STRUGGLE FOR COVID-19 VACCINE IN RURAL AREAS: The challenging track in Okola, Cameroon

Photographs by Alexandre Le Grand Wk for

Within the shadow of the civilization, Sweet Okola

6:30 a.m. The sun rises in Okola, a busy town situated at 30 kilometers from Yaoundé, the political capital of Cameroon. Okola, a sub-Division of about 605 Km2 is located in Lekie Division, in the Center Region. With a population of approximately 41,081 inhabitants, it constitutes one of the most populated neighboring middle localities of the Region. The town of Okola is close to 3,725 inhabitants and is part of a municipality of 68 villages essentially invested in agriculture. However, the literacy level is beyond the national average, the majority of the inhabitants are of the Christian faith but still hold allegiance to strong traditional belief systems.

Covid-19 and Okola population perceptions

Mummy Madeleine, 64 years old, is engaged in a petty trading commonly referred to as “buyam-sellam”. Today, she has got up earlier than usual. After cleaning up quickly, after praying as usual, and handling daily household chores, she hurries to the market to sell her supplies. Indeed, since days, she has decided to take the vaccine against covid-19. After attending an awareness campaign a few days before, she made the decision to protect herself against the dreaded pandemic. However, she in turn could not convince her husband and children to take their doses as well. Anyhow she is sure to have finally taken the good decision that may be will later on convince others.

Since yesterday, our team is going round the town and is surprised to discover that the population in general, both young and elderly have the covid-19 pandemic at the top of their preoccupations. Even in palm wine drinking places where almost all men from different background are gathering after daily jobs, covid-19 mysteries and it vaccines are the up to date news. Everybody feels concerned and even elderly seem to know and understand the danger better than younger ones who instead shout to convince.  All are convinced that live has never been so fragile and that among consequences, economic effects are resulting to a terrible poverty that may kill more than the pandemic and that vaccination will not bring any solution

Mballa, a young carpenter apprentice does not really know enough about the virus; after daily job, he does not usually have time or opportunities to listen to news but pretend to know much about white conspiracy against Africans. With many of his friends, he has long made up his mind about dangers around 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 (COVID-19) pandemic warrants a reflection on health systems strengthening as well as a coordinated response from the local, regional and national levels to support efforts to effectively fight against the pandemic. Cameroon’s COVID-19 situation report (SITREP), as of August 04 2021, revealed the following;

  1. Worldwide 191 countries affected, 199,742,769 confirmed cases with 4,249,118 deaths, and 4,188,893,273 doses of vaccine administered.
  2. In Africa: 53 countries affected, 6,814,706 confirmed cases, 172,842 deaths, and 66,951,701 vaccine doses administered.
  3. 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 of them have noticed more than 40% of cases. 

A cold way of a ‘’ New look’’ immunization campaign against covid19

After subscribing to the COVAX initiative launched in April 2020 by the international community, Cameroon received its first COVID-19 vaccine in the month of April 2021 began vaccination against covid-19 in order to respond effectively against the ongoing epidemic in the 10 regions of the country. In view of this, mindful of the vaccine hesitancy challenge and other expected hurdles, the Expanded immunization programme (EPI) is exploring every opportunity to ensure that the COVID-19 vaccines 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 implicated in this exercise to provide COVID-19 vaccines (including AstraZeneca, Sinopharm and more recently Johnson & Johnson) to targeted populations.

Because of the importance the government attaches to the fight against the pandemic, the EPI has mobilized supplementary means for social mobilization and the many areas, most especially in the remote and rural zones still face enormous logistic challenges and may not readily be served.

To date, there are 293,991 vaccinated people having taken the first dose and 55,854 having taken the second dose, in 188 out of 197 health districts that have started vaccination.

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 neighbouring countries. Hence, for several reasons it is difficult for people living in these hard-to-reach zones to gain access to these precious shots. These reasons may include; the chain of COVID-19 vaccine supply, logistics and transportation Yaoundé to the various localities, 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 covid-19 to be a conspiracy and therefore, they think there is no need of getting vaccinated. Although they continue to immunize children against vaccine-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 covid-19 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 to the vaccination center is not always easy.

Commonly encountered comments are those opined by these community members… “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 a surrounding village of Okola. Mr. Atangana is a school teacher by profession and works in the town of Obala, some 90km away from Yaounde. Here is what Mr. Atangana explains while proudly showing off his 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 Mummy Madeleine is glaring and represents a vivid reflection of many! She has been nursing some pain on the 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. She had crossed a bridge and climbed a number of hills in order to benefit from this vaccine which is expected to protect her from the serious forms of the disease.

On arriving the vaccination center, Mummy Madeleine had to wait again for a few minutes, 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 any Manifestation Adverse Post Immunization (MAPI) and will come back in a month’s time for the next dose.

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 a disability presents more difficulties with the climbing of the hill that leads to the center. And unfortunately, it is the unique COVID-19 vaccine center for the 68 villages of the Sub Division. Indeed, although there are 244 vaccination centers across the country, access is not always easy outside large metropolitan areas. In cities, thanks to infrastructure and means of transport, volunteers have easy access to the services of the covid-19 vaccination. Whereas, in remote localities, the access to COVID-19 vaccine Center is as difficult as the access to other health services which are often situated several kilometers from the population at need.

Despite of 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 and when vaccines are out of stock”.

Since the identification and notification of the first cases of COVID-19 in Cameroon on March 2020, only one death has been registered among 141 cases confirmed in Okola. Since then, the elites in collaboration with administrative, traditional, religious and health authorities have championed population awareness, sensitization campaigns against COVID-19 and encouraging messages to increase COVID-19 vaccine acceptability.

While these efforts are yielding the expected outcomes including the adherence to social distancing measures, the use of face masks and hand washing, there are still diverse perceptions. As more people become interested in taking the COVID-19 vaccine, many are still keeping their trust in traditional treatments made of natural products.

Beyond the threat versus the Hope!

The truth is that things will never be like before. COVID-19 has completely influenced people everyday life: Hands washing and social distancing measures are increasingly becoming part of normal behaviors. In earnest, rural population 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, populations in rural areas must be made more aware of the reality of COVID-19, and the need to protect themselves through immunization. Although efforts have been made by the Cameroonian government to ensure the protection of the Cameroonian people, additional efforts must be made in terms of awareness and accessibility in order to guarantee the accessibility of vaccines to all, especially in rural areas.

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 been vaccinated to rapidly overcome the pandemic.

Hemes NKWA

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.

Posted by Yoheda

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