At the moment, Bwayira hospital in Lilongwe, Malawi's capital is not suited to storing the covid19 vaccines which have been most successful in medical trials.
Moderna and Pfizer/BioNTech vaccines, which have declared success rates of 90 percent plus, need storing in deep freeze temperatures of minus 20 and minus 80 degrees Celcius respectively.
Countries like Malawi face some daunting challenges.
First they have to compete for doses of vaccines with wealthy nations. Any vaccines they do acquire will need large stable storage facilities with reliable power supplies.
Refrigerators like this keep supplies at two to eight degrees Celcius.
Malawi already has a robust vaccine programme called Expanded Programme on Immunisation (EPI).
But in a report in the science journal Nature the Director of Africa CDC (Centres for Disease Control and Prevention) said most existing vaccine programmes are for children.
Dr. Nonhlanhla Rosemary Dlamini is the World Health Organisation's Malawi Representative.
She says: "So normal vaccines that we are using in our EPI (expanded programm on immunisation) schedule right now are between 2 to 8 degrees centigrade but as you may have seen, the two vaccines that have now come up with the effectiveness of over 90 percent require ultra-cold chain, from minus 20 degrees centigrade to minus 80 degrees centigrade. The kind of equipment that many countries have including Malawi is not that ultra-cold chain kind of equipment. As we are doing our assessment we look at that, but however, we still do not know what kind of vaccine is going to come into the country."
Dlamini believes funding from the vaccine alliance GAVI has meant Malawi has been able to set up some cold chain facilities, but this would not be adequate to supply the vaccines needed.
According to Africa CDC the continent needs to vaccinate 60 percent of its population to gain the minimum requirement of herd immunity.
To achieve this Africa CDC says it will need about 1.5 billion doses of vaccine.
The cost of the vaccine and of building systems and structures required for the delivery of it is estimated at between seven and ten billion American Dollars.
The World Bank says Malawi is one of the poorest countries in the world.
Dr. Charles Mwansambo is the Principal Secretary for Health in Malawi.
He believes other vaccine candidates such as the Oxford AstraZeneca vaccine might be more suited.
"Though it is seventy percent effective, there might be a schedule that may improve that performance. So if we are to look at the last candidate I just talked about, as a country, we are ready because the EPI programme already has these storage facilities and Malawi is one of those countries on the continent that does well in its immunisation programes so we have the infrastructure in place already in all the regions. So we have warehouses that can keep this vaccine," says Mwansambo.
At the local hospital Fanny Banda and Ellenita Patrick wait to be seen.
"The vaccine could have started in Malawi or better yet, it could have started in all the countries at the same time. This is because COVID-19 has affected every country. If they choose to start to start with a few countries, it means people in countries left to wait will have died at the time the vaccine reaches them," says Banda.
Patrick says: "Malawi does not have the capacity to handle the vaccine on its own. It would have been better if a nongovernmental organization gave a hand to make sure that every one gets the all-important vaccine."
Ellenita Patrick, another Lilongwe resident, believes Malawi needs lots of support to implement the vaccine.
"Malawi does not have the capacity to handle the vaccine on its own. It could have been better if nongovernmental organization gave a hand making sure that everyone gets the all-important vaccine," she says.
According to Mwansambo, Malawi and other lower income nations will get access to vaccines around the middle of 2021 through COVAX set up by various organisations to ensure lower income countries get equitable access to vaccines.
This initiative, however can't stop wealthier countries from engaging in bilateral deals with the companies making these vaccinations.
Mwansambo is hoping power supplies in the country will be reliable enough to support a large scale vaccination programme.
"Any cold chain will need power so we also rely on our electricity supplier Escom (Electricity Supply Corporation of Malawi) to make sure that they make the power readily available. I must say that in the recent two months they have been very reliable as regards power distribution because that was the major challenge when we were introducing the other vaccines with all the blackouts but now the blackouts are a thing of the past," he says.
According to Mwansambo, Malawi's government has set up a committee to decide who will be eligible to be in the first twenty percent of the population to receive a vaccine.
Dlamini says the WHO has already issued guidance on this.
She says: "WHO, our advice is that it should be front line health care workers and when I say health care workers I don't just mean the nurses and doctors, I mean the sweepers who work in that area, the cleaners the physiotherapists everyone who is a front line worker at risk and then the MAITAG (Malawi Immunization Technical Advisory Group) will give us the list of who that should be. It's the elderly, and then people with comorbidities and people with chronic illnesses for instance, a person with diabetes, a person has high blood pressure, a person has TB (tuberculosis). Those are the people who are going to form that first 20 percent."