What do mules, yaks, 4x4s, walkers, motorcycles, banana boats and drones have in common? They are all used to deliver the Covid-19 vaccine to hard-to-reach areas around the world.

After the devastating floods in western Nepal in October, Budhi Setiawan, UNICEF’s health director in the country, had to come up with a solution to quickly inject Covid-19 into patients’ arms. inside.

He said that the flood cut off “many passages” and the need for air transport of bullets constituted “a huge logistical challenge.” The solution ultimately involved yaks, mules, and walking transport, even though it might take a few days for them to reach the area.

Efforts to vaccinate hard-to-reach areas are part of the problem most parts of the world face in providing life-saving vaccines to people who are not usually vaccinated with the first shot. Moreover, although the lack of vaccine supply in most parts of the world is inherently challenging, it turns out that the logistics of this process is equally tricky.

Setiawan said that smaller vehicles must also be used to deploy vaccines, with smaller vaccine carriers on top, although Nepal “has good experience in these issues” and an extensive network of highly loyal health workers .

Last year, global health observers were mainly concerned about whether countries have the ability to develop appropriate “cold chains” of refrigeration facilities to ensure that vaccines remain effective after delivery.

But in Nepal, the problem may be the opposite. Setiawan said: The vaccines currently used in the country, mainly from China, should be kept at regular refrigerator temperatures. In cold conditions, the challenge is to prevent them from becoming too cold. He said that UNICEF has deployed antifreeze carriers for this purpose.

Nevertheless, the potential lack of vaccination rates hinders vaccination rates, not just in Nepal. In contrast, this landlocked country will start using BioNTech/Pfizer injections on November 14, while the European Union, the United Kingdom, the United States, and other wealthier regions of the world began using it in December last year. Approximately 25% of the population received two doses of the vaccine, and about 30% of the population received one dose.

In poor countries, less than 2.5% of people have received two injections—and in richer countries, this proportion easily exceeds three-quarters of the population. Rich countries will get more booster shots in three months than poor countries will get more primary vaccines-throughout 2021. Some observers call this gap “vaccine apartheid.”

Setiawan said that to help transport to hard-to-reach areas, UNICEF is also discussing the use of drones, which are already in use in the Pacific. However, the average height of Nepal’s terrain makes things very complicated.

Security considerations — such as on the border with China — must also be taken into consideration.

However, he believes that Nepal’s previous success in routine vaccination will help prepare for this progress. “If we had the supply, then we could have done better and reached the population coverage goal faster,” he said.

The most difficult challenge is the simultaneous surge in demand for part of the cold chain, causing supply bottlenecks and further complicating logistics. He pointed out that Nepal’s dependence on India for trade was also a major obstacle to the launch of vaccines during the peak of the Delta earlier this year.

But it’s not just geographic factors that complicate the launch of the vaccine. Benjamin Schreiber, global coordinator of UNICEF’s Covax vaccine access program, said Haiti and Papua New Guinea are extreme examples of violence and mistrust that complicate the problem and go far beyond simple logistics.

“People have to take a banana boat to reach remote islands, and people are really willing to do that,” he said.

But in Haiti, Schreiber explained that six drivers were kidnapped while planning to go out to deliver vaccines. “There are carjackings, kidnappings, real fears of drivers,” he said.

There are carjackings, kidnappings, real fears of drivers

In Papua New Guinea, a medical worker who set up a vaccination site was verbally harassed and then stoned. Some other workers who were sent to provide routine child immunizations were also stoned because the villagers thought they had brought the Covid vaccine. He said that another vaccination tent was burned down. Schreiber said that in the country, a vaccine outreach trip can take three to four days.

“There are a lot of community involvement issues that need to be resolved… This goes beyond hesitation,” he said. “We can’t just assume that people will show up and get vaccinated. People want to understand the situation and get involved-we have some tools to solve these problems, but it will take time.”

He believes that an early investment a year ago can solve some of these problems and ensure that there are enough medical staff in a complex environment. “In some of these fragile environments… we need to really invest more,” Schreiber said. “This is something we really need to work together to support the launch.”