Vaccination express leaves no one behind

Mentions of ‘express’ in Rumphi District, northern Malawi, evoke memories of long-haul buses that seldom stop for latecomers and travellers seen on the way.

However, a new ‘express’ has left tongues wagging on the westward road from Rumphi Town to the border strip close to Zambia. Health workers prefer calling the branded minibus a vaccination express,

Its crew is more openhearted than those on the famous express of old. They happily stop for people who remain unvaccinated though the country rolled out COVID-19 vaccination in March.

“The vaccination express doesn’t leave anyone behind,” says Innocent Chiweza, a Senior Health Surveillance Assistant leading the team. “The idea is to bring vaccines close to those who need them and increase the number of vaccinated people.”

The branded minibus with loudspeakers proclaiming the benefits of COVID-19 vaccines was on the way to Bembe Market when Sandrace Chirambo waved it to a halt.

Much to the joy of the 31-year-old construction worker eager to safeguard his job by protecting himself from COVID-19, the driver applied the brakes, not whining about the target crowds waiting at the busy market ahead.

“I’m back here on holiday, but I couldn’t resist it because my employer in Mangochi district wants every worker to get vaccinated. From January, those not vaccinated must show proof of negative tests conducted within 72 hours,” said Sandrace after getting vaccinated in Zingabalwani Village.

The father of one explained that he delayed to get the first jab because he was overwhelmed by work as well as myths, misinformation and conspiracy theories that spread fast social media.

However, the wait-and-see game was partly halted by fears of the fast-spreading fourth wave.

 “I was hesitant because my friends told me that the vaccine was made to depopulate Africa, but no one has died from it so far. When I heard COVID-19 messages blaring, I stopped the van because it was my chance to get correct information from heath workers and get vaccinated. Today, I feel protected,” explains Sandrice.

He is excited to return to work with a vaccination card exempting him from weekly COVID-19 tests.

“I didn’t have to worry about long walk to the hospital or transport fare. But the vaccine I have received close to home will protect me, my job and my family,” says Sandrice.

The Ministry of Health has embarked on the mobile vaccination strategy with support from UNICEF Malawi through the Kamuzu University of Health Sciences (KUHES). The initiative has received funding from various partners, including UNICEF Germany.

Dr John Phuka, head of the public university’s School of Public Health and Family Health, says COVID-19 vaccine shields the body from the virus and teaches the immune system to overpower possible infection.

The former head of the Malawi’s national COVID-19 response credits the vaccination express with dramatically raising the vaccine uptake in the country which in May this year burnt 19 600 expired doses of AstraZeneca vaccine to reassure people that the remainder was safe.

To Phuka, putting vaccines close to targeted populations is “a good example of universal health coverage”, the global push that requires governments and their partners to ensure everyone gets health services they need closer to where they are and without suffering any financial hardship.

“Coverage is about access and acceptability of the service,” Phuka states. “I wish we had enough rigor, effort and resources to continue with this approach beyond the campaign. Numbers don’t lie.”

The vaccination minibus vaccinated 28 people on the way to the market day at Bembe, where over 100 received the jab.

John Kuwanda, Assistant Environmental Health Officer in Rumphi, coordinates immunisation services in the northern district.

He says the figures from the vaccination express powered by 183 HSAs, 21 supervisors and three vans shows that to some extent, vaccine hesitancy may be just an excuse for failing to make doses accessible.

“We vaccinated 4,113 people within six weeks before the express vaccination campaign started and when the campaign started, we vaccinated 14, 413 in another six weeks. Where were all these people when we were worried about myths and misconceptions? Some people don’t come to health facilities either because they live far away or they are too busy with other activities. When we go to them, they are motivated to get vaccinated.”

Rumphi is among districts that provide lunch allowance to HSAs who finish a vaccine vial containing 10 doses.

“With the finish-a-vial challenge, the vaccinators are reaching more people even in hard-to-reach areas, ensuring no dose goes to waste. Now, we vaccinate about 900 people, but we want to beat this record,” John says.

Speaking after being vaccinated by the roadside in Chikazinga Village, Martha Munthali, a 32-year-old mother of one, thanked the mobile team for safeguarding her from the resurgent pandemic.

Now she hopes to spend more time caring for her family, business and crops and not on a sickbed.

“I am afraid of being hit severely by the fourth wave. I don’t want to die when I hear on the radio that unvaccinated persons are unlikely to experience severe illness or death,” she said.