VillageReach’s fight against polio in the Democratic Republic of Congo (DRC) is a constant reminder that public health interventions are more than just about policies and strategies: they are really about reaching people no matter where they live, temporary or permanent and no matter how difficult the journey may be.
Polio outbreaks require a fast response. This is why VillageReach is working with the Polio Emergency Operations Comittee (COUP) and provinces to quickly disburse funding to stop the spread. This means quickly organizing and funding a vaccination campaign, as well as educating communities quickly about the outbreak to help them protect their families. Through this work, Villagereach has been able to reduce funding disbursement to the affected province from 10 days to three days. As part of our role in monitoring the outbreak response and vaccination, we headed to the Tshuapa province for what we thought would be a routine visit.
However, our destination proved to be much more than routine.
Getting Lost to Find More Under-Reached Communities
Discussions and concerns regarding the difficult health situation in the fishermen’s camps, especially in Wisampasi, located 27 Km from the health clinic. Photo Credit: Gentil Sebihene
When polio is detected in a province, like it was in Tshuapa, the DRC government and its partners have committed to reach every unvaccinated child in the affected area with a vaccine. However, reaching some provinces in very isolated regions of the country has immense logistical and operational challenges. Tshuapa is covered by dense forests and intersected by countless rivers. The distance between communities is vast and with limited road infrastructure many health facilities are only accessible by river or foot. As a result, reaching these communities often requires hours—or even days—of travel by motorized canoe.
We set out to Tshuapa knowing the journey would be long, but as we navigated the rivers, the dry season had caused the water level to drop, exposing hidden sandbanks that repeatedly disrupted our journey. At one point, after several difficult stretches of navigation, we were forced to stop in a fishermen’s camp. This camp, like many in the province where livelihood often relies on fishing, was a transitory camp that did not have access to shelter, electricity or even clean drinking water. Due to river conditions, we ended up staying in this community for three days. At first, we thought we could assist with the polio vaccination campaign here, as the commitments to reach everyone, however, we quickly learned that this community and others like them were not being monitored by the health system – and therefore the vaccination campaign never made it to us.
One of the Special Riparian Zones in Monieka on the Tshuapa River. Photo Credit: Gentil Sebihene
During our three days in the fisherman camp we identified more than 80 fishing camps that are not included in the regular health coverage. This included both access to routine immunization services, as well as access to vaccination campaigns for outbreak response. Most fisherman camps are quite far from their home village (where any child born would need to be registered for health services). On foot it could take a family up to seven hours to reach the closest health facility through challenging forest and swamp terrain, and with these camps moving often it is difficult for health workers to track children down for routine or emergency immunization services.
Adapting Vaccination Strategies to Community Realities
Debriefing on the mission to collect and validate supporting documents for the Tsuapa response from campaign stakeholders (government agencies, donors and other technical partners). Photo Credit: Johny Nsale
In these remote and mobile communities, pregnant women and children lack access to preventive services, which we learned during our stay are not delivered through outreach programs to the camps. This leads to a growing number of children who have never been vaccinated or are under-vaccinated and often suffer from disease like measles and acute febrile illness (AFI) without being detected or treated by routine services. Tshuapa province has low vaccination coverage overall, and cases of polio have been detected after the virus has circulated for several years; this is referred to as “orphan poliovirus (1).” For anyone involved in polio eradication, this serves as a stark reminder that the virus often persists where health services struggle to intervene.
To reach these communities, we must adapt our strategies to the realities on the ground. In Tshuapa, this means using motorized canoes to access these remote camps and track the children there for their routine immunization schedule. We must also ensure these communities are included in emergency campaigns used to stop infectious disease outbreaks. This means ensuring that vaccines remain viable throughout long journeys, and unexpected side trips, by transporting them in specialized cold-chain equipment such as Indigo coolers, which keep vaccines at the cold temperatures needed to keep them from expiring.
We also must integrate health services for these transitory communities whenever possible—combining vaccination campaigns with primary health care, nutrition support and surveillance activities to maximize each trip to these isolated communities. This means we must allocate the necessary resources to specific health zones to effectively address the basic needs of these communities. This requires thorough micro-planning to accurately identify all inhabited settlements (farming, fishing, mining, etc.), understand population movements, grasp the customs and traditions of the communities involved, secure the commitment of local leaders and adapt vaccination strategies and service delivery to include the full range of required vaccines—thereby avoiding vaccination gaps and the continued spread of diseases.
An Eye-Opening Experience
While we were not prepared to stay in a fisherman camp for three days at the outset of our journey — the warmth from this welcoming community and their spirit of sharing quickly put us at ease and helped make our stay more comfortable. Spending time with fishermen, sharing meals and observing daily life in these remote camps offered a deeper understanding of the resilience of these communities. Despite extremely limited resources, people support one another and adapt to challenging conditions with remarkable strength.
It is experiences like this, unexpected as they are, that motivate us to keep working in public health with even greater commitment and determination. For us, this experience has confirmed a simple yet essential principle: if we want to eradicate polio, we must reach every child, even in the most remote areas. This is the only way to ensure that no child is left behind.
(1) Tesfaye B, Chia JE, Nomhwange T, et al. Epidemiology and genetic characterization of orphan polioviruses in Africa, 2022–2024: Unmasking silent transmission and implications for eradication. Vaccine X. 2025;27:100752. doi:10.1016/j.jvacx.2025.100752