The onerous journey to deliver vaccinations amid coronavirus crisis

Health worker Bina Rani wades across rivers and through duckweed in remote areas of Bangladesh to immunize children against vaccine-preventable diseases

UNICEF
Health worker Bina Rani
UNICEF Bangladesh/2019/Mawa
26 May 2020

Bina Rani is a 50-year-old government health assistant who goes the extra mile to ensure that children and pregnant women are protected against vaccine-preventable diseases in a remote area of Sunamganj district in Bangladesh’s Sylhet division.

She provides the BCG vaccine against tuberculosis in addition to vaccines against diphtheria, tetanus, whooping cough (pertussis), Hepatitis B, haemophilus infuenzae B, pneumococcus, polio, measles and rubella among others despite lockdowns and physical distancing measures imposed across Bangladesh.

At the moment she is making her onerous journey on foot amid pre-monsoon rainfall.

 “We don’t lack motivation”

Because she works in a remote area, her job is already challenging, without the additional difficulties caused by the coronavirus pandemic.

“Every month I have to carry the vaccines to eight centres in total. I walk by foot, across two rivers, sometimes I wade through the duckweed,” She said. “It’s physically tiring but you won’t find a single one of us health assistants lacking in motivation!”

Staff delivering the vaccines wear full Personal Protective Equipment.
UNICEF Bangladesh/2020/Dilara
Staff delivering the vaccines wear full Personal Protective Equipment.

“Ever since the ban on public transport due to COVID-19, we have been walking on foot eight kilometres to the last centre and eight kilometres back home. There are no boats or buses.”

Bina’s role is especially important because medics have warned that there will be severe outbreaks of measles and other diseases in Bangladesh if vaccination coverage is not improved. This was planned to be achieved through mass vaccination campaign in early 2020, but the COVID-19 crisis has meant that such campaigns have been suspended to stop the spread of coronavirus.

Ever since the ban on public transport due to COVID-19, we have been walking on foot eight kilometres to the last centre and eight kilometres back home. There are no boats or buses.

Parents are reluctant

UNICEF provides technical and financial support to Bangladesh’s Expanded Programme of Immunisation but with lockdowns in place as a part of the COVID-19 response, routine immunizations have been severely disrupted.

Parents are increasingly reluctant to take their children to health centres for routine jabs. After Bangladesh postponed its national measles and rubella campaign targeting 34 million children aged from nine months to nine years, sporadic outbreaks of measles have occurred in parts of the country.

Bina Rana’s team regularly had to travel on foot when other forms of transport were not available.
UNICEF Bangladesh/2019/Mawa
Even before the arrival of the Corona virus, Bina Rana’s team regularly had to travel on foot when other forms of transport were not available.

The Directorate General of Health Services in Bangladesh has recently issued guidelines to continue routine immunization during the COVID pandemic in line with UNICEF and WHO global and regional advisories. These take place in both fixed and outreach sites as an essential service to combat disease outbreaks. However, the number of immunization sessions performed has dropped significantly in lockdown areas, as has the number of children coming for vaccination sessions.

Bina says that while poorer people generally do not need to be convinced about the benefits of immunisation, more affluent people tend to be more reluctant.

“We try to encourage them until the very last minute,” she said. “We motivate them, visit them at their houses, maintaining physical distancing of course, and explain to them that it’s safest for the children to vaccinate them now.”

Loudspeakers announce her arrival

The dynamic health worker says that while there are so far few outward signs of fear about COVID-19 on the ground, although shortages of some vaccines for other illnesses have become more noticeable. There is also evidence that some parents are delaying getting their children vaccinated until the situation improves, “but we tell them that might be too late”.

“We are also requesting the imams of the local mosques to announce on the loudspeaker that sessions are starting from so that no one in the larger villages misses the news,” she said.

“It’s only natural that parents will be scared in the current climate. But we show them that we can do our work while maintaining physical distancing and wearing protective gear.”