To step up the fight against Covid-19 in the most remote parts of Thailand such as Mae Hong Son requires precise co-ordination of healthcare workers and temperature-controlled storage and transport of life-saving vaccines.
Although more than 70% of the population in Thailand is fully vaccinated, ethnic minorities and vulnerable groups in remote areas still cannot readily access Covid-19 vaccines. With restricted movement and limited access to healthcare and transport, many families with children and elders are left vulnerable to infection. By the end of 2021, less than 50% of the population in Mae Hong Son had received the first dose of the Covid-19 vaccine.
"The risk of the vaccines losing potency was the main reason that healthcare workers were concerned about delivering vaccines beyond the hospital," said Dr Supat Jai-ngam, director of Khun Yuam Hospital in Mae Hong Son province. "At first, we mainly carried out vaccinations at the hospital and, later on, were able to start working with the sub-district Health Promoting Hospitals to deliver vaccines to people."
Vaccines must continuously be stored in a limited temperature range from the time they are manufactured to the moment of vaccination, or else they lose their ability to protect against disease. In partnership with the government of Japan under its "Last One Mile Support" initiative, Unicef procured and delivered 600 cold boxes and 1,000 vaccine carriers to the Department of Disease Control of the Ministry of Public Health to ensure that families living in remote areas can access life-saving Covid-19 vaccines and children can receive timely routine vaccines.
About a two-hour drive from Khun Yuam district, a detour from the main road means navigating endless dirt roads up and down hills to reach the villages. But that hasn't stopped determined nurses from the area making the long and difficult journey to help protect people against Covid-19.
One of the first nurses to make this journey was Supachai Euemanee from tambon Mae Ki Health Promoting Hospital. Together with 10 nurses from other hospitals in Khun Yuam district to help administer vaccines, a doctor to help ease vaccine side effects and a pharmacist to ensure safe vaccine transfer, Supachai travelled to each remote village in an ambulance provided by Khun Yuam Hospital.
Supachai said that at first, people didn't want to get vaccinated as they thought they wouldn't be affected living up in the hills. But then there were Covid-19 cases among their children who got infected while in the city, so they became fully alert to the health risks.
"When we arrived in the villages, there were many people waiting in line to get vaccinated, but there weren't enough vaccines to meet demand back then," he said.
Through managing vaccine supply, storage and transfer in Khun Yuam district, pharmacist Kamonrat Thongrak plays a crucial part in ensuring supply matches the number of people registered at hospital vaccine centres and in remote areas nearby.
"First, we need to get the schedule and requested number of vaccines from each Sub-district Health Promoting Hospital and then make a request one week in advance to get the vaccines from the main ultra-cold chain freezer at Srisangwan Hospital in Mae Hong Son city, which is 1 hour and 30 minutes away. These vaccines are then thawed and made ready to transport in cold boxes for storage in regular fridges at Khun Yuam Hospital," Kamonrat explained.
The pharmacist explained that although remote villages are only 10-30km from the main district, they take two or three hours to reach by car.
"Cold boxes help keep the vaccines at the right temperature, which is 2C to 8C. Vaccines need to be kept in good condition when stored and transferred, avoiding any shaking, which brings the risk of creating bubbles or sediment, and therefore the loss of vaccine potency," said Kamonrat, who also prepares extra doses in case some vaccines lose their potency or there is more demand than expected.
"More is better, as more and more people want to get vaccinated. The more cold boxes and carriers there are, the more vaccines that reach people."
Through these efforts, Khun Yuam district now has 90% of the population who have received the first dose and 50% who have received the second dose.
This success also comes from the help of village health volunteers, such as Patcharin Buakham from Mae Ma Hin Luang, who works to improve vaccine literacy in the village.
"At first, there were only groups of village health volunteers and village leaders of about seven or eight people travelling to get vaccinated at the hospital. When the villagers saw that we were fine, they also wanted to get vaccinated but didn't have cars or family members to take them to the hospital. Bringing vaccines to the area has really helped them," said Patcharin.
The most vulnerable groups in the village requiring vaccination include pregnant mothers or families with children and elders who cannot travel.
One of them is Panaeka Bumrungkiatsakul, a 77-year-old villager who is partially blind and has a condition that severely limits his movement. Eue-eue Chomchobdee, a 59-year-old villager, also faced hardship in getting vaccinated. She takes care of her grandchildren and her mother who has a disability.
Khun Yuam district aims to vaccinate people with a third booster dose before the Songkran holidays when many families get together, so hospitals will be maximising the use of cold boxes and vaccine carriers to reach the most remote and vulnerable groups.
Since the beginning of the outbreak in 2020, the government of Japan has supported Thailand's Covid-19 response through several initiatives. These cold boxes and vaccine carriers in particular help support vaccination efforts in over 970 local health facilities nationwide across 77 provinces.
