In Tunisia, Wasta Kills When It Comes to Covid-19

14 June, 2021

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Emna Mizouni

Tunisia was among the first coun­tries in the world to take severe mea­sures to fight the Covid-19 virus. Flights were can­celled grad­u­al­ly until there was a total shut­down, and all sorts of pub­lic gath­er­ings such as con­fer­ences, cin­e­ma and the­atre were can­celled — although not foot­ball games! Soon after these mea­sures, the gov­ern­ment declared a cur­few, fol­lowed by a gen­er­al lock­down. In ear­ly June 2020, the coun­try start­ed to open up with a tar­get­ed lock­down. At the time, Tunisia was reg­is­ter­ing zero cas­es. A manda­to­ry quar­an­tine on all arrivals from abroad was estab­lished, yet the polit­i­cal sys­tem, as frag­ile as it is, lift­ed this manda­to­ry con­fine­ment to help declin­ing tourism and con­se­quent­ly the econ­o­my. It was a vic­to­ry that did­n’t last.

A stronger third wave hit hard some months lat­er, how­ev­er the abate­ment mea­sures remain arbi­trary and incon­sis­tent. We’ve been in cur­few since Octo­ber with peri­od­i­cal­ly shift­ing hours and gen­er­al lock­downs when cur­fews were insuf­fi­cient or polit­i­cal author­i­ties feared mass mobi­liza­tion. Pub­lic hos­pi­tals are at full capac­i­ty and the cas­es are increas­ing dramatically.

Tunisia has the high­est Covid death rate of all North African coun­tries, with over 13,000 fatal­i­ties, com­pared to only a lit­tle over 3,000 in neigh­bor­ing Alge­ria and Libya. 

— WHO

With the upsurge in glob­al vac­cine news, we had high hopes and in fact, politi­cians promised to bring vac­cines in no lat­er than Feb­ru­ary 17 this year. Of course, this promise was nev­er kept. The first arrival was the Russ­ian Sput­nik vac­cine in ear­ly March 2021 and deliv­ery of oth­er vac­cines has lagged. 

Vac­cine sit­u­a­tion in Tunisia 

The Min­istry of Health cre­at­ed a new sys­tem to go through the vac­ci­na­tion process, pri­or­i­tiz­ing front­line health work­ers with the first received dos­es, then request­ed all cit­i­zens and res­i­dents of Tunisia reg­is­ter in a ded­i­cat­ed por­tal that went online in January.

It all sound­ed good until vac­ci­na­tions start­ed and the virus began to spread. It turned out there was an error in the sys­tem pro­gram­ming and those who reg­is­tered ear­ly were for­got­ten. The web­site remains inac­ces­si­ble from abroad; Tunisians over­seas weren’t able to reg­is­ter their elders. The sec­ond reg­is­tra­tion method is to call a local num­ber that is so con­sis­tent­ly busy that you would think your grand­ma was call­ing every­one over the phone. The third way for reg­is­tra­tion, SMS text mes­sag­ing, gets ignored more than tele­com oper­a­tor noti­fi­ca­tions. Each of these steps have been attempt­ed by many peo­ple who con­test­ed their func­tion­al­i­ty on social media.

Yet, the pos­i­tive side of the process has been that some peo­ple get lucky; hav­ing reg­is­tered, they were invit­ed to get their dose. In that process, there is no pri­or­i­ty ver­i­fi­ca­tion of the data insert­ed upon registration.

Cer­ti­fi­ca­tion became avail­able in the por­tal evax.tn start­ing from May 3.

As of this writ­ing, about 900.000 vac­ci­na­tions had been deliv­ered (less than half of those received their sec­ond shot). In a coun­try of 12 mil­lion inhab­i­tants, with a high rate of death per capi­ta, only two mil­lion are reg­is­tered to receive the vac­cine and less than a mil­lion received at least one shot since March 2021.

Tunisia has the high­est Covid death rate of all North African coun­tries, with near­ly 14,000 fatal­i­ties, com­pared to only a lit­tle over 3,000 in neigh­bor­ing Alge­ria and Libya. 

Aware­ness cam­paign and cit­i­zen mobilization


I Watch  guards against wasta and other forms of corruption.

I Watch guards against wasta and oth­er forms of corruption.

As in most coun­tries, the vac­ci­na­tion in Tunisia was set to be avail­able for every­one. How­ev­er, the work to get the need­ed dos­es was­n’t free and avail­able. The major­i­ty of vac­cine dos­es were pur­chased by the tax­pay­ers’ money. 

1. One cit­i­zens online infor­ma­tion point is a Face­book group Where is the vac­cine? (winou ettal9ih). In Tunisia, Face­book is the inter­net, so Tunisians rely on it to get their news. It’s the num­ber one plat­form in the coun­try. To obtain updates and report on cit­i­zens’ expe­ri­ence with the vac­cine, a Face­book group was cre­at­ed. Ini­tial­ly the group sought to pres­sure secur­ing the vac­cine and then it turned into a focal point for every­one to get updates on vac­ci­na­tion cen­ters, their open­ing hours, Eid break and strikes (yes we go on strike and take the Eid hol­i­day in the pan­dem­ic), etc. The group inter­ac­tions helped mobi­lize many peo­ple and gave many courage to vac­ci­nate after the mis­in­for­ma­tion from count­less sources had dis­cour­aged them. 

2. Civ­il Soci­ety and Activists call :

To push for the vac­ci­na­tion require­ment and trans­paren­cy, I Watch, a nation­al watch­dog orga­ni­za­tion, devel­oped a cam­paign against the gov­ern­men­t’s nepo­tism. Many peo­ple con­test­ed pub­licly the dif­fer­ent cas­es of nepo­tism and dis­re­spect to the pri­or­i­ty group set by the Covid-19 Sci­en­tif­ic Com­mis­sion. Some of them urged for­mer par­lia­men­tar­i­an and human rights lawyer Bochra Bel­hadj Hami­da to launch a peti­tion. Things start­ed to change accord­ing­ly and the chain of vac­ci­na­tion now includes front­line work­ers in the tourism sec­tor, as the coun­try is pre­ma­ture­ly open­ing in June for tourism with less restric­tions or quar­an­tine require­ments.

3. Between anti-vac­ci­na­tion and free­dom of expres­sion: Angeli­na Jolie’s looka­like spreads chaos:

While the Nation­al Mufti declared that the vac­cine was safe dur­ing Ramadan, a TV chan­nel in Tunisia start­ed a show dis­cour­ag­ing peo­ple from the vac­cine, which depict­ed a look-alike of Angeli­na Jolie in a vac­ci­na­tion cen­ter where peo­ple die after get­ting vac­ci­nat­ed. At the same time, the Covid-19 relat­ed death rate was increas­ing (about 100 reg­is­tered deaths dai­ly). The WHO sent an offi­cial let­ter  to the Tunisian Gov­ern­ment to shut down the show. 

Nepo­tism and mismanagement

While the coun­try was beg­ging for vac­cine dos­es, a par­lia­men­tar­i­an leaked that the Tunisian Pres­i­den­cy received 500 dos­es from UAE in Octo­ber 2020 with­out pub­licly declar­ing it. Oth­er than being strict­ly avail­able to the mil­i­tary, no oth­er updates were announced. 

The Covid-19 Sci­en­tif­ic Com­mis­sion of the Min­istry of Health set up a pri­or­i­ty list start­ing with health­care work­ers (doc­tors, nurs­es, phar­ma­cists et alia), then used age as the top fac­tor (75, 65–74, 60–64), then patients with chron­ic ill­ness and at the end of the list the pro­fes­sion­als of the ser­vice sec­tor that are at high risk. Yet, unlike oth­er coun­tries, there was no clear time­line or phas­es for these pri­or­i­tized peo­ple. The pro­fes­sion­als at less risk such as Direc­tor Gen­er­als and Min­is­ters were vac­ci­nat­ed before the cit­i­zens aged over 70 years old, many of whom are still on the wait­ing list as of this writ­ing, or who nev­er were able to reg­is­ter. Iron­i­cal­ly, even the pro­fes­sion­als of the med­ical sec­tors who aren’t exer­cis­ing got vac­ci­nat­ed; an Insta­gram­mer who is a non-prac­tic­ing phar­ma­cist was vac­ci­nat­ed at the begin­ning of the campaign.

The inef­fi­cien­cy of the process resides in many steps. For exam­ple, for the old peo­ple who can­not move, there is no facil­i­ty to vac­ci­nate them at home. The dai­ly extra non-used dos­es are thrown away; so if some­one miss­es the appoint­ment, their dose isn’t allo­cat­ed on the same day for anoth­er per­son but tossed because there is no walk-in or list B con­tin­gency. It’s worth not­ing again that these dos­es are paid for by the taxpayers.


Tunisia received the first direct purchase of Pfizer vaccines in Africa. Here Ambassador Donald Blome joined Minister of Health Faouzi Mehdi and the Tunisia Country Manager of the American pharmaceutical firm Pfizer, Walid Lakhdar, at Tunis-Carthage Airport to welcome the first installment of a total 2 million Pfizer/BioNTech COVID-19 vaccine doses for Tunisia purchased under a direct bilateral agreement with the company.

Tunisia received the first direct pur­chase of Pfiz­er vac­cines in Africa. Here Ambas­sador Don­ald Blome joined Min­is­ter of Health Faouzi Meh­di and the Tunisia Coun­try Man­ag­er of the Amer­i­can phar­ma­ceu­ti­cal firm Pfiz­er, Walid Lakhdar, at Tunis-Carthage Air­port to wel­come the first install­ment of a total 2 mil­lion Pfizer/BioNTech COVID-19 vac­cine dos­es for Tunisia pur­chased under a direct bilat­er­al agree­ment with the company.

More on nepo­tism: Arwa Ben Abbes, a par­lia­men­tar­i­an from Ennah­da and a mem­ber in the par­lia­men­tar­i­an com­mis­sion on the admin­is­tra­tive reform and anti-cor­rup­tion, was priv­i­leged by her friend to get vac­ci­nat­ed in a cen­ter in Manou­ba with­out being reg­is­tered there or even being in the pri­or­i­ty cat­e­go­ry. The nepo­tism and wasta in Tunisia is found at all lev­els, even on the com­mis­sion that sup­pos­ed­ly fights it! 

The USA, a major con­trib­u­tor to the COVAX ini­tia­tive, has already pro­vid­ed about two mil­lion Pfiz­er dos­es as well as a huge dona­tion to the Tunisian gov­ern­ment to respond to the cri­sis. Yet, the polit­i­cal inef­fi­cien­cy and mis­man­age­ment of the vac­ci­na­tion and pro­ce­dures has crip­pled Tunisia. It becomes more and more dif­fi­cult to get over the Covid-19 cri­sis and its reper­cus­sions. In some areas, pub­lic hos­pi­tals, the only place to treat Covid-19, are full with no capac­i­ty to accept even urgent cas­es.


What Tunisians Demand is Equal­i­ty for All 

Restric­tive mea­sures to man­age Covid-19 should be equal for every­one.  How­ev­er, imple­men­ta­tion varies depend­ing on the par­ty or the cat­e­go­ry of peo­ple involved. For exam­ple, no (cul­tur­al) events or polit­i­cal protests are allowed unless the Chief of Gov­ern­ment is invit­ed or it is a polit­i­cal protest that sup­ports his gov­ern­ment. In May, for exam­ple, Prime Min­is­ter Hichem Mechichi paid a vis­it to the annu­al Jew­ish pil­grim­age in Djer­ba and before that he attend­ed a Ramadan Tarawih prayer in Kairouan. He also appeared at many funer­al ser­vices of lead­ers of Ennahd­ha Par­ty such as the late Meherzia Laabi­di. This was also record­ed when the gov­ern­ment allowed a mas­sive protest orga­nized by Ennah­da and pri­or to that the same cur­rent gov­ern­ment attacked or denied almost all oth­er social protests.

Begin­ning of today’s march in sup­port of nation­al uni­ty and the demo­c­ra­t­ic process #Tunisia pic.twitter.com/B1UCxY3ETk

— Ennahd­ha Par­ty (@EnnahdhaParty) Feb­ru­ary 27, 2021

Even for those vac­ci­nat­ed in the USA, it still feels unre­al to go out with­out a mask, while in Tunisia, unvac­ci­nat­ed peo­ple and some­times Covid-19 pos­i­tive ones live nor­mal­ly and move with­out masks or social dis­tanc­ing. At the cur­rent rhythm, Tunisia will need three years to get 70% of the pop­u­la­tion vac­ci­nat­ed. This is an unre­al­is­tic and dan­ger­ous sit­u­a­tion to main­tain in a coun­try that relies on ser­vices and tourism to live. 

After suf­fer­ing from a chaot­ic health sys­tem and con­tin­u­ous protests of the eco­nom­ic sit­u­a­tion, some cit­i­zens are more reck­less than before based on a gen­er­al sen­ti­ment that the gov­ern­ment has let them down in fight­ing the virus. Many have lost so much that they feel they have noth­ing else to lose, so they go on with their lives. Bor­ders are wide open for tourism and the manda­to­ry quar­an­tine became an excep­tion. Cas­es of the South African vari­ant have already been registered. 

On a more upbeat note, at the end of May a new fol­low-up pro­to­col for vac­ci­nat­ed peo­ple was announced by the coun­try’s Direc­tor of Med­ical Research, accord­ing to Agence Tunis Afrique Press. This will include an elec­tron­ic vac­ci­na­tion card in the offi­cial por­tal. Even slow­ly the chain seems to get mov­ing. Com­pared to oth­er coun­tries, there is no option in Tunisia to choose which vac­cine to take (J&J, Pfiz­er, AstraZeneca etc), nor even a hygiene stan­dard to make sure the per­son wears gloves before they vac­ci­nate you. Those who are lucky get vac­ci­nat­ed with what­ev­er is avail­able on the day. 

It will require more work to get enough vac­cines for the coun­try’s res­i­dents and def­i­nite­ly more effi­cient man­age­ment to get out of the cur­rent cri­sis. Unfor­tu­nate­ly, the expe­ri­ence in Tunisia remains not unlike many oth­er coun­tries in the region and the world where the pan­dem­ic will con­tin­ue to exac­er­bate inequities.

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