Philip Hatcher-Moore, Arete’s consultant photographer, recounts his experiences in Liberia during a recent polio vaccination campaign, and the unexpected response from the Liberian people.

Covid-19 has changed the world in innumerable ways, but one of the tragic side-effects is a spike in preventable diseases that have been hitherto successfully managed through routine immunisation. In March 2021, a year after the pandemic gripped the planet and lockdowns were imposed across the globe, I visited Liberia to document the rollout of their first polio vaccination campaign since Coronavirus hit. UNICEF, a partner of the Global Polio Eradication Initiative, who had assigned me, were supporting the Liberian government in the campaign.

Children play on the beach near their homes in the Westpoint neighbourhood of Monrovia. Philip Hatcher-Moore / Arete / UNICEF

Arriving into Monrovia, having taken a pre-travel Covid test in the UK, I took another Covid test on arrival and registered through Liberia’s travel app. The country had recently received a delivery of nearly 100,000 doses of the AstraZeneca Covid vaccines through the COVAX initiative, but was yet to roll them out. The following day, on the 26th of March 2021, Dr. Wilhemina Jallah, Liberia’s Minister of Health administered the country’s first dose of the novel type 2 oral polio vaccine (nOPV2), aimed at curbing the spread of type 2 circulating vaccine-derived polio virus. Late last year, the World Health Organisation granted an “Emergency Use Listing” recommendation for nOPV2, and in February, Liberia declared the polio outbreak in the country a public health emergency. Liberia is one of more than twenty five African nations hit by the outbreak.

Dr. Wilhemina Jallah, Liberian Minister of Health, gives a speech at the launch event of a polio immunisation campaign in Monrovia. Philip Hatcher-Moore / Arete / UNICEF

I spent much of the next few days alongside the teams of volunteer vaccinators, going door-to-door, school-to-school, church-to-church, trying to ensure that every child under the age of five received a first dose of the vaccine. What I hadn’t expected to see was a reluctance to receive the vaccine. As I stood at the border post with neighbouring Sierra Leone, I watched Selena, a UNICEF consultant, desperately trying to convince a mother to vaccinate her child before she crossed the border.

Left: A vaccine volunteer marks a house after administering the polio vaccine to children residing inside it, during a national immunisation campaign in the West Point neighbourhood of Monrovia. Philip Hatcher-Moore / Arete / UNICEF Centre: Selena Montgomery, a UNICEF Communication for Development consultant supporting awareness creation, community engagement and social mobilisation, speaks with a mother to try to convince her to have her child vaccinated against polio, pictured at the border post with Sierra Leone at Bo-Waterside, Grand Cape Mount county. Philip Hatcher-Moore / Arete / UNICEF Right: Lovetee Porter, 30, a volunteer vaccinator administers a dose of the new oral polio vaccine to Mamajah Jalloh, 3, in the West Point neighbourhood of Monrovia. Philip Hatcher-Moore / Arete / UNICEF

I’ve covered many vaccination campaigns across the globe, and just a couple of years ago, I was on the other side of that border post, researching the delivery of vaccines to the “last mile” — how people in remote areas could get their children vaccinated. I met mothers who had trekked for more than a day to reach a clinic in order to ensure their children were protected against disease. Frequently, I have seen people queuing for hours to get their children vaccinated. Yet now, as awareness of communicable diseases sky-rockets (and Liberia is no stranger to quarantine, being ravaged by the Ebola outbreak in 2014-15), I was witnessing a reluctance for something previously considered routine.

A child receives a dose of the polio vaccine in the West Point neighbourhood of Monrovia. Philip Hatcher-Moore / Arete / UNICEF

Mohamed Shariff, a teacher in the capital and former vaccinator and supervisor with the Ministry of Health, explained to me why: “For the previous years, everyone was taking the polio vaccine,” he said. “When we had denials, we would talk with them to encourage them to take it,” he . But now, because of Covid-19, we have so many refusals.” The polio vaccination campaign coincides with the arrival of the Covid vaccine in-country, around which there is skepticism, fuelled by “fake news” on social media and unregulated radio stations. “People think that taking the Covid-19 vaccine will give them the signs and symptoms of Covid-19,” Mohamed explained to me.

Another vaccinator had put it even more bleakly. “They’re saying the Covid vaccine is killing people, that’s why they don’t want their children or anyone to take it,” Kissah Mensah, a volunteer since 2013 told me.

Mohamed Shariff, 28, stands for a portrait in a classroom at the Repentance Baptist Church school in Monrovia. Mohamed has served on previous polio vaccination campaigns in the country. Philip Hatcher-Moore / Arete / UNICEF

I spent a morning in Monrovia with Lovetee Porter, 30, a volunteer vaccinator working in the West Point neighbourhood — a labyrinth of tightly packed tin-shacks spilling out onto the beach of a small peninsula. Children hung washing in the narrow alleyways, people hawked basins filled with huge snails, and teams of vaccinators navigated—somewhat haphazardly—the densely populated area. Whilst Lovetee proudly claimed to have never had a refusal—”I convince people, I talk with them and tell them what the vaccine is for”, she said—she was not met with the same zeal she projected as she knocked on doors. My overall impression of people’s willingness to vaccinate their children was more one of ambivalence and laisser-faire than of enthusiasm. Yet despite the challenges, the previous day Lovetee had vaccinated 240 children and was engaging with every parent she met, leaving in her wake a trail of children with their little fingers inked with a blue marker pen, and chalk marks over doorway lintels, marking a household as vaccinated. “Some people are scared but you just have to talk to them to explain it’s for polio,” she said.

Left: Lovetee Porter, 30, a volunteer vaccinator, administers a dose of the new oral polio vaccine to Mary, 4, in the market in the West Point neighbourhood of Monrovia. Philip Hatcher-Moore / Arete / UNICEF Centre: A team of volunteer vaccinators walk along a dirt road in Monrovia, Liberia, on the last day of a national polio vaccination campaign. Philip Hatcher-Moore / Arete / UNICEF Right: Lovetee Porter administers a dose of the new oral polio vaccine to Frances Brooks, 3, in the market where her mother works, in the West Point neighbourhood of Monrovia. Philip Hatcher-Moore / Arete / UNICEF

In a private health clinic across town, Comfort Morphre, 46, a midwife, was talking with Ummu Passawe, a Ministry of Health officer working on the Extended Programme of Immunisation — Ummu was expecting her third child any day, and Comfort was taking her blood pressure. “I feel the weight [of misinformation] on me,” said Comfort of the confusion about vaccinations. “We tell people ‘all the children under five are getting vaccinated for polio’,” she said. “It is for them, it is for everybody.”

“Immunisation is a preventative method,” said Ummu, later, at her home. “It is far cheaper and simpler to protect them from disease than to deal with them being ill.” Yet the scepticism around Coronavirus has had a knock-on effect on routine vaccinations, she explained. “To my fellow mothers, caregivers, we should not prevent our children from getting vaccines,” she said. “This is a fight that can never be over. We have children being born every day…”

Ummu showed me her daughter’s little finger, which still had remnants of the ink, indicating she had been vaccinated. “The OPV [oral polio vaccine] is going to be given to my baby, for sure.” she said.

Ummu Paasewe, Resource Mobilisation Officer for the Extended Programme of Immunisation (EPI) at the Liberia Ministry of Health, hugs her daughter, Rahima, 3, at Rahima's school in Monrovia. Philip Hatcher-Moore / Arete / UNICEF

Footnotes

All text and photos by Philip Hatcher-Moore