Hope Is A Verb - A Shot At History, Part 2 - The Chain

Episode Date: September 15, 2025

Rolling out a new vaccine across an entire continent takes an extraordinary chain of people - from the scientists in the labs, to delivery truck drivers and healthcare workers on motorbikes who stop at nothing to get this vaccine into far-flung villages. In this episode, we’ll show you what it takes to navigate the last mile challenges of transporting a cold-chain vaccine across the hottest continent on earth and the surprising heroes who are stepping up to champion the world’s first malaria vaccine. Here’s who you’ll meet:Angus Hervey: Founder of Fix The NewsTeresa Chirwa-Ndanga: Journalist & human rights activist, MalawiZacharia Kafuko: Director of 1Day AfricaAmanda Clemens:  Social Mobilisation Coordinator, Ministry of Health, Sierra LeoneKombra Network, Sierra Leone: Sallamatu Barrie – School Health club Champion, Reverend Christina Sutton and Dr Ramadan Jalloh. Special music credit: "Wok Dae Ya" by Speedo'oA Shot At History is produced by Fix The News. SeriesProducer, Amy Davoren-Rose, Fix The News. Associate Producer & Audio Director, Anthony Badolato, Hear That?Producers for Sierra Leone, Marcus Costello and Jodie Bennet.For more information about this production, email [e-mail]

My name we fight Malaya. My name is Salemato Zena Bay. I'm glad to meet with you on the discussion of Malaya. The disease that's fear no one. I'm the school health club champion. I've got to make it straight how to avoid malaria. So Salamato So Salamato is 12

She lives in a little town And she's using her mom's phone So can I call you Salamatu Or does mommy call you another name That you want me to use? No, call me Salamato Tell me who is a school health club champion A school health club champion

It's a person Extend the messages about malaria the prevention and how to take care of your homes. Why did you join? Because I want to learn more and to spread the message all over the world. I asked her, do you know anyone who has suffered from malaria? And she mentioned almost everyone in her family.

Her mother, father, brother, auntie, uncle, cousin. In other words, saying, this I have lived every day. When that happened to my family, I decided to join the Malaya Club for me to understand very well about the prevention of Malaya. So when you go in the community,

are you speaking to people that are older or to children like yourself? I speak both of them. She's so passionate. She does this in both English and her local language. And I found that very fascinating, that a child is able to influence others, not just her age, but parents in the communities. Why do you think they listen to you?

Because they ask me questions. In thousands of communities across Africa, just like Salamartis, malaria is a daily reality. Despite all the tools we've developed to prevent and treat it, DDT, bed nets, antivirals, it remains a deadly, unwanted problem for millions of families, killing a thousand African children every day. But now, we finally have a weapon to fight back, the world's first malaria vaccine.

After decades of scientific struggle and years of rigorous trials, the vaccine began a pilot rollout in Ghana, Kenya and Malawi in late 2019. But then came COVID, a global pandemic. Instead of derailing the pilot, though, something remarkable happened. Healthcare workers put on masks, loaded vaccines into cooler boxes, and kept going. Mothers kept bringing their babies to clinics. The pilot pushed on, and it worked. Early reports showed a significant reduction, a 30% fall in cases of severe malaria across the three countries. Those results were so promising that in October 2021, the World Health Organization recommended the widespread use of the malaria vaccine across Africa.

I'm pleased that together with Gavi and UNICEF, WHO will shortly announce the allocation of 18 million doses of RTSS, malaria vaccine to 12 countries in Africa. But approval was just the beginning. Rolling out a vaccine across an entire continent takes an extraordinary chain of people. From the scientists in the labs and nurses on motorbikes to mothers who are willing to walk with their babies for hours to the nearest clinic and 12-year-old girls like Salamati with a passion for saving lives. And that's what this episode is all about.

I'm Gus Harvey. I'm the editor of Fix the News and this is a shot at history. Episode 2, The Chain. Zachara Kufuco, who we first met in episode one. He's the director of One Day Africa, an organization that's helping countries do the groundwork so that the vaccine reaches as many kids as possible. And at the time of recording our interview, he had just received some pretty amazing news. So I'm happy actually to mention that as of last night, around 11 p.m., Zambia managed to successfully submit its application to Gavi, to purchase the vaccines for malaria, and deliver them to Zambia.

Ah, Zach, it's awesome. Congratulations. What is that going to mean to you when that first batch arrives on the airport tarmac? The vaccines arriving is definitely something worth celebrating, but the African continent has challenges. For example, the people who need them are actually in the far-flung areas

with very difficult access in terms of roads and there's issues around electricity, which is necessary for the storage of these vaccines. because they need to be stored in cold temperatures for them to remain viable. And then there's also the issue of the number of skilled healthcare workers that administer these vaccines. And Africa also has pockets of vaccine hesitancy

that have to be addressed. So when you put all these pieces together, the issue of getting access to a vaccine involves a lot of moving pieces. Yeah, wow. That's so much bigger than I thought, Especially when you consider this has to happen in lots of different countries too, right? The way to end malaria is by continental effort.

You know, countries that are on the continent, they are connected, they have open borders. One country doing so much work is not enough. It has to be a lot of countries pushing the same amount of effort. If we're able to see vaccines get into people sooner, that would translate into thousands of lives actually being protected. Malaria doesn't respect borders. Mosquitoes don't carry passports. To truly break the chain of transmission, this has to work everywhere.

But that's easier said than done. Sub-Saharan Africa isn't one place. It's 48 different countries across 24 million square kilometers. The logistics are insane. Super remote villages deep in the bush with no electricity, communities speaking hundreds of different languages. I asked Teresa, my guide for this series, to paint a picture of how this plays out on the ground. It's a story that is quite common in African countries. For most villages, the major challenge is gating to that place. The road infrastructure is pretty bad, and storage

is a huge issue. Even in the urban areas, we sometimes go eight hours without power. And the hospitals in rural communities don't have alternative power like the generators. Let me just give you this example. There was a time that female journalists were trying to tell the story of maternal health in rural hospitals. And I was one of the journalists that slept at a rural health facility to experience how night goes. And a woman giving birth at night at a rural community, they use tortures in the labor world. And if there is an emergency, we'll just have to pray that they get to the referral hospital in time. So think of this facility that you're transferring medication that needs cold storage.

Teresa talking about the cold chain reminded me of a TED talk by Melinda Gates in 2010 about what NGOs can learn from the distribution of Coca-Cola. When I travel in the developing world, Coke feels ubiquitous. And so when I come back with these trips, and I'm thinking about development and I'm flying home, I'm thinking, well, we're trying to deliver condoms to people or vaccinations. You know, Coke's success kind of stops and makes you wonder. How is it that they can get Coke to these far-flung places? If there's a fridge for a soft drink, actually there's a fridge for a vaccine, right?

Well, it's not quite that simple. The biggest difference between a bottle of coke and a vial of malaria vaccine is that Coke can be stored at room temperature for a long time. A vaccine can't. It needs to be kept between 2 and 8 degrees Celsius. That's regular refrigerator temperature. If it goes outside that range, for even a short time, the batch could be ruined. Imagine how difficult that is when you're transporting thousands of vials across the hottest continent in the world.

this continent in the world, and where the supply chain can break at any point. Massive shipments have to make it from the airport to the capital city, into regional headquarters. But then the local clinic doesn't have money for petrol to collect the supplies. Or the power goes up and there's low fuel for the backup generator. Sometimes the road gets closed because of heavy rains. Well, half the shipment just vanishes, only to mysteriously reappear in private pharmacies. And even if you manage to navigate all of that, you can still turn up in a community where people decide they don't want the vaccine at all. So this is a public maternal health clinic in the outskirts of Lilongue.

Lirongue is the capital city of Malawi. On a daily basis, it will be hundreds of mothers with their babies. And as you can imagine, it's hot, and women are in these long lines trying to get assistance from the nurses. I have a colleague who works near the clinic, and she's a reporter too. So I asked her to visit the clinic for me. Her name is Melifa Chudul, and she spoke with one of the mothers who was standing in line. The mother's name is Maria Smart. They're speaking Chichewa, one of the local languages in Malawi.

Maria was there with her baby to get her second dose of the malaria vaccine, but she was the only one from her village to get her child vaccinated. People in her village were actually angry that she was. she got her child vaccinated. You have to understand, this vaccine is almost like getting medication. And all they know is that we get treatment after we have been diagnosed with malaria. Now suddenly you have to get a vaccine even though the child is not sick. It's difficult for them to change that mindset.

Maria Smart was super brave to do this. Everyone in the community blamed her for it, but there is a stark difference. Her son has never suffered from malaria at 11 months old. And this is rare because by their first birthday, so many babies would have had malaria at least twice. This idea that there's something wrong, weird about the malaria vaccine, is that still a problem? Yeah, especially in rural areas.

as a pilot, the health system really tried. They would carry the cooler boxes with the vaccines on a bike and they went door to door. In some areas where mothers are not actually going to the facility, they would take the vaccine to them. There's still some who refuse to get their kids vaccinated, either out of religious beliefs or because they think when we get our kids vaccinated,

they won't be able to have babies of their own when they grow up. you know babies are just so important to my culture you have to have children it's this really interesting contradiction where on the one hand you say the babies matter so people are scared of a vaccine that means that maybe you won't be able to have the baby but on the other hand you have this vaccine that might save your baby can you explain that contradiction to me yeah i don't know if actually gass i can explain it properly the reasoning is that we were once babies and we survived yeah and parents feel like my kids will also survive the normal way because I never got a vaccine but here I am beliefs in my

country are quite deep rooted it takes a lot of time to change that and especially where you learn about your parenting skills from your mothers. And while our mothers have gotten us vaccinated, these vaccines have been there for a long time. But for a new vaccine, they still would think it's too early to say there would not be bad consequences. And that's why I think there's still this hesitancy. Yeah, that makes a lot of sense. Maybe if I was in that situation, kind of feel the same. But it's still hard for me to get my head around this. Teresa, you and I just have very, very different lives.

Yeah, this may not be relatable for you or rich countries, because we live communal lives. For instance, in my village, all the female children sleep in one house. There is no sleeping in my dad and mom's house. We eat together. So we will cook in these huge pots at the end of the day. And if one family doesn't have food, we share that food. You also need to understand that to make a decision to do something,

it has to take the influence of a number of people. So if a vaccine is being introduced, the health workers have to go through the chiefs, explain to them, there's something new that we're introducing and this is how it is going to go. If the chief is convinced, they will take the message to their communities at funerals or celebrations and make these announcements. You can't get to a community whether it's in a rural village or whether it's in town without having to knock on the door of a local community leader. There are cultural hurdles everywhere.

There's no point in having a vaccine if the people you're trying to reach don't want it. Getting communities on board requires a tailored approach in every village, in every region of every country. That is not an easy task. But it is possible. And one place where it's really working

the Sierra Leone. If I'm being honest, malaria has been one of the most successful vaccines because the prevalence of malaria in Sierra Leone is quite high and a lot of people are really excited about the vaccines. This is Amanda Clemens. She's a social mobilization. coordinator with Sierra Leone's Ministry of Health. One thing you should know is Sierra Leone is a very warm and friendly environment.

No matter where I go in the country, whether the terrain is rough or terrible, I am always going to have this feeling of I am home. Amanda and her team go door to door, village to village, informing people about vaccines like the malaria shut and then running clinics to administer them. Because they're on the ground every day, they know what works. We do not take healthcare workers who are from Community B to go work in Community A because the familiarity level decreases drastically. People are scared of the unknown.

So what we do is we take the community health worker from Community A to work with people in Community A. So the mothers already lead to these healthcare workers because they understand their roles and they respect them. It's an easy way for us to see acceptance for this. vaccines. But getting those vaccines to remote communities, that's where Amanda's job gets really challenging. Most of these places, the roads are really, really bad. And you have to have a really good vehicle. If you do not, just be ready to sleep in the vehicle of the car breaks down. So a few months ago, we went to this village called Nancy Tucker. When you go there, to find a way to spend the night because it's so far and the road is so bad.

We got to the village late and they had this thing called a Luma. It means a very big occasion where traders come and sell their items. So within that Luma day, we made sure that children had the vaccines. And because I do not speak all the languages of Sierra Leone, I always have someone beside me who speaks the language. We are very deliberate in using languages that are in the hearts of people. While we went to this Luma, we came across a mother whose child had bonds over their body. But the mother did not have money to take the child to the hospital. So one of the healthcare workers took out money from her pocket and gave to the mother to take care of the child.

And I think those are one of the experiences that I truly hold to my heart because it made you feel like a chain in the community. If this child is unwell, I cannot function until I make sure that I do something to make her feel better. Throughout the process of making this series, we came across so many stories like this. Reminders that this isn't just about malaria, but about the wider ecosystem. A new community vaccination day is another touch point where a young girl can be referred to a nearby hospital to finally get treated for burns. Or when a grandparent finally gets to see someone about that cough that's been bothering them for months. earning trust is hard but it pays off in a hundred different ways over and over again I wanted to know more from Amanda about how they spread the message

communities trust each other and they believe the experience of other people one of the things that our team does is to use trusted influences within the communities So how do your team find out who these people are? We have something that is called mapping that had already been done by other partners. They have this network that they call Combra Network, starting from mothers to fathers to youth people because they understand that if they have people within the communities

that people listen to, their messages can go faster. So just stop and think about this for a second. How do you contact people to let them know there's a new vaccine? In wealthy countries, you might send a text, post something on social media, or run TV ads. But in Sierra Leone, less than 30% of the population has electricity. Only 20% have internet access, and just 10% use social media. So where do you start? Well, you go to where people gather every day.

The main women's group that the Combrough Network engages is called the Market Women's Association. And in Sierra Luan, a marketplace is a very busy place. There's a lot of shouting. Everyone trying to get customers to their place. There's a lot of eating going on. and you will mostly see women running small businesses, selling tomatoes, selling vegetables,

and they discuss with fellow women within the market. Everything that would affect women, business-wise, personal life, marriage issues, raising children, and they have also been advising each other on the malaria vaccine. We have this malaria campaign. It's very good to get the shots, especially the children. We encourage them that when the vaccine comes, they give the children. And it's free.

It works because when the women come to the market, they're spending a lot of time there, they're able to pass on the message. And when these women go back to their villages, they are also passing on this message to the women in their villages. It's like a chain. of mouth, but very effective. You would think they have nothing to do with the health care system because they're market women, but they're using that peer-to-peer approach to encourage mothers

to take their kids to the health facility. I found it fascinating that groups like the market women taking up this responsibility and saying, if we have to fight malaria, we'll fight it collectively as a community and take up the responsibility to educate each other. I haven't seen that energy in my country and I feel like it's something that we need to be learning from each other in Africa. This is the genius of Sierra Leone's Combra network. It's intimate, personal. Market women sell tomatoes, but they're also trusted advisors on everything from relationships

to raising kids to finding the right doctor. When they pass on information from a health worker about the malaria vaccine, they're lending their credibility, their reputation, they're standing in the community to the message. That credibility matters, because these women have been through so much together. They've helped each other through draughts, celebrated each other's children, mourn each other's losses. When one of them says, this vaccine is safe for your baby, it carries a weight

that no government poster or radio advert ever could and that's not all there's more to the Combra network because when you're asking people to trust you with their children's lives you also need voices that speak to the deepest parts of their belief systems

Khamra means to Khammeda Khammeda Khammeda means to care for someone. In fact, we believe that God himself is a Kumbra because he cares for all of the creations. This is Dr. Ramadan Jalo.

He is an Islamic scholar in Sierra Leone and together with Reverend Christina Sutton, a Christian minister, they've joined the Combra Network to tackle social issues across religious lines. It doesn't matter where you belong or what you believe. What is important is for us to work together. Our mission is to save lives. Everything about religion is to save life.

These religious leaders have put together this document called Religious Messages on Malaria Prevention Control. They handed out to other faith leaders to use in their sermons and conversations and it's got the usual myth-busting health education stuff. But where it gets clever is that next to each myth, there's a verse from both the Bible and the Quran accountes it. So when an Imam or a pastor needs to explain why some belief about malaria is wrong, they're not just throwing medical facts

of people. They've got scripture to back them up. It's basically turning religious authority into public health authority. Reverend Sutton and Dr Jalo, I was reading the malaria pamphlet that the two of you put together and I came across this list of myths that you had written down. Malaria is not caused by drinking a lot of beer, eating a lot of mangoes, oranges or groundnuts, eating oily foods, or staying under the sun for too long.

How hard is it to overcome these kinds of beliefs? The Bible says, My people perish because of lack of wisdom. God has given us this message that we should have been using When we search the scripture and we are able to relate it with the medical messages, then we have got a cure. We are happy to get this malaria vaccine in our country because I believe it will contribute to the well-being of our people. So it is my wish, it is my prayer.

Because authentic hadith of the Prophet of Allah al-Isalam that says, whoever wakes up in the morning, feeling secure in his environment, feeling strong and healthy and household to eat, that person owns the world. Two people from completely different faiths. Both of them trying to find religion to back a scientific message. I was just like, my mind was blown. You can't talk about a medical success story without the local leaders. Because most of the beliefs are really coming from religious backgrounds. And for me, if we use that in Malawi, I feel like there will be a huge change.

People are sitting under a tree waiting for the arrival of this vaccine because health workers already arranged with the local community leaders to say, okay, we'll get there at this particular time. And once it arrives, they immediately get it into the arms of these little babies. So it's a lot of coordination, a lot of dedication. And if we miss just one step where you haven't coordinated well and reached the right person, the whole chain will just collapse.

We started this episode on the airport tarmac in Zambia and we've ended up here talking about scripture in Sierra Leone. But this is what it takes. to break the chain of transmission. And I mean that quite literally. For centuries, malaria has had its own deadly sequential logic. Mosquito bites a child, child gets infected, mosquito bites child again, spreads to another child.

Over and over, link by link, killing a thousand African children every single day. But now humanity is building a different kind of chain, a human chain that fights back. It started in laboratories where scientists spent decades figuring out how to outsmart a shape-shifting parasite, then trials and dress rehearsals across multiple countries testing and retesting until we knew it worked. Manufacturing facilities producing millions of doses, cargo planes, flying pallets across oceans, trucks navigating

impossible roads, healthcare workers loading cooler boxes onto bicycles. And that's the easy part. You also need market women earning trust one conversation at a time. Religious leaders, finding verses from the Quran to back up the science, community health workers who speak the local language and understand local fears. You need 12-year-old girls like Salamatu, becoming vaccine champions in their schools. You need mothers like Maria Smart, who have the courage to let their babies be the first in their village. Every single link matters.

Miss one, the cold storage fails, the fuel runs up, the community leader says no, the religious authority stays silent and children die but when every link holds when this human chain works the way it's supposed to something remarkable happens the malaria chain breaks fewer children get sick families don't have to gather around tiny graves anymore and that's why teresa produces radio stories to educate her community why amanda sleeps in broken trucks why dr jello and reverend Sutton quote scripture to save lives. They're forging the links in a chain strong enough to break malaria's grip on an entire continent. I know you have to rush to school, right?

Yes, ma. Okay, I hope it's not very far. It is far. How do you get there? Do you have to use the bike or you have to run? I have to run. Oh my God. Okay. I'll leave you to run. I wish you a very good day and we'll catch up again. But thank you so much for sharing with us, Samato.

Welcome. Next time on a shot at history. How we ended up with not one but two malaria vaccines. We knew it was a scientific challenge. successful that would save hundreds of thousands, if not millions of lives. Many, many people have been working on this effort well before me for the last century, and we finally have two vaccines being rolled out. We find out if it's working.

I'm optimistic that we'll see situations similar to what we had reported in Kusumu, Kenya. The children's world is not that part like it used to be. Severe forms of malaria have greatly gone down. And what this could mean for the future of the future. Sub-Saharan Africa. This could actually change how the world thinks about us. Maybe for once they weren't just think about poverty. If we all contribute, it will make the whole world

a much more better and safer world for all of us. A shot at history was produced by Amy Rose from Fix the News with sound design by Anthony Badalato from Hear That. This series is our first big piece of original reporting and was made possible thanks to our paying subscribers at Fix the News. We are proudly independent and subscriber funded. We also couldn't have done this without the generous support of the Postcode Lottery Group. Thank you.

There were so many people who lent us a hand along the way. You know who you are at the World Health Organization, Garvey, Path, the Ministries of Health in Kenya and Sierra Leone, the Clinton Foundation, Deutsche Vela and AudioCraft. This story is important to us. If you enjoyed it, please share it around.