U.S. Army medical researchers take part in World Malaria Day, Kisumu, Kenya, 2010. Rick Scavetta. USARAF / FLICKR.
dispatch from cameroon
A Medical Miracle in Cameroon
U.S. Army medical researchers take part in World Malaria Day, Kisumu, Kenya, 2010. Rick Scavetta. USARAF / FLICKR.
dispatch from cameroon
A Medical Miracle in Cameroon
On a Wednesday afternoon on 31 March 2021, the screams from twenty-year-old Moussene Flore travelled through the corridors of the Yaoundé Central Hospital, in the Centre Region of Cameroon. Her screams were so loud that a crew of nurses ran through the crowded hallway to the room she was in. There, the nurses met the grieving mother holding her dying baby in her shaky arms and on her knees. With tears rolling down her eyes, Flore whispered the name of her feverish child, who gave a feeble cry and made her last breath. Flore remained crouched against the bed, grief-stricken by the loss of her child.
Flore’s baby was only nine months old when she died. She had been battling malaria for over one week. Flore was broken, inconsolable and in complete despair. She had used up almost all her savings from her petty dress and shoe-selling business to try to save her daughter’s life. ‘She got sicker and sicker. We tried to get all the drugs. I was not ready to lose my baby. It was a difficult period for me. It still hurts. It was a traumatic experience,’ Flore told me in tears.
The trauma was unbearable, but Flore managed to rebuild her life. She underwent therapy to recover from the trauma. A single mother, Flore told me that after she got pregnant for her boyfriend their relationship ended. She was forced to take care of the child alone although the scar of her child’s death has remained etched in her heart.
In 2023, she became pregnant and had a girl. When she first heard the news of a malaria vaccine in the country, she swore to protect her child at all costs and not go through the same ordeal of losing a child in infancy again. She was one of the hundreds of women who rushed to inoculate their children when the vaccination campaign was launched in Cameroon. Her baby, eight-month-old Tchinda Flora Gabrielle, was one of the first children to receive the first dose of the malaria vaccine.
I visited Flore at the hospital at the Soa District Hospital in March 2024 when she brought her child for vaccination. She told me her daughter was doing well. ‘I am no longer scared. I have to do this for her. At the time I lost my first child, nothing was said about the vaccine. This will go a long way to help,’ Flore said.
Stories like that of Flore are not in isolation. The introduction of the malaria vaccine in Cameroon has brought more than just hope and relief. It has given mothers the chance to see their once-vulnerable children grow and have a future.
CAMEROON ROLLS OUT MALARIA VACCINE
In Cameroon, malaria is an endemic disease. The Central African nation is ranked amongst the 15 highest countries affected by malaria. According to the World Health Organization (WHO), malaria is one of the leading causes of death in Africa. WHO stated in a 2023 report that an estimated 236 million malaria cases (95 per cent of global cases) and 590,935 malaria deaths (97 per cent of global deaths) were recorded in Africa in 2022.
Before the arrival of the vaccine, many families visited the hospital frequently to protect their children. They also adopted preventive methods like using mosquito nets and insecticides. For struggling families, this was a luxury they could not afford. They heavily relied on self-medication and traditional medicine.
The introduction of the vaccine marks a scaling up of the fight against malaria in Cameroon and in a continent that suffers the greatest number of deaths. A July 2023 WHO article revealed that twelve countries across different regions in Africa are set to receive 18 million doses of the first-ever malaria vaccine over the next two years. Cameroon became the first country to roll out the vaccine in January 2024 outside the malaria vaccine pilot programme that was carried out in Ghana, Kenya and Malawi.
Cameroon officially introduced the malaria vaccine, RTS,S/AS01 (Mosquirix), into its Expanded Immunization Programme (EIP) on Monday 22 January 2024. The country received 331,200 doses of the malaria vaccine from WHO on 21 November 2023. The vaccine protects against plasmodium falciparum malaria, which causes the severe form of the disease.
In a communiqué released on 22 January 2024, Cameroon’s Ministry of Public Health, explained that the malaria vaccine is ‘safe and effective.’ The minister, Manaouda Malachie, said ‘it offers an opportunity to reduce hospitalization and deaths due to malaria in Cameroon by more than one-third.’
The introduction of the malaria vaccine into the routine immunization schedule marks a significant step for Cameroon. The Ministry of Public Health said it intends to accelerate the elimination of the disease. The vaccine is part of current malaria control tools, in addition to vector control measures like early diagnosis and appropriate management of cases.
The vaccine is being rolled out in 42 priority health districts across Cameroon’s ten regions. According to the Ministry of Public Health, since 22 January 2024, six-month-old babies and above began receiving their doses in accordance with the updated vaccination programme.
The minister explained that the vaccination will be done in four stages. The first at six months, the second at seven months, the third at nine months and the fourth, a booster dose, at 24 months. A preliminary report from Cameroon’s health ministry shows that 1,833 six-month-olds have been vaccinated out of the 249,133 planned for 2024. According to WHO, Cameroon records six million malaria cases every year, with 4,000 deaths. The death toll in Cameroon is expected to reduce with the rollout of the vaccine.
WHAT ECOWAS DISHED
According to Article 45 of the Protocol on Conflict, in the event of an abrupt end to democracy or ‘massive violation of human rights’ in a member state, ECOWAS can impose sanctions, suspend the erring state, encourage the return to constitutional order in the state, or more directly, support the restoration of political authority in conjunction with relevant regional and international organizations.
ECOWAS placed a number of sanctions on Niger, ranging from a no-fly zone to freezing the assets of those involved in the coup. As ECOWAS is an organization built to foster economic growth through cooperation and integration amongst member states, this meant that sanctions affected both Niger as well as other countries it had strong ties with. Like Nigeria.
Border closures and a tense relationship for one meant that the security situation starring jihadists and insurgents, which gave birth to the Multinational Joint Task Force (that includes Niger and Nigeria), was adversely affected. Nigeria and Niger have cooperated in fighting insecurity across their borders for years and in tackling a number of cross-border issues like trafficking and crime. Also, over 300,000 Nigerian refugees are present in Niger, having fled insecurity in northeast Nigeria. Then there’s also the legal economic activity marked by trade between both countries and collaboration on a number of subregional projects like the Trans-Saharan gas pipeline, which was proposed as an economic opportunity for four African states, including Nigeria and Niger, to supply Europe with gas.
When the sanctions hit, they affected both Nigeriens and Nigerians. Experts called for review of the sanctions, arguing that the sanctions were having adverse effects on Nigeriens (including Nigerians in Niger) while failing to achieve their main goal of getting the junta to return power to President Bazoum. Niger gets two-thirds of its electricity supply from Nigeria, and that supply was cut off. Countries closing their borders with Niger blocked the exchange of goods between countries, including essentials like food, in a country that was already facing a food crisis before the coup. A senior adviser on Nigeria to the International Crisis Group, Nnamdi Obasi, in a call to recalibrate the situation, stated that it would be better if the sanctions being enforced were limited to policies that affected the junta directly (travel bans, assets freezes etc) and recommended that those affecting the lives and livelihoods of ordinary citizens were lifted.
shop the republic
shop the republic
EMBRACING THE VACCINE
The Soa District Hospital situated some 20 kilometres from Cameroon’s capital, Yaoundé, is one of the 42 centres where the vaccine is being rolled out. When the campaign was launched, the facility received 200 doses of vaccine. It did not take long before they finished on 27 March. Following a request from officials of the hospital, an additional 50 doses were added. They have already reached out for more. Due to the insufficiency, health officials at the hospital told me in an interview that they have targeted babies born after July 2023. They promise that when the vaccine is available, they will vaccinate everyone.
‘Our stock is finished. Many parents have been showing up. Many parents came and asked for children who are more than six months old and for adults. I think the community accepts it,’ the director of Soa District Hospital, Dr Ekani Boukar, told me. ‘Soa has its peculiarity. It is a semi-rural health district. We have rural and town areas in the same district and malaria is our first diagnosis and treatment,’ Dr Ekani added.
Vaccination at the Soa District Hospital takes place every day from Monday to Friday between 7:30 a.m. to 3:30 p.m. Health officials at the hospital said Wednesdays have been dedicated to the vaccination campaign. More than 120 mothers visit the facility daily. On other days, only half of that number is registered. Mothers queue up daily to see their children receive the vaccine. One of them is twenty-seven-year-old Vivien Mireille, whom I met sitting at the edge of a wooden bench at the reception. She cradled her son wrapped in a thick cloth as she waited patiently for her turn.
‘When I learnt about the vaccine, I was so happy. I was happy to know that we had a better chance to combat malaria. This will help to significantly reduce the death toll of malaria in the country, especially those below five months. My child is doing well,’ Mireille said with a beaming smile on her face. Mireilles admitted that there have been attempts to dissuade her on multiple occasions. She said:
When I left the house for the hospital, my neighbours told me that the vaccine was the main cause of diseases in children. I will continue to vaccinate my child. The world evolves. We have seen how the death toll has fallen. Today many children have a chance to live. The vaccine will protect them. When I was young, I lost several people. I have lived with that for a long time, and it greatly affected me. I do not want my child to be a victim.
Other mothers like Elizabeth Mbarga have also yielded to calls to vaccinate children. When she first heard about the vaccine, she thought it was not real. She had to visit the hospital, where she saw several women vaccinate their children. At that time, her child was not yet eligible for vaccination. As soon as he reached six months, she had him vaccinated.
‘It was good news for me. I decided to do it for my child. So many children nowadays die because of malaria. It is heartbreaking. For a child that is sick of malaria, it is difficult,’ Mbarga, a mother of two, said. She explained that she was motivated to bring her baby for vaccination after witnessing how a mother lost her child to malaria.
shop the republic
shop the republic
FIGHTING THE ‘MONSTER’
The senior nurse spearheading the EIP on vaccination at the Soa District Hospital, Daniele Ekoto, admitted that since the campaign was launched, it has made enormous progress. The senior health official told me that several mothers have been enthusiastic about the vaccine because they are tired of malaria. Ekoto said some of them visit the hospital every month and spend sleepless nights. She said:
A majority of the cases we have here are mothers whose children have been victims of malaria. Malaria to them is like a monster. If malaria can be eradicated because it is the most rampant disease here, mothers will be delighted. According to our statistics, children between 0-5 years constitute a larger percentage here of consultations. Malaria is causing untold pain to families. Today, parents are extremely delighted to see that, there is a vaccine against malaria.
Ekoto added that some of the women see malaria as a sort of witchcraft. ‘Mothers who have had to see their children go through untold pain are the first to come and tell us to vaccinate their children. They say they do not want to go through such ordeal again,’ she said. ‘This is because in every family here, you will find at least two children who have been victims of malaria. The introduction of the vaccine has been welcomed and it is free.’
Authorities at the hospital have prioritized sensitization to reach out to mothers and persuade them to vaccinate their children. Even before the arrival of the vaccine in Cameroon, they walked around educating families residing in the malaria-prone areas about its benefits for their children. They have also encouraged mothers by sharing the success stories of others. Ekoto said:
We have been sensitizing our patients for a long time even before the vaccine arrived. There are some parents who have already come to the hospital to ask for the vaccine. They said they had heard of the introduction of the vaccine against malaria. There are others we had sensitized and when the vaccine arrived, they embraced it.
You know the easiest way to reach the population is through word of mouth. When we educate mothers who come here, they go out and share the information. In the beginning, we did not have encouraging figures but today, the story is different. There are even children who are not eligible who come here but we deny them. If we had to administer the vaccine to everyone, I can assure you we would be doing around 1000 cases. Everyone wants the vaccine but not everyone can.
At the Regional Hospital Annex in Nkambe, in the restive North West Region, where the Anglophone Crisis has morphed into an armed conflict for over six years now, vaccination has also been going on effectively. The weekly exercise takes place every Friday with hundreds of women from Nkambe and its environs visiting the facility to vaccinate their children. According to the general supervisor of Nkambe Regional Hospital Annex, Njoh Alfred Ngwa, 98 per cent of children who are eligible in the area have received their vaccines. There is also a proper follow-up to ensure they complete the treatment and ‘hesitancy is very rare.’
The population of Nkambe as well as neighbouring villages in this crisis-hit locality have embraced the vaccine. Njoh said that the perception of the community is quite positive. ‘We don’t just administer the vaccine. There is a lot of education that has been done for each session of vaccination. Most of the mothers were excited to have something to protect their children against malaria,’ Njoh told me.
Like in other regions, malaria is among the biggest killers in Nkambe. Njoh explained that although Nkambe has not been gravely affected over the years and has a relatively low prevalence rate, neighbouring villages, where the climate favours the growth of mosquitoes, have had to deal with the Anglophone crisis and malaria. Some mothers have often been left on the brink of despair with no one to turn to. ‘It has really been difficult to contain malaria,’ Njoh said. ‘There are seasons where malaria is at its peak whereby every child receives treatment in the hospital. Before, the only choice they had was the use of a mosquito net which has not been very effective.’
According to Njoh, the arrival of the vaccine in Nkambe has been described as a miracle by the local population. Several families have been grappling with the socio-economic situation in the region, which they say has gone from bad to worse over the years. Njoh said:
The impact will be serious. When you look at the cost of treatment for malaria and compare it with the socio-economic situation in the region, most of the members of some of these communities see that the burden is really huge. The coming of this vaccine, I think it is a laudable idea. In fact, I am anticipating that if the target population could be increased, it will reduce malaria drastically
WHERE DOES THIS LEAVE WEST AFRICA?
In February 2024, sanctions on AES states were lifted in a move seen as a means to facilitate dialogue that would bring them back into the fold. The junta in Niger didn’t step down under the weight of sanctions. Usually, one of the things states rely on with the imposition of sanctions is that the great discomfort within a country will be pinned on the government, causing it to lose any support it already had, and that the force of both internal and external pressures will cause the government’s will to bend, or break.
It doesn’t always go as planned, including in this case. Nigeriens not only supported the coup (at least in its infancy), they also found a common enemy to rally against; a big bad ECOWAS, under the influence of Western powers, threatening their security, sovereignty and perhaps freedom.
Again, the sanctions didn’t exactly work, raising concerns about other states joining the coup belt if the coup contagion theory holds true. It largely exposes the great faults in West Africa and the continent. Legitimacy in this case extends from the acceptance of the earned right of a president to rule a country to West African states attempting to hold each other to ideals that they do not always abide by at home. ECOWAS has faced criticism for a constellation of leaders who though not in khaki have often gone to great lengths to ensure their indefinite stay in power, including amending national constitutions.
Eguegu argues that fundamentally, while ECOWAS under Tinubu was firm on the issue of democracy, Nigeria and ECOWAS’s policy has not been a success. Eguegu said:
One year ago, ECOWAS was a community of 15 members. Today, it’s still not clear whether the Alliance of Sahel states will walk back on their decision and announcement to exit ECOWAS or whether they will move ahead with it. Beyond the possible fracture, the stated aim which is to complete Niger and other juntas to return to democracy has not been achieved. So, ECOWAS is weaker today than it was one year ago.
With the government of Burkina Faso announcing in May 2024 that it will be extending military rule in the country by five years, the future of democracy in West Africa becomes more uncertain.
shop the republic
shop the republic
VACCINE HESITANCY DESPITE EXCITEMENT
Despite the introduction of ‘safe, effective’ vaccines, hesitancy has been recorded in several communities where there is scepticism towards vaccines and vaccination. According to experts, it is fuelled by misinformation. One of such parents, whose name I got as Madame Ebode told me that she will not vaccinate her child because she is not sure about the vaccine claiming it was sent to Africa to be tested. She said:
My child has not taken the vaccine yet. I have heard about the vaccine. I don’t intend to vaccinate my child. The vaccine was sent to Africa to be tested. It is a vaccine that we are not sure about. And come to think of it, if even the whites dread and reject the vaccine, why should we accept it? It is bizarre.
When my baby falls ill, I will go to the hospital and have him treated there. As for the vaccine, I am against it. Maybe later but as of now, I am still very reluctant. You cannot use children to experiment a vaccine. It is not done; it is not normal. I have friends and family members who have vaccinated their children. Some health officials have encouraged me, but I told them my reasons and they did go further to persuade me.
Health officials at the Soa District Hospital have admitted that some parents have refused the idea of vaccination. Ekoto said: ‘A lot of people come here daily. We seize this opportunity to talk with mothers. We do not oblige them. We show them the effects of malaria. We educate them.’
Vaccine hesitancy has led several mothers to rely on self-medication. Rodrigue Atangana, a street drug vendor in Yaoundé told me that mothers have continued to buy roadside drugs to treat their children from malaria. He says most of them have resorted to roadside drugs because they are ‘afraid of the vaccine and cannot afford the means to take their kids to the hospital for proper medical checkups.’
Atangana said he receives at least 15 women who come to get malaria drugs for their children weekly. He said: ‘Most of them do not even end up taking the drugs because they cannot afford it. Some just take what they can and promise to come for the rest which they don’t. Some of them say they prefer herbs which is easy to lay hands on.’
It has been seven months since Cameroon launched the malaria vaccine into its routine national immunization services. In an interview with the International Vaccine Alliance, Gavi, the permanent secretary of the immunization programme, Dr Shalom Tchokfe Ndoula, said that the coverage rate of the first dose is at 54 per cent. Dr Tchokfe also added that ‘we can expect to reach an 80 per cent coverage by the end of 2024.’ He added that by 2025 there are plans to extend access to this vaccine to the 116 districts, which have been prioritized as being the worst-affected by malaria⎈