Vaccination Efforts in Mali: Overcoming Challenges Amid Insecurity

In Gao, a city in northern Mali, healthcare workers are confronted with significant challenges as they strive to immunize children against preventable diseases. On May 8, health teams conducted vaccination drives in Dioulabougou, a neighborhood in Gao, where families gathered despite the oppressive heat and ongoing insecurity in surrounding areas. Zahara Guitteye, the family planning lead for the Gao health district, explained that on specific days, vaccinations for BCG, yellow fever, MMR, and polio are administered to children in the community. The access to health facilities in Gao is relatively better compared to remote areas, which are plagued by unstable conditions and logistical challenges.

Community health workers play a pivotal role in these vaccination campaigns, educating families about the importance of immunization. According to Hawa Assalia, head of the vaccination team, these workers, often from the communities themselves, serve as essential intermediaries to reassure families about vaccine safety and efficacy. In many instances, they are the primary point of connection for health teams when traditional access is restricted due to conflict or displacement.

The vaccination process becomes increasingly complex as health teams venture beyond urban settings. In remote villages and nomadic camps, two strategies are employed: an 'advanced strategy' for communities within 5 to 15 kilometers of healthcare facilities and a 'mobile strategy' for those further away. Dr. Yehia Seydou Dicko, head of Gao's health district, highlighted the necessity of collaboration with local leaders to identify safe locations for vaccination.

Insecurity in the Gao region manifests not just through armed conflict but also via banditry and threats from armed groups, which can deter healthcare workers from returning to certain areas. This unpredictability necessitates meticulous planning and community involvement. "Families become our protectors when they recognize the value of vaccination," Dr. Dicko noted, emphasizing the importance of community mobilization in ensuring the success of vaccination campaigns.

Despite the ongoing efforts, logistical issues persist, particularly concerning the cold chain essential for preserving vaccine efficacy. Dr. Niaky Camara, UNICEF immunization consultant, warned that without proper refrigeration, vaccines cannot be stored effectively, especially in regions where temperatures can exceed 40°C. The 2023-2024 Demographic and Health Survey indicated that 13% of children aged 12 to 23 months nationwide had received no vaccines, with that figure rising to 27.9% in the Gao region.

The district of Almoustrat exemplifies the challenges faced, where only one out of ten health areas has a functioning refrigerator. As a result, health teams are often forced to transport vaccines over long distances, complicating regular immunization efforts. Moreover, nomadic populations present additional challenges, with vaccine hesitancy being a common issue. Volunteer vaccinator Fatima Silla noted that often a tangible incentive, such as a mosquito net, is required to encourage acceptance of vaccinations.

However, increased awareness resulting from local outbreaks can shift perceptions rapidly. Dr. Camara confirmed that vaccination efforts have led to a significant decline in diseases like measles, polio, and meningitis in the region. The introduction of a malaria vaccine also brings new hope, with local leaders believing it could significantly reduce the burden of disease in Mali. As Zahara Guitteye stated, "If this vaccine works, it will be a revolution for us."

Despite the numerous challenges faced by healthcare workers in Mali, their commitment to vaccinating children continues to yield positive outcomes. The resilience of local health teams and community involvement underscores the critical importance of immunization in safeguarding public health in the region.