Actions for Development and Empowerment (ADE has initiated conversations on vaccine equity to obtain citizens’ perceptions of health care service delivery as well as sensitize the population on the importance of vaccination.
On July 28, 2023, ADE organized a meeting with the Expanded Program on Immunization (EPI) focal points in Buea, Southwest Region, to examine the performance of the EPI in strengthening immunization coverage in the Southwest Region and in Cameroon in general.
During the meeting, healthcare workers raised several concerns and challenges they go through daily as far as vaccination is concerned.
“We have difficulty with Vaccine supply; when we go to take vaccines, they say vaccines are not available. Like the Rufarex vaccine, many patients came and left without taking it, said Celia Beringwe. They also attested to the fact that the BCG vaccine for children, ATC, is always low in supply, as is the COVID vaccine, which was unavailable during the second coverage.
Apart from the fact that the number of teams deployed for campaigns did not match the percentage of the population in the given area, healthcare workers also pointed out that the Lack of Motivation of EPI nurses was also a major concern, as some of them used their funds as transportation to go for training
However, some recommendations were outlined to strengthen immunization coverage in the Southwest region. Some of these suggested that EPI workers working in a particular district should be assigned to vaccinate in that community to solve the problem of trust.
Also, the government should ensure proper communication on vaccination before vaccination campaigns to avoid hesitancy from the population, send vaccines promptly and in large quantities to avoid shortages and motivate EPI staff financially for their efficiency.
Presentations were done on the dangers of non-vaccination and its effects on the population, the expanded program on immunization in the South West Region and success stories, government measures in ensuring immunization coverage and its effectiveness, and an analysis report on COVID-19 vaccine distribution in Africa: “COVID-19 vaccination, contextual analysis, and training manual.
ADE also carried out a sensitization campaign on Thursday, July 27, 2023, at the Muea market, Buea.
A team made up of three ADE personnel, five community mobilizers, the head of the communication unit for EPI, South West Region, a publicity agent, and ADE’s brand ambassador for #saveonesaveall; Auntie Felicia, stormed the Muea market and sensitized vendors and buyers on the importance of vaccination while presenting to them vaccines available in the region.
The citizens expressed their concerns concerning vaccinations. Among other things, they stated that the reason for their reluctance towards vaccination is due to a lack of adequate information from health personnel on the usage and side effects of vaccines.
They also mentioned that they do not trust some health personnel who are deployed to carry out vaccinations, especially in open spaces, as everyone has gotten into the process and they cannot differentiate who is authentic or not, hence the reason for their reluctance.
Promoting vaccine Equity is part of the COVID-19 Transparency and Accountability Project in Africa, which aims to encourage conversations about vaccine equity, distribution, hesitancy, and government commitment to the health sector.
CTAP is a project sponsored by Skoll Foundation and Conrad N. Hilton Foundation in partnership with Connected Development, CODE, and Follow The Money International which is currently the largest social mobilization and accountability movement in Africa.
ADE is a non-governmental organization created in 2019 to empower youth to act on issues surrounding them. ADE’s thematic areas include good governance and democracy, girl child education, and education for sustainable development goals.
Cameroon is targeting to get at least 13,944,491million of its population with Covid-19 jabs. But for now, only about 418,855 Cameroonians have been vaccinated. Even more, only 160,803 persons are fully vaccinated.
“A total of 3 percent of the target population has already received the first dose. And 1.2% of this same population is fully vaccinated. The proportion of health personnel vaccinated is 40.1% for the first dose and 18.1% for those fully vaccinated”, vaccination situation report of October 27.
Presently, 102,499 persons have had Covid-19 and 1686 deaths have been recorded as Cameroon grapples under the third wave of Covid-19.
In May, 2021, the World Health Assembly the world policy body set the target of 10 percent global vaccination by September, 30, 2021.
While 90 percent of high-income countries have hit the target, for Cameroon and other low-income countries, this target has not been met.
Low vaccination has been attributed to several factors, among them, the lack of information on side effects, fake news on side effects, religion, culture and government policies.
But according to the EPI, since the beginning of vaccination in April, there have been 501 minor side effects, 38 serious side effects out of the 472,156 vaccines administered. The most common side effects are headaches and pains on the injection spot.
According to Prof. Yap Boum, an Epidemiologist, “A study carried out in the ten regions of the country revealed that the people doubt the efficacy of vaccines, but vaccines are showing high efficacy for preventing deaths and hospitalization.”
Some reports have blamed low vaccination on the communication strategy which was neither validated nor implemented.
The gaps which initially drove low vaccination were the lack of involvement of the health personnel in the COVID-19 vaccination sensitization campaign.Besides, “sensitization campaign on COVID-19 vaccination is not adapted to the profiles of the hesitant population and their geographical location”, the United Nations Humanitarian Office, OCHA reported.
Another worry raised was about the two-dose vaccines not encouraging the population.
But, going by the Deputy Country Director of the Expanded Programme of Immunization, EPI, Andreas Njoh Ateke, over six months, many Cameroonians have been vaccinated with the two-dose AstraZeneca.
He added that other single-dose vaccines like the Johnson and Johnson are a plus making it easier for mobile teams to vaccinate the population with a single dose.
Despite the low vaccination and gaps, there are regions in the country with high vaccination rates like the Far North, Center and East regions.
What has actually worked in these regions that other can emulate?
Community leaders luring the population to get vaccinated
It is 7:00am on a sunny Monday morning at the Djungolo neighbourhood in Yaounde, in the Centre region of Cameroon. Ekobo Isidore, president of Djungolo Health District Committee is applying the last stroke of the brush to polish his shoes and ready to move out for the day.
He is going to give a talk on the need for Covid-19 vaccination in an association that has accepted to him and his colleagues a listening ear. He also visits and talks to families, religious and traditional rulers among other groups in the community.
It is a door-to-door work that they do, and all the times, they talk with community members who in turn spread the message in their communities.
“We pass our prevention messages through religious leaders and local government officials who are trusted opinion leaders people listen more to them”, Ekobo stated.
“Traditional rulers call us from time to time to take vaccines to those they have convinced to get a jab”, Ekobo recounts how they have been able to convince traditional and religious leaders.
Ekobo says “We are mobilized to fight Covid-19. As a structure of dialogue and community participation, we are in charge of sensitizing the population, convincing them to take the Covid-19 vaccination and practice barrier measures”.
Community health agents, or social mobilisers, spend days convincing the population, to adhere to vaccination which is not easy with misinformation on social media, he added.
“We visit associations, during their meetings spend time, to discuss to know why they are against vaccination. We send messages to churches, and mosques. We also have advocacy and community engagement meetings where we invite traditional rulers, religious leaders, Divisional Officers, Influencers and mayors to discuss with them.We try to convince health workers who are reticent about vaccination”.
The head of state cannot bring something to kill all Cameroonians, who will he govern? We know government needs the population in good health, to work and pay taxes and if every-body is sick who will pay? That is why, government is putting enough means to prevent and ensure the health of the community, these are some issues we raise to convince them.
“I am vaccinated and I have not been transformed into a horse, and there is no 5g network in my body,”, i tell the population to convince them and stress that vaccine is free, efficient and enables us to prevent Covid-19, Ekobo stressed.
“Local leaders, working with over 2300 community mobilizers and 1450 vaccination teams, were crucial to the success of a rapid COVID-19 vaccination drive that saw 52 000 people vaccinated across Cameroon in just five days in July”, WHO states.
According to the EPI deputy boss, the role of the community leaders has been very important in getting the numbers.
“Regions where vaccination coverage is high like in the Far North, Centre and East regions, have actors who hold a lot in reinforcing community participation, and the use of local stakeholder to improve communication and adhesion. This has partly helped to get these regions to better performance than the other half of the country”, Ateke said.
“We think this is an effort which is being learnt by others regions and gradually all the regions are trying to improve.”, he added.
Region like the South and Southwest, bottom on the vaccination table have certainly have not leverage on the community leaders.
“For the Southwest region being the last on the table this is a major call for concern and effort out of campaign are explored. The frontline workers have been trying to vaccinate in groups of enterprises, but they are still at the bottom though in these last days they are vaccinating more persons. The insecurity in the region has really limited access to vaccination services”, Ateke said.
Community leaders have a lot of impact both in out of campaign and during vaccination campaigns to scale-up vaccination.
Ateke maintains that “Given that Covid-19 is a public health issue for which vaccination is one of the most effective ways to prevent this infectious disease, vaccination campaigns have proven to be a great way to get vaccine closer to the population and to rapidly improve vaccine uptake”.
“Campaigns can be an opportunity to rapidly improve vaccine uptake though they are relatively more costly than the routine vaccination intervention but they are more cost effective because they help to rapidly immunize a huge number of persons within a shorter period of time” the deputy EPI Boss said.
Cameroon had the first vaccination campaign on April 12, when the country received the first consignment of Covid-19 vaccines, Sinopharm from the Chinese government.
To kick-start the campaign, Health Minister Manaouda Malachie took the first jab (televised for all to see) but, at this stage, hesitancy seemed to be at the peak so may doubted public vaccination.
Health officials then launched the second vaccination campaign from 7-10 July to reach a larger number of people.
During the Covid-19 vaccination campaigns in July, community leaders were major actors playing a determinate role in mobilizing the target population in their communities so they are really indispensable, Ateke thinks.
“We need to have the proper messengers, who are mostly the health workers, but also community leaders, for community engagement to move forward getting the vaccine and protecting population. If we have a large number of people who need hospitalization admission, it can be a challenge for the health system”, Yap stressed.
For the upcoming campaign from the November 17-21, every actor is key in improving vaccination so the health personnel- medical doctors, health workers are very vital and have been integrated in the communication group of actors, Ateke stated.
It is good to note that at the moment we have been able to vaccinated more than 30 percent of the health workers, they are being used to pass across messages to other health workers and to the population, he concluded.
“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”
Thousands gathered; to hell with masks, there were hugs, hand shakes, no social distance; they were mourning.
It was the burial of the Sultan, Ibrahim Mbombo Njoya, the king of the Bomoun people of West region of Cameroon, and the enthronement of Nfonrifoum Mbombo Njoya Mouhamed Nabil, the 20th King.
“It is an ideal avenue for the spread of covid-19 especially with the third wave and the Delta variant, which experts say spreads as fast as it kills”, Prof. Yap Boum II , Epidemiologist, lamented.
Cameroon is still experiencing its third wave of Covid-19.
Some African countries experienced the third wave of covid-19 earlier than others, amongst them, South Africa with the Delta variant.
South Africa, Morocco, Tunisia, Libya and Ethiopia account for over 60% of the continent’s caseload, the African Centre For Disease Control Director, John Nkengasong stated.
The World Health Organization, WHO, said the third wave, “could be 60% more contagious. Greater contagiousness means more cases, more hospitalizations, and a greater risk of overwhelming health systems. Some evidence also suggests that the Delta variant which is responsible for the third wave, is linked to more severe and longer-lasting cases”.
In Cameroon Health Minister Manaouda Malachie maintained that the country did not register any case for about three months before the surge in the new cases with the Delta variant at the origin.
“Malachie on national television maintained that genomic surveillance put in place detected out of 745 samples of positive cases analyzed, 43 were the English variant cases, 17 South African variant cases and 14 Indian Delta variant cases circulating in Cameroon.
“In October 2020, there were three variants in Cameroon, then in December eight, and there was a particular variant found in travelers that came from Central Africa. We learnt that the second wave of Covid-19 was caused by the South African strand, Prof. Wilfred Mbacham, Virologist said.
A report from the Cameroon Health Emergency Operations Centre indicate that the country recorded its first two confirmed cases of COVID-19 on 06 March 2020, the situation evolved rapidly and the first wave occurred around the period from 18 May to 05 July 2020, and the second wave appeared during the period from 22 February to 16 May 2021. Then the country observed a period of calm from June 2021.
“Since August 9, 2021 we have observed a rise in the number of cases. It is important to note the heterogeneity in the progression of cases with the central and coastal regions leading the way as expected. On the other hand, in this wave, regions such as the North West and the West have a much higher number of cases than in the last waves. A striking fact of this 3rd wave is the increase in the proportion of deaths, which has led us to intensify the death audits”, Belinga said.
According to Prof. Yap Boum, Epidemiologist, “This third wave, seems to be the worse, with the Delta variant.
Presently, 90 percent of the cases in the country are caused by the Delta variant that is highly transmissible, which means it may touch a large proportion of people who are vulnerable”.
To him, there is a difference between the first, second and third waves of Covid-19 in Cameroon.
“During the first wave, we didn’t know what was happening, we had very strict measures; the second wave was a bit more relaxed compared to the first with much more cases and deaths, with the peak around March and April”.
“In this third wave, we have even young people dying of Covid-19, kids of three months, three years and young adults. This was rare in the first and second waves, so there is need to readjust the measures we are taking”, Boum said.
The fact is that when you have ten persons hospitalized, nine out of the ten have not been vaccinated. 90 percent of the people dying are those who are not vaccinated, Yap stressed.
He warned that having taken a jab and still being hospitalized can happen for many reasons: such cases may have other conditions. We now know that people with HIV are immune depressed and responding less. So, the need for vaccine boasters.
The challenge with the third wave of Covid-19, is how to get the population to respect barrier measures, wear masks, wash hands regularly, and get vaccinated.
So far, Cameroon has confirmed 98,402 cases since the first case was declared in 2020 till date. The cases, and deaths correspond to the three waves of Covid-19.
Only 142,778(1.0%) Cameroonians are fully vaccinated and 397,607 have taken the first dose as of October 11.
Experts agree that were Cameroon to have more hospitalizations, the hospitals would be overwhelmed with the low level of vaccination.
Mbacham, maintains that “those who have taken just a shot of a two doses of the vaccines are as vulnerable as those who have not had a jab”.
What preventive measures for third wave?
Cameroon Health Emergency Operation Centre, is in charge of monitoring and taking record of the covid situation in the country on a daily basis.
Dr Belinga of the Emergency Health Emergency Operations Centre maintained that “At land, sea and air entry points, passengers are systematically screened and tested whether or not they have a negative test less than 72 hours old, as required by the regulations in force in Cameroon.
In the community, contacts of confirmed cases of COVID-19 are identified and followed up over a period of 14 days to look for the early appearance of signs of the disease.
Finally, there is surveillance in health facilities through triage systems set up at the entrance to the health facilities, active research in consultation registers and systematic screening of suspected cases, Belinga added.
Surveillance is part of a strategy based on awareness-raising and case detection. Vaccination is offered to people who test negative, while positive cases are managed.
In the run-up to the TotalEnergies 2021 African Cup of Nations football tournament, surveillance will be stepped up, particularly with “new Covid-19 exposure notification tools that will enable people who have been in contact with a positive case to receive notification leading to screening and then vaccination or treatment depending on the result”,Belinga revealed.
The third vaccination campaign is set from November 17-21 postponed from October 27-30 would cost the state a whooping FCFA 928 million to scale up vaccination.
Meanwhile, Cameroon can count on the support of its partners in coping with the third wave. Cameroon’s partners, the EU and Germany donated equipment for the management and protection of severe cases.
Germany donated 924,000 surgical masks worth more than 165 million and the EU, 50 oxygen concentrators, 50,000 surgical masks, 03 ventilators with accessories, 3,040 protective glasses and 3,120 visors.
The EU has in the past, constructed waste treatment areas in 18 health facilities in five regions, in addition to the commissioning of a borehole.
Saudi Arabia donated, 25,000 sterilized blouses, 125,000non sterilized, 2.302000 surgical masks to help government to meet up with increasing cases of Covid=19 from the delta variant.
Cameroon has got her very first sequencing device for monitoring the circulation of Covid-19 variants through CEMAC. The African Development Bank, ADB, financed to the tune of FCFA 468,501,777 a subregional response plan that provided biomedical equipment, protection kits, medical ambulance, the ministry of health disclosed.
A group of Cameroonian pathogen-genomics are following up the evolution of the virus, to understand the virulence in collaboration with Redeemers University in Nigeria, Mbacham disclosed.
Africa and Cameroon have not had the massive deaths predicted and according to Mbacham, “It could be that our foods are contributing besides the washing of hands, social distancing”.
In the past, viral infections have gone through four waves before they completely get out of the community. With many passages of the virus through many people and mutating, it will slowly tend towards a less virulent strand like the common colds, Mbacham concluded.
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”
The two Anglophone regions are among the bottom four regions where the COVID-19 vaccination rate is still very low.
Mary Wirdin, 35, mother of two, and primary school teacher, set out to take a jab of the COVID-19 vaccine, but after trekking for 10k from Wahsi to the Jakiri Health Centre, she could not get the vaccine.
It is Friday, August 13, Bamenda Northwest Cameroon, and roads leading into the regional capital are blocked.
“I wanted the Johnson & Johnson vaccine, but could not get it, I was told due to roadblocks, vaccines have not been sent to the district hospital, so, I have to wait”, Wirdin, said.
It is not the first time roads have been blocked, but a constant phenomenon since 2017 when the Northwest and Southwest regions turned into an armed conflict till date.
With the roadblocks around major towns, Bafut, Bali, Kom, Wum, Banso, and Ndop, general access to healthcare is problematic.
Patients have pushed trucks to the Bingo Baptist Hospital. access to the Banso Baptist and Shisong hospitals, some of the reputable hospitals is blocked.
There has not been a movement of vehicles, hence, not much activity concerning COVID-19 vaccination.
Dr. Cornelius Chebo, Chief of the Northwest regional Covid-19 Incident Command Centre says with the roadblocks there is nothing much they can do but wait till when the roads are opened.
Cameroon has received more than 1,204,300 vaccines, 200,000 doses of Sinopharm, 300,091 doses of AstraZeneca, 303,050 doses of Johnson &Johnson, and 158,400 doses from ECA -Afriximbank.
According to Dr. Chebo, the format or line of vaccines in the country is the same for COVID-19 since their integration into the Expanded Programme of Immunization, EPI.
“Vaccines are delivered in the central pool and taken from Bafoussam in the West region by the Covid-19 incident command center in Bamenda”.
After collection, the vaccines are registered and distributed according to requests from the districts.
The chiefs of district health centers then collect for their units and down to the population.
In the region, it is very challenging to transport and stock vaccines, because the distance has increased drastically for some districts due to the crisis.
For example, officials from Donga Mantung Division used to pass through Kumbo but the road is no longer accessible. They have to go through Magbwa in the Adamawa before they get to Ndu, Nwa, and Ako, Chebo explained.
In other areas, the Ndop, Fundong, Bali, and Kumbo roads are blocked and vaccines cannot go as armed groups imposed recent roadblocks.
“There is a need to wait until the roads are opened for the vaccines to reach the areas and this slows the vaccination process”, Chebo says.
According to Chebo, the transport fare that used to be FCFA 2500 is now 10,000 from Kumbo to Nkambe. A Nkambe man who used to pay FCFA 5,000 now pays FCFA 25,000.
Ako-Nkambe used to be FCFA 4000 and today the distance is paid at FCFA 10,000, he laments.
The district hospitals have been paying more to transport the vaccines. It has been tough but the goodwill of the managers at the district level has been overwhelming- they incur charges but they still take the vaccines, Chebo stated.
80 vaccines destroyed
To scale up vaccination, following hesitancy, Cameroon organized the national vaccination days from 7-14 July.
During the campaign, some vaccines were seized and destroyed in Kumbo East, Batibo, and Bafut. According to Chebo, “80 vaccines were intercepted and destroyed”.
But, this has not only happened to COVID-19 vaccines but with other vaccines within the context of the ongoing crisis, he added.
Electricity pools destroyed
In some parts of the Northwest region, armed groups destroyed the electricity grid lines and even in Bamenda there has been constant outage with the central cold room, not an exception, Chebo said.
“We used to stay here more than 10 hours without electricity, and it was difficult to respect the 8 degrees Celsius to store vaccines.
“Once the cold room reaches 10 degrees Celsius, it signals. When the outage has lasted for more than ten hours, it is not a good sign when keeping vaccines”, he stressed.
The challenge was more in April 2021, with more than eight signals a month, which meant we were out of electricity for more than ten hours, he adds.
To salvage the situation, health authorities brought in a generator and have been supplying fuel.
“But the challenge still lingers in some districts, and they had to resort to using fuel-powered generators too,” Chebo explained.
“Nkambe has not seen electricity for more than a year; Wum has also had no electricity for about two years and now runs their cold chains on solar or fuel.
However, the good thing is that the districts are looking for ways to overcome the challenges. “Most health facilities in Fundong, Ndop, and Nkambe are using solar energy to maintain their cold chains, a recommendable effort, Chebo said.
Regrettably, Batibo has solar fridges, but the panels were vandalized within the context of the ongoing crisis.
“If the facilities are not in a secure zone, there is a risk of them being vandalized,” Chebo maintained.
Despite the challenges in the Northwest region as of June 8, 2021, statistics from EPI were in the fourth position in the overall vaccination table. Presently, the Northwest has vaccinated more than 12664 people.
Data from the Northwest COVID-19 Incident Command Center shows that some of the areas where vaccines were destroyed have low vaccination rates, except Kumbo East.
The bigger challenge, however, is that many people in the Southwest region are reticent about taking a jab and prefer to take their local herbs.
The situation is not different in the Southwest region where access and storage remain a major hindrance to vaccination, especially in remote areas.
“I don’t think I will take the vaccine if I am not forced, I rather go for local herbs”, Njie Lyonga John-Paul, a resident of Bokova, in Buea in the Southwest region, stated.
Cameroon vaccinated 400,000 persons on August 14, according to a tweet from the Minister of Health, Dr. Manaouda Malachie.
However the latest information from the Expanded Programme of Immunization (EPI, shows the total number of persons vaccinated by region.
The crisis hit Northwest and Southwest regions are among the bottom four least vaccinated of the Cameroon ten regions. The ongoing conflict may in part, have contributed to the slow vaccination. However, the South region is the region with the least vaccinated population.
"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"
Only 48,999 out of a total of 316 445 vaccinated people in Cameroon have taken their second dose of Covid-19 vaccine.
Cameroon organized national Covid-19 vaccination days from July 7-11 to scale up vaccination following hesitancy observed.
According to the Enlarged Programme of Immunization as of July 10, 2021, while data from approximately 40% of Health Districts was still pending.
Partial data on the intensification of vaccination against Covid 19 showed 106,044 vaccinated, i.e. 9,763 for the first dose and 8,381 for the second.
Vaccination continued in the 10 regions of the country where Astra Zeneca and Sinopharm vaccines were administered in order to protect the population from COVID19.
Following the report from PEV on July 19, after the vaccination days still with data awaited, 316445 people have been vaccinated against Covid19 in Cameroon since April 2021, including 267446 for the first dose and 48999 for the second.
-Only 48,999 persons have gone for the second dose
-Cameroon is now running short of vaccines, after receiving a total of 591, 200
-5,3 million does of Johnson & Johnson requested for not yet supplied
-Cameroon still at 2 percent vaccination
Taking only one dose is as good as not being vaccinated according to virologist, Prof. Wilfred Mbacham.