2020, with the virus immediately spreading in nine regions of the country [37]. It was confirmed that there were 20,813 confirmed cases of Corona Virus and 379 deaths, with a total vaccination of 2,554,907 vaccines administered as at March 14th, 2022 [38]. In a swift response, an emergency response team was set up by the Ministry of Health to support the National Influenza Reference Laboratory and the activities of the US Center for Disease Control and Prevention (CDC) to curtail the disease. It is unfortunate that a lack of accurate epidemiological data hindered the effectiveness of this intervention in Burkina Faso at that time [39]. There was also concern by the commitment of the Government of Burkina Faso to actually handle and respond to COVID-19 as a public health disaster [39]. According to Moumini Niaone, a 38-year-old doctor in Burkina Faso, the government at the inception had done little or nothing to reach out to religious leaders and local traditional authorities which eventually lead to anti-lock-down protests in the country [40].
COVID-19 Response Strategy in Niger
In Niger Republic, the first case of the Corona Virus was recorded on Thursday, March 19th, 2020. This was announced by the Nigerien President through his Twitter handle that the patient was a 36-year-old Nigerien who had traveled to Togo, Ivory Coast, and Burkina Faso [41]. A report by John Hopkins University, Corona Virus Resource Center shows that Niger recorded 8,799 confirmed cases, 308 deaths, and 2,674,381 doses administered [42]. The report also shows that in total, only 6.61% of the total population is vaccinated. The Rapid Emergency Response Project was set up with the assistance of the World Bank to support the government of Niger in making procurements for medications and equipment to tackle COVID-19. Notably, $13.95 million was set aside to take care of this project [43]. It was primarily focused on preparedness, response, and straightening of an already weak health system [43].
These interventions were very difficult to get to, especially for IDPs and refugees. For instance, delivering COVID-19 protective equipment to remote areas was more difficult, owing to armed conflict and violence, particularly in the Diffa and Tillabery regions [44]. It is unfortunate that Doctors without Borders stated categorically that IDPs and refugees living in camps where safety is not guaranteed are vulnerable, exposed, and are a threat to COVID-19 given the precarious nature of their living conditions [44].
COVID-19 Response in Nigeria
In Nigeria, the index case of COVID-19 was recorded on March 23rd, 2020, which was traced to an Italian in Lagos. This was followed by many other cases on a daily basis, as reported by the Nigeria’s Center for Disease Control (NCDC). The news brought a lot of apprehension and panic to the general public, as I 11f to say the worst has come. The Federal Government of Nigeria, in a swift reaction, constituted a Presidential Taskforce headed by Boss Mustapha on March 17, 2020, to handle the pandemic [45]. This later led to the declaration of a total lock down of the whole nation by the then President-Muhamadu Buhari as a way to control the spread of the pandemic.
The common measure among countries in the region and elsewhere was the closure of international borders for migrants, among others. Unfortunately, most of these measures could not work in a region where there are very porous borders between neighbouring countries. For instance, the Nigeria Immigration Service (NIS) stated that Nigeria's borders share a 7,73 km and 87 km long border with Benin and Chad respectively, as well as 1,497 km and 1,690 km long with Niger and Cameroon, respectively. Only 853 km of Nigeria's borders are coastal, mostly in the Atlantic Ocean with Sao Tome and Principe, Ghana, and Equatorial Guinea [46]. It is a matter of concern that the NIS admitted that the nation had only 84 official borders, but there are more than 1,490 illegal routes into Nigeria, which are mostly unmanned and serve as illegal entry points for people (who may otherwise become stateless) into Nigeria [47].
Private organizations and international donor agencies, international governments and other well-meaning Nigerians donated large sums of money, PPES, isolation centres, vehicles, among others, to both states and the federal government in Nigeria to fight the outbreak. Many Nigerians, including the business mogul, Aliko Dangote, donated the sum of two billion naira (N2,000,000,000) to the Nigerian government. The Lagos State Government, which was the epicentre of the pandemic, also received various donations from both individuals and cooperating organizations. Reports indicate that these donations amounted to over 25 billion as at May 31st, 2020 [48].
In addition, there are no adequate measures and policies put in place to address the needs of the hard-to-reach population with COVID-19 services in West Africa. In Nigeria, for example, a study conducted by REACH in 2021 in Borno and Adamawa States (two of the worst hit states by terrorism caused by Boko Haram in North East Nigeria) revealed that hard-to-reach and vulnerable populations were living in extremely dangerous and disturbing circumstances, posing a significant challenge to humanitarian actors [49]. According to data collected from 400 settlements in Borno and Adamawa States, only 62% of newly arrived refugees in refugee camps were asked to wash their hands; 89% of sick people were mixed with other members of the community [49]. With these records, the vulnerability of the population in hard-to-reach areas is still hanging in the balance as far as the fight against COVID-19 is concerned.