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PILING into makeshift canoes, trekking across mountains, wading over waterfalls... and risking death by crossing dangerous war zones.

These are just some of the extremes health workers across the world go to every day to deliver vaccines to hard-to-reach areas - and only some of the terrains they'll brave to deliver Covid-19 jabs in the coming months.

Health workers carry vaccines en route to a measles, rubella and polio vaccination campaign in Gorkha District in 2015
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Health workers carry vaccines en route to a measles, rubella and polio vaccination campaign in Gorkha District in 2015Credit: UNICEF/Panday
A drone delivery is tested at a community in Malawi, potentially paving the way for future meds deliveries
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A drone delivery is tested at a community in Malawi, potentially paving the way for future meds deliveriesCredit: UNICEF/Chisiza

While the UK celebrates the incredible roll-out of vaccines to its most vulnerable - with thousands of amazing volunteers helping out as part of The Sun's Jabs Army - many low and lower-middle income countries face lengthy waits for heroic volunteers and health workers to reach them.

Now Robin Nandy, Unicef’s principal adviser and chief of immunization, has lifted the lid on some of the terrifying trips these workers have been making to vaccinate kids for years - and how Covid-19 has now meant that challenge has become "unprecedented".

“We’ve never tried to, at the same time, deliver vaccines right across the planet in countries of different income levels, and all competing for limited quantities of Covid-19 vaccines," he tells Sun Online.

“It’s going to be a huge challenge, but we’re really optimistic."

Workers unload cartons of a Covid-19 coronavirus vaccine being delivered from India to Myanmar
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Workers unload cartons of a Covid-19 coronavirus vaccine being delivered from India to MyanmarCredit: AFP or licensors

'They’re the true heroes'

While receiving potentially life-saving jabs as a child is very much the norm in the UK, Unicef estimates that around 20 million children around the world do not receive the full compliment of vaccines each year.

Of those, 14 million receive no vaccines at all.

Mr Nandy says it's an issue that they, as well as others such as the World Health Organisation and Gavi, the vaccine alliance, are working tirelessly to overcome.

However, with Covid-19 vaccines, adults are now the priority target and this means the complexity has increased. Programmes that have traditionally targeted children now have to pivot to reach adults.

“These children we’re missing year after year after year are largely in three types of communities," he explains.

Robin Nandy has lifted the lid on some of the extreme ways vaccines are delivered around the world
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Robin Nandy has lifted the lid on some of the extreme ways vaccines are delivered around the worldCredit: UNICEF/Nesbitt

“They’re either remote/rural populations, where the health system doesn’t have the reach, they’re conflict-affected communities where there’s been a breakdown of systems and damage to health facilities, or they’re urban poor communities like urban slums.

“Then you have countries that are affected by conflict and war, and that’s going to be a huge challenge.”

Despite the risks, health workers - many of whom are paid very little - are putting their lives on the line to reach these areas, and will continue to do so as the Covid-19 vaccines are more widely rolled out.

Children in Aden, Yemen show off the spots on their arms where they were vaccinated during a mobile Measles and Rubella vaccination campaign in 2019
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Children in Aden, Yemen show off the spots on their arms where they were vaccinated during a mobile Measles and Rubella vaccination campaign in 2019Credit: UNICEF/Fadhel

“They utilise whatever form of transport they can get hold of – various animals, camels, cows, donkeys, they go by boat, they have bikes, motorcycles, sometimes on foot for several hours, crossing rivers, climbing mountains, it’s actually monumental," Mr Nandy says.

“They’re the true heroes in communities."

He adds: "I’ve heard stories of health workers putting their lives at risk to deliver vaccinations in conflict settings – polio vaccinators, for example, in Pakistan and Afghanistan and northern Nigeria.

“It’s not a one off. They don’t just do it once, they’re doing it repeatedly, at great risk to themselves and potential impact on their families, should something bad happen to them.

They utilise whatever form of transport they can get hold of – various animals, camels, cows, donkeys, they go by boat, they have bikes, motorcycles, sometimes on foot for several hours, crossing rivers, climbing mountains, it’s actually monumental.

Robin Nandy

“I’ve also come across health workers operating following national disasters, like the earthquake in Haiti and the countries affected by the Indian Ocean tsunami, where they themselves have lost members of their family but have not taken a single day off to grieve for them."

Many countries are now relying on the , a scheme which aims to guarantee rapid, fair and equitable access to vaccines for people in all countries.

Here we look at some of the most extreme ways health workers have been delivering vaccines for years...

Mali

Mamadou Kassé, 29, a vaccinator at the Sofara community health centre, travels for miles by donkey cart in 2019 to reach the remote Kankelena village in Mali, where families are waiting with their children for vaccines
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Mamadou Kassé, 29, a vaccinator at the Sofara community health centre, travels for miles by donkey cart in 2019 to reach the remote Kankelena village in Mali, where families are waiting with their children for vaccinesCredit: UNICEF/Keïta
Mamadou is community health worker in Mali's central region of Mopti, where a partial ban on traveling by motorcycle between towns in 2019 significantly limited women’s access to health services
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Mamadou is community health worker in Mali's central region of Mopti, where a partial ban on traveling by motorcycle between towns in 2019 significantly limited women’s access to health servicesCredit: UNICEF/Keïta

Nepal

Porters and a local health official carry vaccines on difficult terrains on the way to a measles, rubella and polio vaccination campaign, to be conducted at a health post in Gorkha District, in 2015
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Porters and a local health official carry vaccines on difficult terrains on the way to a measles, rubella and polio vaccination campaign, to be conducted at a health post in Gorkha District, in 2015Credit: UNICEF/Panday
The health workers braved treacherous stairs to deliver the vaccines following the earthquake in 2015
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The health workers braved treacherous stairs to deliver the vaccines following the earthquake in 2015Credit: UNICEF/Panday
Vehicles are often forced to cross horrendous terrain to reach their destination
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Vehicles are often forced to cross horrendous terrain to reach their destinationCredit: UNICEF/Panday

Afghanistan

In 2018, in southern Afghanistan, this hero health worker, 19, vaccinates a child in an old military barrack. She works with one of the largest female workforces in Afghanistan, fighting polio. Female polio workers are critical because only women are allowed to access a family's home to check that every infant child has been vaccinated
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In 2018, in southern Afghanistan, this hero health worker, 19, vaccinates a child in an old military barrack. She works with one of the largest female workforces in Afghanistan, fighting polio. Female polio workers are critical because only women are allowed to access a family's home to check that every infant child has been vaccinatedCredit: UNICEF/Hibbert

Timor-Leste

After an immunisation session in Asanunu village in 2018, a vaccination team continue to Fataliri - a part of Soba village, Laga sub district, which is very remote and can only be accessed by foot
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After an immunisation session in Asanunu village in 2018, a vaccination team continue to Fataliri - a part of Soba village, Laga sub district, which is very remote and can only be accessed by footCredit: UNICEF/Soares

Yemen

A one-room house on the outskirts of Sana’a, Yemen, where there is no road - meaning mobile health workers and a vaccination team had to clamber to reach it in 2016
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A one-room house on the outskirts of Sana’a, Yemen, where there is no road - meaning mobile health workers and a vaccination team had to clamber to reach it in 2016Credit: UNICEF/Nassir
A local health worker carries vaccines in a cold-chain container from Dhamar, Yemen, to a mobile vaccination campaign in 2019
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A local health worker carries vaccines in a cold-chain container from Dhamar, Yemen, to a mobile vaccination campaign in 2019Credit: UNICEF/Al-Qaflah

Democratic Republic of the Congo

A community relay crosses a water stream with his bike to vaccinate children in the health zone of Manono, Tanganyika Province, in Democratic Republic of the Congo in 2018
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A community relay crosses a water stream with his bike to vaccinate children in the health zone of Manono, Tanganyika Province, in Democratic Republic of the Congo in 2018Credit: UNICEF/Wingi

Papua New Guinea

Families congregate at a mobile clinic in Kambaramba village to have their children vaccinated against polio, having travelled in dugout canoes in 2019
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Families congregate at a mobile clinic in Kambaramba village to have their children vaccinated against polio, having travelled in dugout canoes in 2019Credit: UNICEF/Holt

Cambodia

A health worker at Sambo health centre (right), on a speed boat crossing the Mekong River with his outreach health team to Koh Sam village, Sambo District, Kratie Province in 2018
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A health worker at Sambo health centre (right), on a speed boat crossing the Mekong River with his outreach health team to Koh Sam village, Sambo District, Kratie Province in 2018Credit: UNICEF

India (2017)

Health workers brave dangerous roads to vaccinate children in a hard to reach district, as part of a vaccination campaign for children between nine months and 15 years in Tehsil Thunag, Himachal Pradesh, in 2017
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Health workers brave dangerous roads to vaccinate children in a hard to reach district, as part of a vaccination campaign for children between nine months and 15 years in Tehsil Thunag, Himachal Pradesh, in 2017Credit: UNICEF/Sharma

Vanatu

A health worker, from Melsisi Mini Hospital, trekking across the mountainous Pentecost Island to deliver the vaccine order to the remote Tsingbwege Dispensary in 2018
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A health worker, from Melsisi Mini Hospital, trekking across the mountainous Pentecost Island to deliver the vaccine order to the remote Tsingbwege Dispensary in 2018Credit: UNICEF/Chute

Pakistan

Polio teams crossed Indus river on a boat to vaccinate young children in village shah Nawaz, UC Mirzapur, Shikarpur district of Sindh province in Pakistan in 2012
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Polio teams crossed Indus river on a boat to vaccinate young children in village shah Nawaz, UC Mirzapur, Shikarpur district of Sindh province in Pakistan in 2012Credit: UNICEF/Zaidi

'Delivery is one thing, acceptance is another'

Mr Nandy says one major issue that many countries face in the months ahead is the spread of misinformation, which may put people off having the Covid-19 jabs.

He says combatting this with real facts is a number one priority.

"Delivery is one thing, acceptance of the vaccine is the other," he says.

“The Covid-19 pandemic and the way countries have responded has unfortunately led to an erosion of trust – in governments, in the health systems.

A 10-year-old is vaccinated by a mobile health team in an informal tented settlement near the Dead Sea in Jordan
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A 10-year-old is vaccinated by a mobile health team in an informal tented settlement near the Dead Sea in JordanCredit: UNICEF/Herwig
In Shanga, Nigeria, a mobile medical team is seen administering drug to child last year
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In Shanga, Nigeria, a mobile medical team is seen administering drug to child last yearCredit: UNICEF/Esiebo

“We need to build this trust back as we deliver the vaccine in order to have the maximum impact. Unicef, along with partners like the World Health Organisation, are doing a number of things to track vaccine perception in countries.”

He remains very optimistic, however, and says the COVAX scheme offers hope for all countries around the world.

“Unicef and partners are establishing the COVAX facility, a pool procurement mechanism of vaccines for low and low-middle income countries so all countries get access to some doses of vaccines at least," he explains.

“The idea is that each country will get enough vaccine doses for at least 20 per cent of their population.

“That will ensure enough doses for the frontline health workforce and the population at high risk.

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“Once we’ve successfully done that, and more doses become available, they can scale up and expand the vaccine to be used in other populations too."

To help Unicef UK deliver history as it rolls out the Covid vaccine to the world's most vulnerable, . 

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