VACCINES MUST TRAVEL TO THE PEOPLE

Deploy motorcycle brigades and foot soldiers in villages and slums, urges Rajendra Aneja

Just a few words can define or change the course of human history. Abraham Lincoln’s eight words “A government of, by and for the people” defined democracy forever. Martin Luther King’s four words, “I have a dream”, amplified the struggles of minorities globally.

Mr. Robert Winship Woodruff, was the President of the Coca-Cola Company from 1923 until 1954. His five words defined the key task for consumer product companies across the world, for generations. He wanted to put Coca Cola “within arm’s reach of desire” of every consumer in the world. Coke is ubiquitous everywhere. Coke sells two billion drinks daily. Every consumer product company aims to place its products at arm’s length of the consumer.

Now, governments across the world are struggling to place vaccines “at arm’s length” of 7.67 billion people. Many countries are just flummoxed by the overwhelming task.

A challenge confronting developing countries like India, Brazil, Nigeria, etc., with large rural populations, is the distribution of vaccines to small towns, villages and slums. It is an enormous undertaking, to place the vaccines “at arm’s length” in these remote areas, due to lack of all-weather motorable roads and logistics.

Companies engaged in the retailing of consumer products in small towns and villages, use grass-root distribution techniques, to reach their products to consumers. Principally, since middlemen are not available for this “Last Mile Distribution”, companies have innovated appropriate techniques like the Bicycle Brigades and Retail Foot Soldiers. These mass-distribution ideas can be deployed for vaccinations by local health authorities to ensure rapid inoculations in villages and slums.

Covid-19 “Warrior Motorcycles Brigade”

The “Bicycle Brigade” model of distribution comprises of teams of youngsters visiting villages and slums, to distribute small packs of toothpaste, washing powder, etc. The project in Africa was covered by the Financial Times, London, (“Bicycle Brigade take Unilever to the People” FT. 7 Nov. 2000). An organisation, Riders for Health, comprising of health workers, also visited villages on motor cycles, to distribute anti-malaria mosquito nets and medicines.

Health departments could launch “Covid-19 Warriors Motorcycle Brigades”. These would be health workers, with ice boxes containing vaccines, mounted on motorcycles, visiting villages to inoculate locals. Two health workers, could cover one or two villages daily and vaccinate 500 villagers daily.

Hand-held Terminals & Printers

The visiting health workers should carry Hand-held terminals, on which they record the names, ages and locations of the people they inoculate. Small printers should be attached to the terminals, to print the vaccination certificates and issue them immediately to the recipients of vaccines.

The “Covid-19 Warriors Motorcycles Brigade” programme should inform the villages being visited in advance. Then, the local residents will be ready, at a central place like the village school, church or mosque.

The “Bicycle Brigade” innovation was covered in a book, “Brands and Branding” by Rita Clifton and John Simmons, published by The Economist. It states, “In Tanzania, where half the population earns less than $1 a day, Unilever’s new company has set up a bicycle brigade of sales people drawn from local unemployed youngsters to supply small shops with products such as Key soap, sold in small units for a few cents. All these branded innovations deliver direct business benefits to Unilever through increased sales. And yet they deliver powerful social benefits too, contributing to improved hygiene and nutrition and thereby helping to tackle disease and infant mortality.”

The “Covid-19 Motor-cycle Warriors” comprising of Health workers, can make significant social contributions by accelerating vaccinations in the villages, slums and interiors areas.

“Covid-19 Foot-Soldiers”

A major challenge in developing countries is to vaccinate people in villages, which have no motorable roads at all. Even motorcycles find it difficult to reach some villages due to rains or slush. We had initiated a scheme called, “Mama-Mia Retail Programme”, which translates to “Hundred Mamas Retail Programme”. These were 100 housewives who would collect a carton of toothpaste in the morning. Then, they retailed the tubes to villagers in their homes. In the evening, they returned the cash and received a commission.

The scheme can be relaunched as “Covid-19 Foot Soldiers”. Health workers could carry an ice-box of vaccines to villages, which are inaccessible by road and vaccinate the villagers. Retired doctors and health workers, residing in the villages can also assist the “Covid-19 Foot-Soldiers”. The execution of the programme on the ground will require resolving various logistical issues like sourcing the appropriate type and number of ice-boxes, replenishments, meal arrangements for the inoculators, etc.

Each team of two “Covid-19 Foot Soldiers”, should aim to cover at least one village, with 300-500 vaccines per day. The Foot Soldiers will have to be trained thoroughly. They should be provided with Hand-held terminals, micro-printers, uniforms and identity cards.

Bill Gates in an article entitled, “Meeting the Musahar: A trip to a remote corner of India taught me a powerful lesson about what it will take to wipe out polio,” January 10, 2018, discusses the contribution of foot soldiers in the polio vaccination in India.

He writes, “The Indian government deployed more than two million vaccinators who covered every speck of the country, including the Musahar village I visited, which was often inaccessible because of flooding from the Kosi River. One of the most inspiring photographs of that time was an image of polio workers wading waist deep in water to reach remote villages with the polio vaccine.”

Liaise with Village Leaders

The “Covid-19 Foot-Soldiers” should liaise with the village headman about the dates, times and place of inoculation, to ensure local support. The vaccination will carry credibility if they are undertaken in the premises of a public health centre or school.

A manual detailing the work of the “Foot-Soldiers” and how to conduct the vaccination, should be prepared.

Every country should aim to create this “Covid-19 Foot-Soldiers” health army to battle the pandemic.

In cities, people may travel to hospitals to get vaccinated. In villages, small towns and slums, the vaccines will have to travel to the people. Countries should recognise this reality and plan accordingly.

Aneja was the Managing Director of Unilever Tanzania. He is an alumnus of Harvard Business School and the author of books entitled, “Rural Marketing across Countries and “Business Express”. He is a Management Consultant.