I sent a WhatsApp message to an old acquaintance, a nurse, requesting to know the state of vaccination in Sierra Leone. Unlike other messages to her in the past, her response did not take long in coming and it was via a voice call.
We had not spoken in a long while and after the pleasantries she (let us call her AB, as she wants to remain anonymous) went straight into action. For the soft-spoken person I knew her to be, it was surprising to hear a high pitched tone in what was a seemingly endless rant: “We are not going to accept that. They do not have to come and test their vaccinations here. You know with viruses if someone has the slightest inkling to be infected and that person is vaccinated, the virus will spread in that individual much faster than if not vaccinated. Let me tell you….” She was about to continue and I stopped her.
“I was not asking about the current coronavirus pandemic,” I told her, “but rather wish to talk about vaccination in general in Sierra Leone.” She breathed heavily, softened her tone and continued: “You know when we learnt that there would be a fresh vaccination drive at this time and with the experience we had with the Ebola outbreak, we were appalled and wanted to stop that immediately.”
Sierra Leone, she said in a more composed tone, has had a series of successful vaccination campaigns over the decades. She is in a position to know because she was with the Expanded Programme of Immunisation team in the Ministry of Health for many years. During those many years she had the opportunity of working in all but one province in the country.
Globally the EPI team had been recording huge successes in their campaign, she said. “We have certainly had difficulties getting some people understand why we are embarking on some campaigns.”
This nurse with over 40 years’ in the profession catalogued some of the challenges they have had to cope with over the years. “We always experienced logistical problems. Access and storage of vaccines posed some difficulties. You know also that the decade-long civil war was not a source of comfort for us at all. Talk less of the Ebola outbreak that caught us off guard. The location of our health centres had sometimes posed some complications for mainly mothers as they would have to travel long distances on foot to get their children immunised. This is even worse off for those in riverine villages where even health workers have difficulties getting around these areas. Some mothers who may be close to these health centres do not see the value in the immunisation so they stay away.”
For this latter group of mothers the EPI team has not relented in its efforts to get them on board. It has organised campaigns using traditional rulers in their regions to drive the message home. These traditional rulers are viewed in high esteem and if they are on board that will be a source of comfort for the health workers.
For the usual vaccinations such as the five-in-one shot, which protects against diphtheria, tetanus, whooping cough, hepatitis B and Hib the country has been doing an excellent job. There has been collaboration with both the United Nations Children’s Fund, (UNICEF ) and the World Health Organisation, WHO to ensure that the vaccines are administered to all the children in need.
As mentioned earlier by Nurse AB, the combined decade long civil war and Ebola had a devastating effect on the vaccination drive. They not only temporarily halted the efforts of the country’s health authorities in performing their duties, they set the vaccination drive years back. That notwithstanding, Sierra Leone has been doing creditably well when compared to other countries in the sub region.
Three years ago the country embarked on the electronic immunisation Registry and Tracking System which is also known as VaxTrac. It provides timely and quality data for children’s immunisation and helps decision making. This has helped the government track down immunised children but that does not mean all the children were immunised. That said, Sierra Leone has been lucky. Unlike countries like Nigeria, Pakistan and Afghanistan where there have been violent, and sometimes deadly opposition to vaccination drives, to the point of castigating them as a means to wipe out their population by sterilising their women folks or rendering their children autist, the authorities in Sierra Leone have successfully carried out their campaigns relatively hitch-free.
Perhaps one of the reasons for the success in Sierra Leone is the involvement of traditional leaders. Not only have they involved in getting their kith and kin vaccinated they have also been encouraging their subjects to get their children and even adults that had not been vaccinated to do so.
With the Coronavirus etching its way deep into the society with no end in site, it will not be an easy task to right now continue with normal vaccination campaigns. As Nurse AB put it. “It is a new challenge that has befallen us. All we have to do now is go back to the drawing board and strategize on the way forward. It will not be too soon. We will have to wait for positive results on the cure or otherwise of the Covid 19 virus before we can get back on the field. Any attempt at doing that now will be met with stiff resistance.”