​Mbabane ‒ The Kingdom of Eswatini, like the rest of the world, was immensely affected by the COVID-19 pandemic, experiencing different waves each affecting an increasing number of people. Between March and December 2020, the country experienced three waves. The reported cases were 6,633 in the first wave increasing to 10,313 cases in the second wave and 45,971 cases in the third wave. Deaths on the other hand also increased from 126 to 524 and 1,212 deaths in the second and third wave respectively in the same reporting period with the case fatality rate being recorded at 2.6% in the third wave. Eighty-two percent of the reported deaths were from people with diagnosed comorbidities with 10% being elderly. Based on this data, the most at risk of dying were the population with comorbidities and the elderly. 

The country is registering more reports of people living with comorbidities (cardiovascular diseases, diabetes, and obesity) among the elderly population in general which means that targeting the elderly with the COVID-19 vaccine will also spread the benefit to most people with comorbidities. As such, with this data and other evidence, the need to prioritize the elderly with the vaccines cannot be overemphasized. 

At the onset of the COVID-19 pandemic, the World Health Organization (WHO) Eswatini,  within its normative role of providing technical guidance to the Ministry of Health, shared the recommendation on prioritization of the most at-risk population. Furthermore, the guidance was clear on ensuring that countries should prioritize 20% of their populations among which were healthcare workers who formed the front line;  the elderly ( 60 years and older), and those with comorbidities who were deemed most vulnerable to severe illness and death from the virus. Further to this, technical assistance was provided in crafting the National Deployment and Vaccine Roll Out Plan (NDVP)  to clearly stipulate these prioritized population groups and further ensure that the COVID-19 vaccine rollout is implemented in line with the NDVP.   

In March 2021, Eswatini introduced the COVID-19 Vaccine - AstraZeneca initially prioritizing the elderly, healthcare workers, and those with comorbidities in compliance with the recommendation from the World Health Organization. As the rollout progressed, other population groups were targeted starting with the next older age group among the population aged 59 years and below. Despite that, the focus on the initial priority groups of the elderly and those with comorbidities remained unchanged. By December 2022, the vaccine uptake had slowed down with national coverage increasing from 25.7% to a mere 35.5% between December 2021 and December 2022. In December 2022, the coverage among the elderly population was highest (71.5%) compared to the younger age groups (12 to 29 years) who were not a prioritized population group where the coverage was about 34%.  Whilst the national vaccine coverage at the national level is at a low of  36% and falls short of the national target of 70%, among the elderly population, the coverage was comparatively the highest. Prioritization of the high-risk population is one of the positive actions that has helped in increasing vaccine uptake of the vaccine among the most at-risk elderly population. 

Anna Mdluli, a 75-year-old, attributes her motivation to getting vaccinated from the Ministry of Health (MoH) and WHO’s tireless campaigns that mostly encouraged the elderly to prioritize vaccination since they were more vulnerable compared to the younger demographic. 

“I was afraid. My friends died and I was so touched I could not go to the funeral because I was asking myself, does it mean all elderly people will die - especially if I am exposed? I was among the first people to get vaccinated. I went to Raleigh Fitkin Memorial Hospital (RFM) to get the first dose of the vaccine. I later got the second dose from King Sobhuza II Clinic and took the booster dose of the vaccine as scheduled “. 

The incidence of COVID-19 cases has significantly reduced and according to the MOH, Week 13 report of 2024, there were only thirteen (13) reported active cases and no deaths. In a population of 1.1 million people, there are only 75,276 cumulative reported cases and 1,427 reported deaths (which has been constant since November 2023). The most affected population remains to be the elderly and those with comorbidities, particularly those who have not been vaccinated. The need therefore to continue not only making the vaccine available but also to provide accurate and timely information for informed decisions to the population at higher risk cannot be overemphasized. 

“I am still in pain that my friends died, and I could not console their families given I was so close to them. Some were looking after their grandchildren, and it was sad that they passed on. In our culture, we must pay respect, and now that even made it more painful because I feared COVID-19 yet the deceased’s kids expected me to go. I have asthma so that added to my fear.” 

Anna’s neighbor contracted COVID-19 but was fortunate enough to come back from the COVID-19 treatment facility at the Mavuso Trade Center in the Manzini region. The community members were afraid of the people who had recovered from COVID-19. Anna reiterates that she got more scared since COVID-19 affected everyone including the educated in the society. Two of her friends, including a school principal, died after contracting COVID-19. Anna’s relative also passed away prompting her to encourage and push her relatives to get vaccinated especially her brothers’ children and other close relatives citing it was better to vaccinate than to not. 

“After I took the vaccine, I never experienced any side effects, but I made sure that I distanced myself from people as I didn’t know their status.”

The success of increased vaccine coverage among the elderly would not have been possible without the tireless campaigns by health partners, the Ministry of Health, and donors including the United States Department of State (USDOS), France, UNICEF, the European Union, Bill and Melinda Gates Foundation and Gavi, The Vaccine Alliance. 

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