Introduction

Rwanda is one of the fastest-growing economies in the continent with a reputation for innovation in various sectors such as healthcare.1Edwards, Neil. “Rwanda’s successes and challenges in response to COVID-19.” www.atlanticcouncil.org. March 24, 2020. https://www.atlanticcouncil.org/blogs/africasource/rwandas-successes-and-challenges-in-response-to-covid-19/(accessed April 27, 2022) The spread of COVID-19 to Rwanda in March 2020 coincided with the 26th commemoration of the 1994 genocide against the Tutsi. For the first time in the country’s history, the pandemic prevented the annual marking of the anniversary through a series of engagements in collective mourning and community healing. However, Rwanda’s resilience during the COVID-19 pandemic can serve as a lesson to the global community on addressing public health challenges through national coherence and standing on resilient values.2Louis, Elizabeth Farrah, Dominique Eugene, Willy Chrysostome Ingabire, Sandra Isano, and Judite Blanc. “Rwanda’s Resiliency During the Coronavirus Disease Pandemic.” Frontiers in Psychiatry 12 (2022).

Understanding the Context for Rwanda’s Response

Between January 2020 and December 2021, exposure to COVID-19 rose sharply in the African continent from 3 percent in June 2020 to 65 percent by September 2021. Additionally, 11.5 million confirmed cases and more than 252,000 deaths were reported in the African continent as of April 6, 2022.3WHO Africa. “Over two-thirds of Africans exposed to virus which causes COVID-19: WHO study.” www.afro.who.in. April 7 , 2022. https://www.afro.who.int/news/over-two-thirds-africans-exposed-virus-which-causes-covid-19-who-study  (accessed April 26, 2022).

One of the sectors most affected by the 1994 genocide in Rwanda was the healthcare system partly because of the killing or fleeing of some healthcare providers. During this period, with infectious diseases such as HIV/Aids and tuberculosis on the rise, life expectancy in the country was among the lowest in the world. The Rwandan cultural values of patriotism, self-sacrifice, discipline, and integrity as well as mutual aid and a sense of cooperation contributed to the country’s achievements during the past two decades. These values have also been taken advantage of by post-genocide leaders in order to mobilize the entire Rwandan population to advance the country’s economic and socio-political transformation. Furthermore, the efforts of the government and local people led to the creation of a community capable of adapting to disasters by finding local solutions. Rwanda’s community resilience together with the country’s decentralized healthcare system led to the building of a strong response system during the COVID-19 pandemic.4Louis, Elizabeth Farrah, Dominique Eugene, Willy Chrysostome Ingabire, Sandra Isano, and Judite Blanc. “Rwanda’s Resiliency During the Coronavirus Disease Pandemic.” Frontiers in Psychiatry 12 (2022).

The Rwandan government’s successful efforts and response to the Ebola (EVD) health emergency in 2019 prepared it for the COVID-19 pandemic when the government established ThermoScan thermometer checks for people entering the country and handwashing stations with the aim of preventing Ebola from entering the country through the borders with the Democratic Republic of Congo (DRC). The same strategy was adopted by the government to prevent the spread of COVID-19 before the country’s first confirmed COVID-19 case. Handwashing stations were established in the bus park of the capital city and officials with fever scanners were present at all borders. With the increase of the COVID-19 cases in the country, the government adopted newer measures.5Edwards, Neil. “Rwanda’s successes and challenges in response to COVID-19.” www.atlanticcouncil.org. March 24, 2020. https://www.atlanticcouncil.org/blogs/africasource/rwandas-successes-and-challenges-in-response-to-covid-19/(accessed April 27, 2022)

The government took strict responsive measures and mitigation strategies characterized as “cultural tightness” to protect against COVID-19. These included a country-wide lockdown, curfew, and the wearing of face masks.6Louis, Elizabeth Farrah, Dominique Eugene, Willy Chrysostome Ingabire, Sandra Isano, and Judite Blanc. “Rwanda’s Resiliency During the Coronavirus Disease Pandemic.” Frontiers in Psychiatry 12 (2022). The government implemented social distancing and banned gatherings, encouraged citizens to use online banking and mobile money, and closed all non-essential businesses while essential services were allowed, such as security, medical care, and telecommunications.7Edwards, Neil. “Rwanda’s successes and challenges in response to COVID-19.” www.atlanticcouncil.org. March 24, 2020. https://www.atlanticcouncil.org/blogs/africasource/rwandas-successes-and-challenges-in-response-to-covid-19/(accessed April 27, 2022)

Despite Rwanda’s well-coordinated response, hospitals were overwhelmed when the number of COVID-19 cases and deaths started to increase in early 2022. An initiative called Operation Save the Neighbor was launched in September 2021 in the Gasabo District8Rwanda Cooperation. “www.twitter.com.” September 3, 2021. https://twitter.com/Cooperation_RW/status/1433797692417789954 (accessed June 28, 2022). which had the highest COVID-19 infection rates in Rwanda with more than 2,500 cases in 501 villages. The initiative integrated doctors into home-based care teams with the aim of reducing the burden on hospitals by saving lives at the community level. The home-based care approach positively influenced Rwanda’s response to the high pandemic waves. Within two weeks of this initiative’s launch, home-based visits increased from 30 percent to 92 percent. By the end of March 2022, 98 percent of COVID-19 confirmed cases in Rwanda were treated in their homes.9WHO Africa. “How home-based care eased Rwanda’s COVID-19 response.” www.afro.who.int. April 19, 2022. https://www.afro.who.int/news/how-home-based-care-eased-rwandas-covid-19-response (accessed April 26, 2022).

The country provides universal healthcare to all its citizens and delivers medical products around the country, such as blood donations through drones.10Edwards, Neil. “Rwanda’s successes and challenges in response to COVID-19.” www.atlanticcouncil.org. March 24, 2020. https://www.atlanticcouncil.org/blogs/africasource/rwandas-successes-and-challenges-in-response-to-covid-19/(accessed April 27, 2022) According to the Lowy Institute, an Australian think tank, Rwanda has been ranked first in Africa and sixth globally in 2021 in managing the Covid-19 pandemic.11Rédaction Africanews. “Rwanda ranked first in Africa, sixth globally in Covid-19 management.” www.africanews.com. January 29, 2021. https://www.africanews.com/2021/01/29/rwanda-ranked-first-in-africa-sixth-globally-in-covid-19-management//  (accessed April 27, 2022)

Months before the first Covid-19 vaccines arrived in Rwanda, the country adopted a national coordinating framework that centralized decision-makers from all essential categories. The government designed a strategy, identified gaps, and created a prioritization system based on updated demographic data to determine the number of needed vaccines. The mass national screening process conducted by the government aimed at enabling elders, persons with chronic diseases, and frontline healthcare workers to receive the vaccines first proved to be effective. More than a month before the beginning of the vaccinations, two vaccination teams were assigned to each hospital and health center across Rwanda and an inventory was given to each location the day before the vaccination in order to enable the personnel to be ready when the vaccines arrived. The first batch of 240,000 doses of the AstraZeneca-Oxford vaccine arrived on March 3, 2021 in the country’s capital of Kigali.12Aderinto, Nicholas. “OPINION | What Africa can learn from Rwanda’s effective Covid-19 vaccine rollout.” www.news24.com. March 7, 2022. https://www.news24.com/health24/medical/infectious-diseases/coronavirus/opinion-what-africa-can-learn-from-rwandas-effective-covid-19-vaccine-rollout-20220307 (accessed April 26, 2022). These were dispatched by the Rwanda Ministry of Health to district hospitals and afterward to all 508 health centers in the country.

The first phase of the comprehensive nationwide vaccination against COVID-19 targeted high-risk groups and was launched on March 5, 2021, with 350,400 people vaccinated, and the second phase began on March 29, 2021. The vaccination was later extended to everyone, such as market vendors, people ages 18 years and above, and those aged 12 years and above. Based on the National Institute of Statistics of Rwanda, the country’s total population is over 12.6 million. According to the Rwandan Ministry of Health, 7,587,808 Rwandans aged 12 years and above have received at least one dose of the COVID-19 vaccine as of December 31, 2021. Furthermore, 5,364,026 people received two doses, while 111,681 people received booster shots. The country succeeded in achieving the World Health Organization (WHO) target of vaccinating 40 percent of the entire population by December 2021. More than 80 percent of its population aged 12 years and above received at least one vaccine dose by the end of 2021 as stated by the President of the Republic of Rwanda.13XINHUA. “Rwanda leads Africa in reaching global COVID-19 vaccination target.” www.africa.cgtn.com. January 1, 2022. https://africa.cgtn.com/2022/01/01/rwanda-leads-africa-in-reaching-global-covid-19-vaccination-target/ (accessed April 27, 2022). The Ministry of Health of Rwanda announced on March 3, 2022, that 60 percent of Rwanda’s population has been fully vaccinated against Covid-19.14Aderinto, Nicholas. “OPINION | What Africa can learn from Rwanda’s effective Covid-19 vaccine rollout.” www.news24.com. March 7, 2022. https://www.news24.com/health24/medical/infectious-diseases/coronavirus/opinion-what-africa-can-learn-from-rwandas-effective-covid-19-vaccine-rollout-20220307 (accessed April 26, 2022). Vaccination sites have been set up in Rwanda’s capital Kigali in crowded public places such as bus stations where between 200 and 400 residents are vaccinated daily and several people registered for booster shots.15Africanews. “Covid-19: Rwanda has vaccinated over 60% of its population.” www.africanews.com. April 9, 2022. https://www.africanews.com/2022/04/08/rwanda-has-vaccinated-over-60-of-its-population//  (accessed April 27, 2022)

Various vaccines are used in Rwanda including Pfizer, AstraZeneca, Johnson & Johnson, Moderna, and Sinopharm. Through the government’s efforts, community engagement, strong leadership, coordination, rapid distribution, and partnership in the country, the needed vaccines have been acquired and a large number of the population has been vaccinated.16XINHUA. “Rwanda leads Africa in reaching global COVID-19 vaccination target.” www.africa.cgtn.com. January 1, 2022. https://africa.cgtn.com/2022/01/01/rwanda-leads-africa-in-reaching-global-covid-19-vaccination-target/ (accessed April 27, 2022). Furthermore, the country implemented a policy of vaccine delivery to communities which are the hardest to reach and are at the highest risk, such as providing door-to-door vaccination to people with disabilities and elders above the age of 60.17Binagwaho, Agnes, and Kedest Mathewos. “Rwanda’s success in rolling out its covid-19 vaccination campaign is.” www.bmj.com. April 1, 2022. https://www.bmj.com/content/bmj/377/bmj.o881.full.pdf  (accessed April 27, 2022).

In the Rwandan President’s Liberation Day Message marking the 27th Liberation Day in April 2021, he stated that overcoming Covid-19 is a continuation of the country’s liberation efforts. He added that the country is working toward establishing capabilities with the aim of manufacturing vaccines in Rwanda in order to reduce dependency on imports which are dependent on other interests and are unpredictable.18Mwai, Collins. “Rwanda: Overcoming Covid-19 is a Continuation of Our Liberation Efforts, President Kagame.” www.allafrica.com. July 4 , 2021. https://allafrica.com/stories/202107050086.html(accessed April 27, 2022). The country announced in October 2021 that it will construct a vaccine manufacturing plant that uses the mRNA technology of the German company BioNTech which co-developed the Pfizer COVID-19 vaccine by mid-2022. As stated by the Rwandan President, this would boost the national economy and would be “a turning point in vaccine equity.”19Ravinetto, Raffaella. “VACCINE PRODUCTION IN RWANDA: A STEP TOWARD VACCINE ACCESS EQUITY FOR AFRICA.” www.itg.be. February 14, 2022. https://www.itg.be/F/Article/vaccine-production-in-rwanda-a-step-toward-vaccine-access-equity-for-africa (accessed April 27, 2022).

Conclusion

Post-genocide Rwanda’s success story in combating COVID-19 has contributed to the consolidation of trust, reconciliation, and solidarity. Its successful effort in managing the COVID-19 pandemic presents an example to other low-income countries. Lessons should be learned from the Rwandan experience and successful journey through a collective strategy, community-oriented mechanisms, and well-informed policies aimed toward combating COVID-19. Other African countries can also implement a decentralized health system where health workers are capable of reaching and providing immediate medical care to all individuals residing in the country, in particular the rural areas. Besides that, promoting community resilience and adopting science-based strategies as well as modern technology such as drones and digital surveillance are essential to the containment of the virus.

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