Juba, South Sudan — More than 1.1 million doses of an oral cholera vaccine have arrived in South Sudan, as the government launched a program to inoculate more than 80 percent of the population. But the mass vaccination exercise faces numerous challenges, including a lack of access to the areas dealing with the worst cholera outbreaks.
Medics in South Sudan will attempt to vaccinate at least 9 million people against cholera, an exercise that targets mostly children and mothers.
More than 1.1 million doses of oral cholera vaccine arrived in the capital, Juba, and will be dispatched next week to hot spots areas like the town of Bentiu.
The country’s Ministry of Health reported last week that 199 people have died of cholera, with 13,000 more diagnosed so far with the bacteria.
Dr. Gabriel Boum Tap is an immunization officer at UNICEF in South Sudan.
“Of course, we had also received some vaccines before; only that they were not enough, because, you know, it’s not like the cholera vaccine is manufactured and is put in one place already,” he said.
At least one cholera case has been recorded in 29 of the 79 counties in South Sudan, with Bentiu, Renk and Juba most affected.
The first case was reported on September 23 in Renk, northeast of the capital.
But as the country prepares to roll out a mass vaccination exercise, the process faces some serious headwinds.
Thinjin Khoat is one of the victims of the cholera outbreak. He says he has seen people die of the disease, with many more trooping to local health centers seeking urgent medical attention.
“I was at one of the health facilities, and there was a suspected case of cholera. The patient was a 5-year-old. The patient was vomiting, and in the process, the health workers couldn’t get the vein. The patient is not able to get the oral fluid. … In that process, the patient died of dehydration,” he said.
Cholera is an acute diarrhea infection caused by consuming contaminated food or water. If not treated, it can be fatal within hours.
Khoat says accessibility to health care remains a major hindrance to the fight against the disease.
“Some of the community members, they don’t have access, because, you know, in Bentiu here, there is flooding. There are some areas that health workers cannot access because of the flood and also security issues,” he said.
According to Doctors Without Borders, or MSF, poor living conditions in South Sudan have created the perfect breeding ground for cholera.
Stephanie Ngai is MSF’s project coordinator for cholera response in Bentiu, located in Rubkona County, an area with a large refugee population.
“Here in Rubkona, the explosion on the outbreak very quickly overwhelmed the local systems that are responsible for coordinating the response and scaling up the interventions,” she said. ‘Other partners don’t have adequate funding to properly scale up the level needed, which is massive. And the overall response coordination has not been strong enough to manage the response and ensure that the needs are adequately met.”
The government says the vaccination exercise is expected to roll out next Monday with support from international partners such as MSF and the World Health Organization.
Buok Danhier, the immunization program manager for the Unity State Ministry of Health, says the various entities will split up duties in Rubkona.
“Rubkona has many payams [local districts]. Most of the payams are affected by flooding, and these are the ones that will be taken by WHO — the hard-to-reach areas. WHO and other partners are pledging to cover all those areas that are hard to reach and also very far from town. Bentiu IDP, Rukona and Bentiu town — these areas will be covered by MSF, and the recruitment process is ongoing,” said Danhier.
The vaccination exercise will target children 1 year and above.
WHO says up to 143,000 people worldwide die from cholera each year out of an estimated 4 million annual cases.
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