Padmavati, a 65-year-old widow living in Dewan Para in Tabolchari Union of Matiranga Upazilla (Sub-district) in Khagrachari of the Chittagong Hill Tracts (CHT), was far from receiving the Covid-19 vaccination in September 2021 – seven months after the government launched the nation-wide vaccination drive. As a resident of a remote village with no electricity or modern transportation system, Padmavati, like many fellow locals, faced severe constraints in physically going to the nearest vaccination camps located a few dozen kms away in Sadar Upazilla. Sharing her frustration with the UNDP team, she stated, “The Covid-19 pandemic has caused panic among my family. Receiving sophisticated health care support and treatment in our remote village is anyway very difficult. But we are now also unable to protect ourselves against Covid-19 due to how far the vaccine centers are located from our village. We do not have the financial means to pay for the transportation cost of traveling such long distances’’.

Padmavati and her family finally received the vaccines, thanks to the installation of mobile vaccination booths at the union level and door-to-door vaccination service made available by the UNDP Accelerator lab. The intervention was part of the lab’s several activities to bring the locals of Bandarban and Khagrachari districts under the vaccination innovation initiative with administrative support from the Upazilla Health Department.

            Despite making commendable progress in covering the majority of the country’s population since the inception of the vaccination drive in February 2021, the CHT region remains among the least vaccinated areas of Bangladesh. The Accelerator Lab, jointly with the Health Department of the government, undertook a situation analysis in four sub-districts (Thanchi, Ruma, Matiranga, and Dighinala) from the Bandarban and Khacrachari to understand what factors contributed to the low coverage. The exercise involved thorough secondary research as well as consultations with locals, health departments, people’s representatives, NGOs, and other stakeholders in the CHT area. Various factors including, remoteness, hard-to-store vaccination tools, superstitions, misbelief, lack of information, the inadequacy of necessary government services, complex registration system, linguistic and cultural barriers, etc. were found to contribute to the poor vaccine uptake.

However, two major hurdles were identified as primarily responsible for the poor performance in the region. First, the long distance to the nearest vaccination centers at the Upazilla Sadar meant prolonged traveling time, high transportation costs, and significant travel complexity unbearable for the locals. It was particularly harder for people with different access-related vulnerabilities such as physical disabilities, ailments, and old age. As pointed out during a focused group discussion, fewer vaccination centers also meant longer queues which discouraged school-going students to get vaccinated.

The second major obstacle was related to safely carrying the vaccines to remote areas in a properly preserved manner. Since some of these villages had limited basic infrastructure, setting up vaccine centers was not an option in the absence of necessary storage facilities. The allotted vaccines for the CHT areas – Sinopharm (Vero cell) and Pfizer vaccines – required sub-zero temperatures to be preserved beyond the 72 hours maximum capacity of the vaccination containers.

To find out ways to tackle the dual challenges of covering the population in the remote, hard-to-reach, underprivileged areas while also minimizing vaccine wastage, the accelerated lab organized workshops and planning exercises. The overwhelming proposal from the participants of these workshops was to run vaccination campaigns at the community level. This entailed making union-wise vaccination plans and expanding the vaccination centers at the union and ward levels to make it easier for eligible people to reach vaccination centers to receive their doses. It also meant setting up temporary/mobile vaccination booths in remote areas and providing door-to-door service in harder-to-reach areas.

Based on secondary research on vaccination coverage, assessments of distance, remoteness, population density, institutional facilities, earlier immunization practices, and state of malnutrition, the most vulnerable areas were selected to carry out the intervention. In total 44 additional vaccine booths were set in the remotest villages covering 163 hard-to-reach subordinate villages with the support of local communities and the health department. The locations of the booths were selected based on people’s affordability and availability to come to the location. The UNDP lab in collaboration with Upazila (sub-district) Health Complex, and UNDPs SID-CHT project in the areas, jointly organized campaigns on COVID-19 vaccinations to encourage vaccine uptake in the interiors of the hilly areas.

            In some hard-to-reach locations with hardly any accessible roads e.g., Menpung para, Chinglok para, Thindolte para in Bandarban and Kolinggo para, and Naraichari para in Khagrachari, volunteers and vaccine workers had to carry the vaccine storage containers by boat or even on foot. Some places were so distant that they walked for 5 to 6 hours a day to reach the camps. The volunteers were wholeheartedly supported by the local Headman (Head of Mouza or a group of villages), Karbari (Chief of a village) throughout the process. 

To give an example of the dedication demonstrated by these workers – Laldusan Para village in Tindu Union, Thanchi belonging to the Tripura and Khyang communities, is 41 km from Sadar. This village is among the chosen locations for the vaccination booth as it would be able to cover five neighboring villages. But when the team started their journey toward the location, it was monsoon season and the roads were muddy and hard to drive. Half of the journey was made by a “jeep” and the rest on foot. The already precarious and dangerous road sometimes required the team to fix it on the spot if they wanted to proceed further. It took an arduous journey of over 5 hours to reach the center safely with the vaccines.

But in the end, it was all worth it. In the words of a local, Chayarung Tripura, " It has been three months since I could not take the 2nd dose of my Covid-19 vaccine because our village is far from the Sadar (town) vaccine center; I would not have taken another dose until the team reached here. Today I received my 2nd dose. I cannot thank enough UNDP for this initiative.”

Locals taking vaccine shots in different locations in Chittagong Hill Tracts Area