Taking COVID-19 Vaccine to - High Risk populations

In her 90s, Elfas Nyaukandawire has lost count of her years as well as the tenacity to walk and work. Advanced age increases the risk of dying from COVID-19 and also denies Nyaukandawire access to vaccines, the only weapons against the virus.

“I know the sting of death,” Elfas says. "I've lost all my seven children and their children need my care.”

Grandma Elfas waited 10 months for her first COVID-19 vaccine.

“I've been hearing from the radio that people aged at least 60 years are severely affected by COVID-19, but I couldn't get vaccinated because I couldn’t walk to Rumphi District Hospital. I don't have the energy or money to make the trip," she laments.

Grandma Elfas finally got  the vaccine from her verandah on 17 December 2021 when her neighbour Rose Nyasulu stopped a vaccination van passing through Kaiwale Village.

The roadside village is located 10km west of Rumphi Town in northern Malawi. Motorcyclists charge K2 000 (about $2.50) for a round trip.

“I feel lucky to be protected. I couldn't go to the hospital using my walking stick and frail limbs. I don't work or yield much, so the money from well-wishers is best spent on daily needs, especially food," she explains.

Her sigh of relief exposes how confining vaccinations to health facilities silently excludes people who need them most, including the elderly and those with comorbidities.

By contrast, the van carrying vaccinators on the move branched to her homestead.

The leading health surveillance assistant (HSA) asked her not to queue in the sun, but to get vaccinated while relaxing in the shade of her grass-thatched house.

Nyasulu, 61, smiled broadly to see the old woman receiving her first vaccine.

She stated: “I know Covid is deadly. Now that I’m fully vaccinated, the virus won't overpower my body defences.

"However, my sister in marriage needed it more because the elderly and persons with diabetes, high blood pressure and other underlying conditions are highly likely to die if they catch the virus. She needed it more."

Nyasulu considers the mobile vaccination campaign a big boost for vulnerable persons unlikely to go to their nearest health facility.

“When vaccines come home, we don't spend our limited funds or time. Even those who were hesitant to get vaccinated change their minds,” she observes.

About 30 people in Kaiwale got the vaccine the day Nyasulu put a close to futile trips to Rumphi. She says the search for the second dose cost her enough money to buy a bag of cement for constructing a chicken house.

“I made four trips to Rumphi in June when the country run out Covid-19 vaccines, so when I saw the branded minibus with Covid-19 messages blaring in loudspeakers, I knew it had carried the rare vaccine,” she says.

The fully vaccinated farmer envisions the AstraZeneca vaccine keeping her healthy and energetic to tend to her family, tobacco, groundnuts and maize.

The Ministry of Health with support from UNICEF Germany and UNICEF Malawi through the Kamuzu College of Health Sciences has deployed 30 community outreach vans, which contribute 60 percent to the country’s daily vaccination coverage. 

UNICEF reports that a daily uptake of about 14 000 doses helped utilise 543 261 doses within the first two months, saving vital vaccines before they expired on 31 December 2021.

Innocent Chiweza, senior HSA and cold chain technician at Bolero Health Centre who led the vaccinators to Nyaukandawire’s home, says it is pleasing when people stop them to get shots.

“When the vaccine was confined to health facilities, few people were coming and the granny had no chance. Even fake news was spreading faster than accurate information," she says.

The vaccination express teams tackle misinformation both publicly and privately.

John Kuwanda, coordinator of the Expanded Programme on Immunisation in Rumphi, says the smiles of people like Nyaukandawire personify how the van with a public address system is improving access to the vital vaccine.

He explains: “It is not easy to vaccinate every eligible person, including the elderly, because some people in Rumphi still travel 30 to 40km to get to their nearest health facility.

“Previously, we needed a week to vaccinate 900 people, but the weekly figures have risen to 4 000 with people stopping the van when they need a jab,” John brags.

HSAs in Rumphi have almost met the district’s target to vaccinate 36 000 by New Year’s Eve.

"Almost 27 400 people had received their first dose like Nyaukandawire by 17 December. With a few days to go, we'll surely beat the target."

John salutes the district health supervisory committee and environmental health officer for constantly checking on the vaccination teams.

“We are motivated to beat the targets because we know our supervisors care about it," he says.