Riding the last mile to deliver life-saving vaccines to children in hard-to-reach areas

Mattru Jong — On a rainy afternoon, Sulaiman Kamara revs his motorbike from the Bonthe District Vaccine Store. Clad in a windbreaker and a pair of rain boots, Sulaiman is part of the Direct Delivery of Routine Immunisation Vaccines for Equity (DRIVE) programme, a last-mile vaccine delivery and outreach service funded by GAVI to ensure that even the most remote communities receive essential immunisation services. Today, his first stop is Mobefa, a riverine community accessible only by a combination of bumpy roads and winding waterways.

“The challenge is not just the distance,” Sulaiman says, tightening his grip on the handlebars. “It’s the terrain, the unpredictable weather during the rainy season, and making sure the vaccines stay safe until they reach the children who need them.”

Sulaiman’s journey begins on rugged dirt roads, waving through villages where children play barefoot and people greet him with waves. The DRIVE motorbike, equipped with insulated vaccine carriers, rattles over bridges made of timber and mud, overgrown with vegetation that hints at the rainy season’s recent rains.

For communities like Mobefa, this service is a lifeline. John Tucker, the District Operations Officer (DOO), emphasizes the importance of the programme: “Without DRIVE, vaccines could take days or even weeks to reach these areas. Timely delivery is critical for the potency of the vaccines and for children to receive their full immunisation schedules to prevent diseases.” In addition to the delivery of routine vaccines, the DRIVE supports the delivery of other essential primary health care commodities such as essential medicines, nutrition supplements for routine services, and during integrated campaigns.

After navigating a particularly tricky stretch, Sulaiman arrives at the riverbank, where a small wooden boat waits. He carefully transfers the vaccine carrier and his motorbike onto the boat, mindful of the jostling waters. As the boat glides through the mangrove-lined river, Sulaiman reflects on the responsibility his role carries.

“Every dose I deliver is someone’s hope for a healthier life,” he says. “Sometimes I think of the children waiting at the other end. That keeps me going, even on the toughest days.”

At Mobefa Maternal and Child Health Post (MCHP), Nurse Halimatu Massaquoi is ready to receive the vaccines. She checks the vaccine carrier and confirms that all doses are accounted for and in good quality. “Sulaiman’s dedication makes our work possible,” she explains, “We can plan our outreach sessions confidently, knowing that the vaccines are arriving on time and in good condition.”

Parents in the community, like Edna Koroma, see immediate benefits. “My son just received his measles vaccine,” she says, smiling as she cradles her little one. “If Sulaiman and the DRIVE team didn’t bring the vaccines here, I would have had to travel for hours to the next town. This saves us time, money, and worry.”

Beyond Mobefa, the DRIVE initiative is achieving results that are transforming immunisation in Sierra Leone. The integration of COVID-19 and HPV vaccines alongside the introduction of malaria vaccination has expanded coverage, reaching high-risk and hard-to-reach populations, reducing both zero-dose and under-immunized children. Initially planned for six districts, DRIVE has now expanded to eight districts, with 80 trained delivery partners provided with motorbikes, Android phones and rain gear. Their work has improved the availability of vaccines at service delivery points, reduced stockouts, and allowed health workers to spend more time caring for patients rather than traveling to collect supplies.

Digital innovations are also strengthening vaccine delivery. The Electronic Stock Management Tool (eSMT) has expanded to 84 health facilities, providing real-time visibility of vaccine stocks. Meanwhile, Thrive360, a digital data platform integrated into the national health information system, enables districts to track stock levels, utilization, and wastage more effectively. Cold chain and storage capacities are being upgraded, with the establishment of new district vaccine stores with solar systems, the solarization of facilities, and the procurement of vehicles to enhance the storage, distribution and management of supplies.

According to UNICEF Health Specialist Monsen Owusu-Aboagye, these achievements are part of a bigger picture. “This is more than delivery, it’s about equity,” he says. “From solar-powered vaccine stores to real-time data tracking, every improvement means children in places like Mobefa get the same chance at health as those in urban centers. DRIVE ensures that no child is left behind simply because of geography.”

Sulaiman’s day concludes after several hours at the health post, supervising the transfer of vaccines, assisting with outreach sessions, and recording data for the district’s health information system. The vaccines have been safely delivered, children have been vaccinated, and the community has been served.

Reflecting on the journey back, Sulaiman smiles. “It’s tiring, yes, but when I see a child receive a life-saving vaccine, it makes everything worth it. Every bump on the road, every wave crossed—it’s all for them.”

As the sun sets over Mobefa, the hum of his motorbike fades into the evening, having achieved results for children. It has carried hope, health, and a promise that even in Sierra Leone’s most remote corners, no child will be left behind.