Chiefs, health workers collaborate to bring COVID-19 vaccines to the last mile, with UNICEF support

It’s Friday 11 am and people in Chibibi Village, Traditional Authority Chikowi in Zomba, are pacing to go to a mosque in their midst.

Some stop to listen to COVID-19 messages and others get vaccinated near a truck carrying health workers and loudspeakers.

“This vaccination team has been deployed on request from village chiefs who also identify the sites,” says district immunisation coordinator Simeon Chizimba. “The idea is to increase the number of people getting vaccinated and reduce loss of dose.”

The District Health Office (DHO) has trained four village chiefs around every health centre to increase access to vaccines.

The community leaders work closely with health surveillance assistants (HSAs) in their localities to rally people to get vaccinated when the COVID-19 express vaccination van arrives.

“If they get 20 people, the HSA phones us and we send two vials. Each vial contains vaccine doses for 10 people, so we don’t waste any,” explains Chizimba.

Elise Mphatso was the first to get a jab that Friday.

“The vaccine is important because I hear that over 2000 people in Malawi have died from COVID-19. These include prominent politicians, so I need to protect myself?” she asked after getting the prick.

The 23-year-old mother of two commends the mobile vaccination team for saving her a long trip and extra costs to access the vaccine. The villagers pay about K2 000 (just over $2) for a two-way motorcycle ride to Namikango Health Centre and K3 000 (about $3.50) to Zomba Central Hospital.

“Good health allows me to work so that my children don’t starve, but the transport fare to Zomba is enough to buy food for a week,” says Elise, whose maize yield run out two months after harvesting. She now survives on meagre earnings from washing clothes and working the fields of her well-off neighbours.

Village chief Chibibi got vaccinated at the central hospital in June. He was excited to see the people getting the jab close to home.

The local leader says putting the vaccines close to a mosque was a strategic call because the majority of the locals are Muslims.

“I got vaccinated to set a good example for people who were suffering in silence because of fear of the unknown, so I’m happy that some people delayed by misinformation are getting vaccinated close to where they live,” he says.

The COVID-19 express vaccination exercise is supported by UNICEF in partnership with the Ministry of Health and Kamuzu College of Health Sciences. It has proven handy in bringing vaccines closer to people who would otherwise be unable to make the trip to hospitals.

Taking vaccines to shopping malls, busy markets, workplaces, schools, prayer houses and other accessible spots helped utilise thousands of doses before expiry.

“There is no reason for a dose to expire while people are dying from the vaccine-preventable condition. No one has been confirmed to have died from COVID-19 in my area, but two succumbed to strange coughs and breathing difficulties similar to the coronavirus disease. Maybe a timely vaccine would have saved them,” Chief Chibibi explains.

In its first month, the express vaccination exercise helped save about 500 000 of almost 700 000 doses that were due to expire in September and December.

Since the roll-out of the COVID-19 vaccination exercise in Malawi in March 2021, UNICEF has facilitated the delivery of 2, 089, 790 doses of Astra Zeneza from the UK, France, African Union through the COVAX facility, 655, 200 doses of JJ vaccine from the US Government via the COVAX facility and 372, 060 doses of Pfizer from the United States Government. With funding from GAVI and the Government of Japan, UNICEF continues to support the Government of Malawi’s cold chain system to store and transport vaccines safely and on service delivery.

UNICEF Malawi Representative Rudolf Schwenk says UNICEF remains committed to support upcoming vaccination activities and strategies. “UNICEF is working with the Ministry of Health to address critical obstacles in COVID-19 vaccination. We assisted in developing the express vaccination strategy and in mobilising funding to reach Malawi's most remote populations with COVID-19 vaccines."

The 30 vans—each carrying four vaccinators and entertainers—visit villages and urban locations with a public address system playing hit music laced with COVID-19 messages.

District immunisation coordinator Simeon Chizimba commends UNICEF and its partners for investing more to create and satisfy COVID-19 vaccine demand with the involvement of community health workers and local leaders involved.

He narrates: “Before the van goes to any target area, community heads and other influential voices work with health workers to mobilise the people, telling them the importance of vaccines and where the truck would stop. As such, the arrival of the van is just a fulfillment of what the local leaders tell them.’

Mphatso Mtenje, cold chain manager for the Expanded Programme on Immunisation (EPI), says increased access to doses has reduced pressure on the vaccine storage facilities.

He explains: “Before the new strategy, we used to release 200 000 to 235 000 doses a month, but now dispatch up to 400 000. As these vaccines go to the districts, we create room for more vaccines.

“At the slow pace, the doses would be piling and expiring in the refrigerators at the national, regional and district vaccines stores. This would not only affect COVID-19 vaccination but also other routine vaccines.”

 “Increasing access has helped the EPI clear the vaccines that were supposed to expire in December. As some people were talking about the potential expiry of the doses, others were getting vaccinated in large numbers. In so doing, we have utilised all the at-risk vaccines and created room to welcome more vaccines in 2022,” he explains.