The global vaccine cold chain is a branching network with myriad endpoints. In South Sudan, reporter Winnie Cirino profiled one of them.
- 15 January 2025
- by Winnie Cirino
About 12 kilometres from the town of Magwi in Eastern Equatoria State, South Sudan, lies Omeo Payam, a rural settlement of scattered, grass-thatched homes. At the heart of the payam – South Sudan’s second-lowest administrative unit – tucked away inside the local Primary Health Unit (PHU), there lies a solar-powered vaccine fridge.
This fridge is one of many endpoints in South Sudan’s branching vaccine cold chain. Since its installation in 2021, it has been the final storage point for all doses destined to immunise the children of this community and many surrounding villages, including Imbaru, Ikoo, Agoro-Unity and Lalor.
“It has never broken down,” says Alex Onek James, a vaccinator at the Omeo PHU. James begins each day at the fridge door, monitoring the internal temperature – it needs to remain a steady 2°C to 8°C to preserve the vaccines inside, even when the weather outside is scorching – and checking individual vaccine vial monitors stuck to the tiny bottles to make sure none of the doses are close to expiry. “I then follow the monitoring chart, set the attendance register and wait for mothers to bring their children,” he says.
“When the fridge was brought here, people were really happy because, initially, it was very challenging to carry vaccines daily from Magwi. Sometimes there was no transport, and children would miss their vaccines.”
– Alex Onek James, vaccinator, Omeo PHU
That’s a big improvement on his pre-2021 schedule. “Every day, I had to travel to Magwi to pick up vaccines. By the time I arrived in Omeo, the ice packs would have often started melting,” James recounts. “I would have to return to Magwi to replace them, and then return them again in the evening. This was a big problem, but now, these mothers can get vaccines anytime because we are always here, and the vaccines are available.”
His own relief was shared. “When the fridge was brought here, people were really happy because, initially, it was very challenging to carry vaccines daily from Magwi. Sometimes there was no transport, and children would miss their vaccines. And mothers would have to travel up to Magwi, which was difficult because getting a means of movement here is hard.”
Easy access makes for better coverage
Before the fridge arrived, mothers often walked to Magwi in groups, for companionship. “We used to gather in a group of women and move together,” recalls Joyce Achan, a mother of four. “We would chat to make the distance feel shorter, but we would still get tired.”
For those who could afford it, the alternative was hiring a boda-boda, a motorbike taxi. “It’s expensive,” Achan says. “Sometimes you miss the vaccines and combine several programmes together so that you go to town and do a number of things like shopping, all together.”
Now, with the fridge in place, mothers can come on scheduled dates, ensuring their children receive all necessary vaccines without disrupting their daily routines. “Before, some children would miss vaccines because we could not find the time to go to Magwi, because you have to go the farm very early in the morning.” Achan reflects. “But now, we can get everything just here, even the one for us mothers, TT [tetanus toxoid], we get here. So, we are very happy with the government for bringing this service near to us.”
Fathers – who in this community are less likely than mothers be tasked with ensuring children’s’ vaccination – are glad their wives and children no longer need to undertake what can be quite a gruelling hike. Stephen Modi, a father of seven, relaxes on the veranda of the PHU. “Moving from Omeo to Magwi town under the hot sun or during the rainy season was very hard. Sometimes, as a father, you worry for the safety of the mother and child, but what do you do?”
The fridge has now brought vital preventive healthcare to within an easy stroll. “I have seen people coming from Agoro, Omil, Losirap, and the surrounding areas to this centre,” Modi adds. “The fridge here has made it easy for children to be vaccinated. There is always a vaccinator here, and it’s a shorter distance for us to come to, which makes it simple.”
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Four-dose malaria vaccine, close at hand
A local vaccine storage point has made it easier to establish the latest addition to South Sudan’s routine vaccination schedule in Omeo.
The malaria vaccine, which began rolling out in South Sudan in July 2024, might represent a step forward in the fight against the deadly parasitic disease, but the fact that it’s administered in a relatively lengthy four-dose series can make it a challenging vaccine to deliver in where health centres are far away.
But in Omeo, the new vaccine has been greeted with open arms. “The recent malaria vaccines have been so much welcomed,” says vaccinator James. “Many mothers have praised it because they spend a lot of money treating their children for malaria. If they don’t get medicine at the Magwi hospital, they go to [private] clinics, which are expensive.”
Martin Okot, County Health Director in Magwi County, confirms that the fridge has reduced vaccination “drop-outs” across the board. “We noted those days, many mothers would come once for immunisations and then default due to distance issues,” Okot explains. “We tried to resolve with outreach activities, but they were irregular because of mobility constraints, and sometimes we couldn’t meet the schedules we set. That broke trust with the community.
“We’ve seen a remarkable improvement in the number of children being immunised compared to when all vaccinations were done from Magwi,” Okot confirms.
This article was originally published on
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