From warehouse to remote indigenous communities: The journey of vaccines in Brazil

April 2017

Thanks to a highly effective National Immunization Programme, most Brazilian parents can feel confident that their children will get the lifesaving vaccines they need – when they need them.

Routine vaccination coverage in the country averages above 95% for most vaccines on the child immunization schedule every year – exceeding WHO’s recommendation of at least 90% coverage.

Most of the vaccines are produced through local manufacturers and provided free of charge in more than 36 000 public health care facilities throughout the country. Every year, the country provides more than 300 million doses of vaccines. It recently boosted immunization efforts against the yellow fever outbreak with more than 27 million extra vaccine doses.

But some people remain hard to reach. One of the biggest challenges in Brazil is providing essential medical supplies and health care to remote communities deep in the Amazon jungle, where roads are few and medical teams have to travel hours by boat to reach them.

This photo story describes the journey of vaccines from a warehouse in Rio de Janeiro to indigenous communities living in remote jungle villages in the State of Amazonas.

A man in cold-proof gear pulls a trolley to carry vaccines from a cold storage, as another personnel watches him, in Brazil
WHO/A. Silva

The National Center for the Storage and Distribution of Immunobiologicals (CENADI) in Rio de Janeiro, distributes vaccines nationwide. In addition to analysing the inventory control, the agency is responsible for monitoring all the immunizations purchased abroad by the Ministry of Health. It also distributes diagnostic kits for measles, rubella and HIV; as well as pesticides to combat diseases such as dengue.

Two workers dump buckets of ice into vaccine coolers, in Brazil
WHO/A. Silva

CENADI has about 150 employees, which include technicians that work in the storage, handling and packaging of immunizations. Since many vaccines need to be kept at low temperatures, the employees ensure they are kept in cold rooms with temperatures between 2–8°C and -20°C, and then are packaged in coolers with dry ice for distribution.

Two men carry a cooler box of vaccines over a wooden bridge into a boat, in Brazil
WHO/A. Zambrana

Once packaged, vaccine coolers are flown from Rio de Janeiro and then driven to a port in Manaus to be loaded on a ship, and sent on a 30-hour journey by river or 2 hours by plane to São Gabriel da Cachoeira, in the State of Amazonas. At this point, the vaccines have travelled roughly 2000 kilometres.

Two women package vaccines into coolers, in Brazil
WHO/A. Zambrana

When the vaccines arrive, they are stored in refrigerators and then redistributed to local villages. Bruna Araújo (on the left), a nurse on the Indigenous Health Teams, arranges some coolers, thermometers, and carefully checks the vaccine quantities, temperatures and packaging before heading out for the next part of the journey.

A young woman carries a cooler of vaccines through a market in Tabatinga, Brazil
WHO/A. Zambrana

Bruna then takes the coolers through the local market in the city of Tabatinga down to the Solimões River, where she’ll embark on a boat to “Belém do Solimões”, the largest indigenous village in the Amazon, with more than 6000 inhabitants. From here, she will begin 20 days of uninterrupted work in the area, helping to vaccinate children and adults.

A river boat with people in it, in Brazil
WHO/A. Zambrana

On the upper Solimões, about 95% of the indigenous villages are only accessible by river and residents' only means of transport are small canoes. At this time of year the waters are high. "It's a very difficult trip all year around, because even when the river is dry the difficulties are also great," says Bruna, who for the past 6 years has been working to immunize the indigenous people in the region.

A young woman climbs up stairs from a river bank, in rural Brazil
WHO/A. Zambrana

After 3 hours on the boat, Bruna arrives at Belém do Solimões and transports the cooler to the health unit, 300 meters from the river bank, where an immunization room is equipped with a refrigerator specially for the vaccines brought from Tabatinga. Families are waiting nearby for their vaccinations.

A healthcare worker vaccines a newborn baby girl, as her mother breastfeeds her
WHO/A. Zambrana

Today, Bruna vaccinates a newborn baby girl against tuberculous, while the infant's mother, Francisca Moreno Manduca, breastfeeds to bring her comfort and reduce the pain. After, she receives her vaccination card to keep track of the baby’s record.

A health worker pulls vaccine from its container into an injector, in Brazil
WHO/A. Zambrana

Throughout the immunization clinic, the vaccines are kept in coolers and refrigerators, monitored for the correct temperatures throughout, and used before they expire. "Today is much better, thanks to the arrival of electricity to the villages,” says Bruna. “Before the arrival, the vaccines were all packaged inside a cooler and monitored by thermometers every hour .”

A healthcare worker holds a vaccination card while typing data into laptop
WHO/A. Zambrana

When every patient visits the local clinic, a nurse enters their vaccination card data into the electronic system and checks to make sure they are up-to-date. Even with all logistical difficulties, the Indigenous Health Team maintains one of the best vaccination coverage rates in Brazil – almost 95% of the population is up-to-date on their vaccination schedule.