What the Democratic Republic of Congo Could Teach Us about Strengthening Global Health Systems

By Alice Zhang on July 25, 2022

Members of an island community in the Congo River bring their children to be vaccinated at a “vaccination day” clinic held every few months. Photo: Ley Uwera.

As the Communications Officer for Shot@Life, Alice Zhang reflects on her recent visit to the DRC and the challenges and opportunities to deliver lifesaving vaccines to the country’s most vulnerable children.

Against the backdrop of birds of paradise, the Congo River, and women dressed in colorful Liputa dresses, I arrived in Kinshasa well aware of a heartbreaking fact: that the Democratic Republic of Congo is among the top 10 countries with the most zero-dose children — children who have never received a single vaccine. In fact, the DRC is one of the hardest places to live in the world, with steep rates of malnutrition and 73% living in extreme poverty, making people all the more vulnerable to polio, measles, COVID-19, and other diseases.

My talks with families, health workers, and UN agencies in the DRC hammered home three key factors about what can’t be ignored in order to ensure good health and well-being for all.

Access is Everything: Paving Good Roads & Sustaining the Cold Chain

In Kinshasa, a city whose population is more than double that of New York City, the impact of urbanization is visually obvious: Traffic is almost always congested along the main — and only — thoroughfare. Even in DRC’s capital, only the sturdiest vehicles are able to navigate the bumpy, unpaved roads to access local health clinics and to deliver lifesaving medical supplies.

Health workers take a motorboat to island communities on the border of the Democratic Republic of Congo and the Congo, carrying with them vaccines and personal protective equipment. Photo: Ley Uwera.

Consequently, the roads often pose an ironic logistical roadblock: Vaccines rely on a continuous cold chain that has to run like clockwork. During our visit to the solar-powered Kinkole vaccine warehouse, which stocks more than 136 million doses of routine immunizations a year, the warehouse manager explained that once a cargo shipment of vaccines arrives at the airport, it must be immediately transported to one of Kinkole’s 12 temperature-controlled cold rooms. Then, when the vaccines are ready to be distributed, they are loaded onto refrigerated trucks or small planes and delivered to regional health clinics. Timing is key. All it takes is a traffic jam, inaccessible road, or unexpected fuel shortage for the vaccines to be delayed to their destination or get too warm in transit, thus becoming ineffective. Not only would this lead to vaccine wastage, but ultimately, it would hinder people’s ability to receive lifesaving immunizations, especially in rural provinces where flights are few and far between, or where rocky paths fade into the dense forests of the Congo River Basin.

Local organizations are implementing innovative solutions to these transportation-related challenges. For example, some organizations are piloting vaccine deliveries with drones to avoid unreliable ground transportation altogether. Health workers continue to go to great lengths to reach every child, going door to door to bring vaccines to every home in the neighborhood. But despite creative solutions and the unrelenting determination of health workers, the reality is that access to vaccines is heavily dependent on infrastructure. The importance of safe, navigable, and well-connected roads — especially within Africa’s second-largest country — cannot be overstated.

The Kinkole vaccine warehouse is strategically located near Kinshasa’s N’djili International Airport. After receiving large vaccine shipments, workers must quickly unpackage supplies so they can be stored in temperature-controlled rooms. Photo: Ley Uwera.

Local and Global Cooperation Is Key to Strengthening Health Systems

Geopolitical challenges like the Kivu military conflict in the eastern DRC also have a history of straining the country’s health systems. During the Ebola epidemic of 2018, which caused more than 2,200 deaths, rebel groups commonly killed vaccinators and exacerbated both the outbreak and the war. To this day, the ongoing conflict inhibits thousands of people — especially women, refugees, and internally displaced persons — from accessing the primary care and immunizations they need, due to fear of violence.

At the same time, the pandemic has taken an acute toll on health systems in the DRC: Less than 2% of the population is vaccinated against COVID-19. On top of high vaccine hesitancy and initial difficulties receiving a steady supply of vaccines, doctors and nurses have been on strike multiple times in the past two years due to a lack of regular pay and adequate equipment, causing routine vaccination rates to drop by up to 10%.

Still, during my time in the DRC, health workers continually stressed the need for improved disease surveillance to stop outbreaks before they spiral out of control. For example, there is only one laboratory in the DRC that can run the blood tests needed to confirm a measles outbreak. In some cases, by the time a sample comes back positive, it can already be too late to save the child. In a country where more than 1.7 million children missed their first dose of the measles vaccine in 2021, such gaps in health infrastructure can have life-or-death consequences.

Shot@Life’s Alice Zhang stands outside of the Barumbu health clinic in Kinshasa. Photo: Martha Rebour.

Much of my work involves advocacy and education around the need for strong health systems and improving access to lifesaving immunizations globally. But my visit to the DRC showed, in very real terms, why we can’t wait to shore up international efforts like COVAX, the new fund for pandemic preparedness, and sustainably fund agencies such as the United Nations Children’s Fund (UNICEF) and the World Health Organization that work with local partners in the DRC. Without the adequate health infrastructure and political cooperation needed at the national level, multilateral efforts to save lives will remain tragically stunted.

A Human Touch Is Essential

One of the most memorable experiences of the trip was accompanying vaccinators to a remote island in the Congo River. For this island community, immunization day is a big deal. They welcome outside visitors only about once every three months, so when our boat pulled up — a journey that can take up to an hour via canoe — the whole island came out to greet us. Mothers brought their babies to be vaccinated, eager to see if their child had gained weight since their last weigh-in. Meanwhile, the older children brought a makeshift soccer ball to play a pickup game while waiting for their siblings, and the men who weren’t fishing gathered around the clinic, everyone eager to participate.

Patients wait after receiving vaccinations at a vaccinodrome in Kinshasa. Photo: Ley Uwera.

Being on the island that day and seeing vaccination teams in action, I was reminded that good health unlocks life’s possibilities and that vaccines really do bring us closer to realizing the promise of health for all. I saw health workers hard at work, giving sugary syringes of rotavirus vaccine to babies or mixing measles vaccines and diluents with hawk-like focus. In other health clinics around Kinshasa, I had watched as community health workers diligently scanned their handwritten vaccination logs for empty rows, marking the families they needed to visit at home to encourage them to bring their children back for subsequent doses. For all that the scientific miracle of vaccines does to save lives, it’s the human connection that gives science wings and strengthens communities.

Everyone deserves a shot at life, and there’s never been a more important time to double down on global health efforts. Vaccines have the potential to save an additional 1.5 million lives a year, but the COVID-19 pandemic has led to the most significant setback for routine immunization in a generation. In 2021 alone, the number of zero-dose children increased by 37% to 18 million, a number not seen since 2005.

My recent visit to the DRC reminded me that two seemingly opposite things can be true at the same time, like being sobered by the massive challenge of single-digit vaccination rates and simultaneously inspired by the health workers committed to protecting children against disease. There’s a lot we have achieved together, but there’s still a lot left to be done. I’m grateful to the people we met in the DRC for reminding me of that.