As the rainy season begins in the city of Kinshasa, Democratic Republic of the Congo (DRC), the biggest ever yellow fever emergency vaccination campaign in Africa is drawing to a close. More than 7 million people in Kinshasa province have been successfully vaccinated in the last 2 weeks. But in the country’s remote areas on the Angola border, the campaign is still being rolled out, targeting a further 3 million people at risk with the aim of ending this outbreak of the potentially fatal disease.
For desperately poor people living in the cramped slum of Pakajuma, Kinshasa, yellow fever vaccination is vital protection from an outbreak that has already claimed more than 400 lives in Democratic Republic of the Congo and Angola. Cramped shanties in the densely populated alleyways are surrounded by dirty stagnant water and poor sanitation – conditions that bring high risk of mosquito-borne diseases like yellow fever, as well as water-borne diseases like cholera.
Even after the official end of the vaccination campaign in Kinshasa, social mobilizers like Bebe Bola continue to circulate, publicizing ’mop-up’ campaigns and ensuring that every last person has the opportunity to protect themselves and help end the outbreak.
The logistics to vaccinate more than 10.5 million people in Kinshasa province and remote areas bordering Angola have been complex and challenging. WHO and partners have helped the government of Democratic Republic of the Congo to organize and transport more than 10 million syringes and 38 000 vaccine carriers - by truck, car, motorcycle, boat, and foot to the targeted 8000 vaccination sites, many of them in remote and hard-to-reach areas.
On the border with Angola, the health zone of Popokabaka covers almost 7000 square km and is split down the middle by the River Kwango. The car ferry, which once took people backwards and forwards across the river, has broken down, and vaccines and other materials often have to be transported over 100 km in dug-out canoes. WHO works with local health authorities to assess how best to get vaccines and supplies for the campaign to where they are needed in this and the other 14 health zones being targeted along the border.
Many people in these rural border zones have to walk miles to get to their nearest health centre. Less than half of the vaccination sites have any telephone network and collecting essential data on the progress of the campaign can involve two days of travelling. Local supervisors frequently walk to nearby villages and climb trees in an attempt to access a signal and transmit information to the health zone headquarters.
This rural community health centre is vaccinating around 11 000 people during the campaign. From first light, people begin queuing in order to receive their vaccinations before they head for the fields. The vaccine is given to everyone aged more than 9 months, including to pregnant women.
Whole communities are involved in this campaign. Community mobilizers go door-to-door and village-to-village – often bringing entire families from remote locations to their nearest vaccination site. The campaign is a rare opportunity to give people free protection from a potentially fatal disease with a safe and effective vaccine.
Crowds gather at a health centre during a yellow fever vaccination campaign in the rural district of Maluku on the outskirts of Kinshasa. Many of the people who live here are subsistence farmers or petty traders who have to work during the day to be able to feed their families. These areas are among those identified for reinforced mobilization and extra vaccination even after the official end of the campaign to cater to those who may have missed out on vaccination.
A young woman is vaccinated at a private hospital in Kinshasa that is supporting the campaign. During the first two days of the campaign, this clinic vaccinated some 1500 people. The business community in the central business district of Gombe also supported the campaign by allowing its workers, many who come from outlying areas, to get vaccinated where they work.
A child, suspected of having yellow fever, is photographed next to his heavily-pregnant mother at the Amitié Sino-Congolais reference Hospital in Kinshasa. All patients in the ward are being cared for by MSF Belgium which is in charge of clinical management of yellow fever patients in this hospital.