In more than 50 countries, most of them wealthy, coronavirus vaccination efforts are well underway, with some 20 million doses already distributed in the United States alone. But most poorer nations have yet to even begin. World Health Organization officials said last week that the West African nation of Guinea is the only low-income country of 29 to begin vaccinating. And those efforts have been limited in scope — just 55 people out of the population of more than 12 million have received doses so far.

The initiative, using the Russia-backed Sputnik V vaccine, began Dec. 30 as part of a pilot program carried out on an “experimental basis,” Sakoba Keita, director general of Guinea’s National Health Security Agency, told The Washington Post.

The Russian government proposed the idea, in a “climate of good bilateral relations,” and Guinea accepted, Keita said. Most of the initial vaccinations went to government officials: President Alpha Condé, 82, received a shot in early January.

“We intend to initiate the first real campaign by the end of this first quarter,” Keita said, referring to a wider effort, likely using the Sputnik V vaccine and others procured separately.

“At the moment I cannot provide an exact date because we have not had any announcement of the supply of the first batch of vaccines, which could come to Guinea from any of our suppliers,” he said. “Negotiations are ongoing.”

The unusual arrangement, under which the country has received limited Sputnik V doses, appeared to be the result of close ties between Condé and Russian President Vladimir Putin. Russian business interests connected to the mining of bauxite, a key ingredient in aluminum production, has led Moscow to rekindle its Soviet-era relationship with Conakry, Guinea’s capital.

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The slow-to-static pace of vaccinations in low-income countries such as Guinea, which has a gross domestic product per capita of less than $1,000 per year, has been condemned by public health experts, who say that the hoarding of vaccine doses by wealthier nations could extend the pandemic.