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At a COVID-19 vaccination site in the Ugandan capital, metformin for weightloss Kampala, tempers flared among those waiting for scarce AstraZeneca jabs, with some accusing others of trying to jump the queue.

Nurses intervened, telling them the accused had been waiting since the previous day and averting violence in what has become a tense atmosphere as Ugandans jostle for vaccinations.

In the aftermath of a brutal wave of infections driven by the delta variant, many Ugandans seeking a first dose of vaccine are competing with hundreds of thousands who have waited months for a second dose. But the country now has only 285,000 shots donated by Norway.

The delta surge has touched off a vaccination rush across Africa that the slow trickle of donated doses can’t keep up with, compounding the continent’s vaccine disadvantage compared with the rest of the world. The urgency to obtain a second dose across much of the world’s least vaccinated continent contrasts sharply with rich countries now beginning to authorize third doses.

Dr. Alfred Driwale, the top official with Uganda’s immunization program, said ruefully that the small number of doses will do little to remedy the situation as the 5 million Ugandans eligible for vaccination—everyone from soldiers to health workers—scramble for shots under a first-come, first-serve system.

“You can’t make a policy when there is no certainty of supply,” Driwale said.

Health officials throughout Africa’s 54 nations have repeatedly expressed disappointment over what they see as vaccine nationalism as rich nations appear to hoard doses while poor countries lag far behind. In June, amid severe shortages, the World Health Organization warned that vaccination campaigns in Africa had come “to a near halt,” underscoring the continent’s plight at a time when many countries faced deadly surges.

Less than 2% of the continent’s 1.3 billion people are fully vaccinated and African countries have received just over 100 million vaccine doses, according to the Africa Centers for Disease Control and Prevention.

Donations of AstraZeneca from countries such as France are not considered large amounts in efforts to vaccinate 60% of Africa’s population by the end of 2022, said John Nkengasong, the group’s director. He told reporters Thursday that large shipments of AstraZeneca are not expected anytime soon until the situation with an Indian manufacturer changes.

“The best vaccine to use as a second dose is any vaccine that’s available,” he added, using the example of getting the first AstraZeneca dose and then the one-shot Johnson & Johnson vaccine, which has begun arriving in African countries after the continent purchased 400 million doses. Uganda recently received 300,000 doses of China’s Sinovac vaccine that authorities insist cannot be used in combination with AstraZeneca.

In Congo, health experts are awaiting a Sunday shipment of more COVID-19 second doses, said Dr. Jean-Jacques Muyembe, who is coordinating the government’s pandemic response. Some 81,910 people have been vaccinated with AstraZeneca since the start of the vaccination campaign in April, and more than 4,000 people have returned for the second dose. AstraZeneca is out of stock there.

The scarcity of AstraZeneca is causing anxiety in countries that used it widely while hoping substantial shipments would continue arriving. Some health workers, teachers and others who spoke to The Associated Press said their second dose has been due for several weeks, leaving them feeling unsafe.

“We are told that (the delta variant) is very deadly and we are all scared. So most of my colleagues have taken the first AstraZeneca vaccine, but we are unable to the second jab now,” said Ifeoluwa Oluseyi, a teacher in the Nigerian capital of Abuja.

Nigeria, Africa’s most populous nation with more than 210 million people, earlier this month received 4 million Moderna doses donated by the U.S. and expects a delivery of more than 29 million Johnson & Johnson doses purchased by the government through the African Union.

Oso Kowe, a Nigerian physician who is among many yet to be fully vaccinated, said she considers herself lucky to have escaped COVID-19 as she waits to get a second dose after a first one received on May 7. Kowe, of the Ekiti State University Teaching Hospital, said she has tried three times to get her second dose.

“My not getting the second dose wasn’t really my fault,” she said. “So, I will just try my best and hope for the best that I won’t contract the virus.”

Dr. Misaki Wayengera, head of a technical committee advising Uganda’s pandemic response, said it was inevitable that “some, unfortunately, are going to have to wait longer” for doses.

A Ugandan teacher, waiting her turn at a crowded vaccination site on a recent morning, said she would not leave until she got her second shot, due since June 2.

“My question is, does that first dose still work? I mean, was it wasted? Will I need to get a third shot? There are questions in the air and no one is giving me answers,” Racheal Nambuya said. “I am trying my best to get this shot and, as you can see, I am not the only one.”

There have been reports of fake vaccination certificates issued to people who got jabs outside designated centers—and some even paying bribes to get jabs—adding to the confusion surrounding a vaccination campaign that teeters on availability. And because of logistical challenges, vaccines take even longer to reach remote places outside urban centers.

With some vaccination sites allocated about 100 doses per day, the struggle for vaccines can literally be physical.

“Some people almost exchanged blows here this morning,” said Robinah Wataba after getting a second dose that had been due for several days. “There was too much disorganization here. More than you can imagine.”

She felt discouraged the previous day when she came to Kampala’s City Hall and witnessed the clamorous crowd.

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