Struggle for Covid-19 vaccine in rural areas: The challenging track in Okola, Cameroon
By Hemes Nkwa
It’s 6:30 am, and the sun is rising in Okola, a busy town located 30 kilometers from Yaoundé, the political capital of Cameroon. Okola, a sub-division of about 605 Km2, with close to 3,725 inhabitants and is part of a municipality of 68 villages with agriculture as the main economic activity. Christians mainly inhabit the region, but residents still hold allegiance to the traditional belief system.
Covid-19 and Okola population perceptions
Mummy Madeleine, 64 years old, is engaged in small scale trading, commonly referred to as “buyam-sellam.” Today, she got up earlier than usual. After cleaning, praying as usual, and undertaking daily household chores, she hurries to the market to sell her supplies. Unlike most residents, Madeleine is vaccinated against Covid-19 after days of contemplating taking the jab. After attending an awareness campaign a few days before, she decided to protect herself against the deadly virus. However, in turn, she could not convince her husband and children to take their doses. Mummy is convinced that she made the right decision and hopes others will follow suit.
Our team’s survey of the town shows that the population in general, both young and elderly, is preoccupied with the pandemic and its effects. Even in palm wine drinking dens, Covid-19 mysteries and vaccines are among the most discussed items. Everybody feels concerned, and even the elderly seem to know and understand the danger better than younger ones. All are convinced that life has never been so fragile and that economic effects has resulted in terrible poverty, with some claiming that vaccination will not offer any solution.
Mballa, a young carpenter apprentice, does not know enough about the virus because he does not keep tabs on the news. Alongside his friends, Mballa seems to have made up his mind about the alleged dangers of the vaccine. “We long knew about the plan, how can’t they never help even during when our brothers are dying why crossing the desert, but they are now insisting for a free vaccine not? I will never take it!”
General situation of the pandemic
The advent of the novel coronavirus pandemic warrants a reflection on strengthening health systems and coordinated response from the local, regional, and national levels to effectively support efforts to fight against the health crisis. Cameroon’s Covid-19 situation report (SITREP), as of August 04, 2021, revealed the following;
- Worldwide 191 countries affected, 199,742,769 confirmed cases with 4,249,118 deaths, and 4,188,893,273 doses of vaccine administered.
- In Africa: 53 countries affected, 6,814,706 confirmed cases, 172,842 deaths, and 66,951,701 vaccine doses administered.
In Cameroon: 82,454 confirmed cases and 1,338 deaths have been noticed with pics on September 2020 and June 2021. Among the 197 Health Districts of the country, about 25 have noticed more than 40% of cases.
A cold way of a” New-look” immunization campaign against covid19
After subscribing to the international community’s COVAX initiative launched in April 2020, Cameroon received its first batch of vaccines in April 2021. Mindful of the vaccine hesitancy challenge and other expected hurdles, the Expanded immunization program (EPI) is exploring every opportunity to ensure that the jabs get to the hard-to-reach zones at any cost.
The goal is to allow anyone over 15 years in Cameroon to have access to the vaccine. The device used to fight against vaccine-preventable diseases (VPD) is the same that is used to ensure vaccination throughout the national territory. All regular EPI vaccination centers were included in this exercise to provide the jab (including AstraZeneca, Sinopharm, Johnson & Johnson) to targeted populations.
The EPI has mobilized supplementary means for social mobilization. Many areas, especially in remote and rural zones, face enormous logistic challenges and may not readily be served.
To date, 293,991 vaccinated people have taken the first dose, and 55,854 have taken the second dose in 188 out of 197 health districts.
According to the Expanded Vaccination Program (EPI), since April 2021, 244 vaccination sites are available in all health districts of the country. This includes the rural areas which remain poorly covered with routine EPI vaccines, despite their demographic importance, especially those which share frontiers with neighboring countries. Hence, it is difficult for people living in these hard-to-reach zones to access these precious shots.
However, the supply of vaccines faces challenges like supply, logistics, and transportation from Yaoundé to the various localities. Furthermore, other major concerns include awareness-raising activities, difficulties encountered by the populations in gaining access amidst the vaccine hesitancy concerns against the Covid-19 vaccination.
Perceptions of covid-19 vaccination by rural populations
In Okola, the population is divided on the subject of vaccination against Covid-19. Many people consider the health crisis a conspiracy, and therefore they disregard vaccination. Although they continue to immunize children against preventable diseases, they are not convinced of the necessity of taking the Covid-19 vaccine. Like in most communities, opinions are mixed in Okola with regards to the vaccination. While many residents are aware of the threat, most do not want to take the vaccine. For those who want to be vaccinated, it seems that accessibility is the main challenge.
Commonly encountered comments include… “You should leave people alone with your vaccine business here!! Corona does not exist! We have real problems here. Don’t distract the people”. These are excerpts from an octogenarian when asked for his opinion on the Covid-19 vaccination.
A few kilometers away is an anxious individual returning from his plantations in the surrounding village of Okola. Mr. Atangana is a professional school teacher and works in Obala, some 90km away from Yaounde. Here is what Mr. Atangana explains while proudly showing off the herbal collection he had to say, … “I am an educated person; I have a mastery of Covid-19. I do everything in my best efforts not to contract the disease. I know it exists, but I can’t take the vaccine. I have a whole plantation of very effective remedies for all these flu. I don’t see what this vaccine is going to be used for”.
Access to the vaccine against covid-19: A path full of pitfalls
The ordeal of Madeleine is glaring and represents a vivid reflection of many. She has been nursing some right leg pain following a chronic discomfort a few years back. She narrates how it finally took about an hour and a half, on foot, leaving the village of Ntsama, to get to the district health service in Okola, which serves as the local vaccination center.
On arriving at the vaccination center, Madeleine had to wait again for a few minutes. The time within which the health worker introduces her to the benefits of vaccination and gives her the different options. However, on this day, Sinopharm is the only vaccine available, and it is being administered to her. Mummy Madeleine is now happy and is going back the other way. She has not experienced Manifestation Adverse Post Immunization (MAPI) and will return for the next dose in a month.
The Okola Immunization Center is located in the District Health Unit, housed in the buildings of the District Hospital in the heart of downtown. The access to his services by the sick, the elderly, and people living with disability presents more difficulties as a majority have to encounter challenging terrain to access the center. Unfortunately, it is the only vaccination center for the 68 villages.
Although there are 244 vaccination centers across the country, access is not always easy outside large metropolitan areas. In cities, thanks to improved infrastructure and means of transport, residents have easy access to vaccination. Whereas, in remote localities, the access to the vaccine center is as tricky as the access to other health services, which are often situated several kilometers from the population at need.
Despite these challenges, there is reassurance from the Okola District Medical Office and Hospital staff, … “Vaccination against covid-19 is available and free of charge every working day, except on Thursday, from 8 am to 3:30 pm when vaccines are out of stock”.
Since the first coronavirus case was reported in Cameroon in March 2020, only one death has been registered among 141 cases confirmed in Okola. Since then, in collaboration with administrative, traditional, religious, and health authorities, the elites have championed population awareness, sensitization campaigns against Covid-19, and support messages to increase vaccine acceptability.
While these efforts yield the expected outcomes, including the adherence to social distancing measures, face masks, and handwashing, there are still diverse perceptions. As more people become interested in taking the vaccine, many still trust traditional medicine.
Beyond the threat versus the Hope!
With Covid-19, it is clear that life might never go back to the way it was before. The pandemic has completely influenced people’s everyday lives by introducing new behaviours like hand washing and social distancing. In earnest, rural populations face realities that are sometimes different from those encountered by urban populations. Indeed, limited means of transport and insufficient infrastructure make access to healthcare in general and vaccination services particularly difficult. In addition, there is a need to sensitize the rural populations on the reality of Covid-19 and the need to protect themselves through immunization.
Although the Cameroonian government has tried to shield its people, additional efforts must be made in terms of awareness and accessibility to guarantee the vaccines are available to all. In conclusion, although vaccines are getting gradually available, other protective measures (hygienic and sanitation measures, approved therapeutic options, and constant education on health) should be continuously followed even after being vaccinated to overcome the pandemic rapidly.
Photographs by Alexandre Le Grand Wk for Yohedahealthsolutions.com
This OUTBREAK story was supported by Code for Africa’s WanaData program as part of the Data4COVID19 Africa Challenge hosted by l’Agence française de développement (AFD), Expertise France, and The GovLab.