Ambatondrazaka, Madagascar – “The vaccine at all costs to survive the COVID-19 pandemic.” This is the credo of Justine Rasoanindrina, a grandmother of eight Ambatondrazaka district, more than 270 km from Madagascar’s capital, Antananarivo.

At 78, Justine continues to practice both as a masseuse and a matron. Well-known in her community, she embraced the profession of masseuse at the age of 15 and that of matron at 22 years old. Because of her devotion to the work of giving and saving life, Justine is part of the steering committee of the Association of Traditional Medicine practitioners in Ambatondrazaka.

But a little over a year ago, Justine added a new string to her bow: she became a community mobilizer in June 2021, following the death of her brother from COVID-19.

"His passing affected me to the extent that I made a commitment to fight against this pandemic alongside modern medicine," says Justine. “I pledged to be among the messengers of this good news [of vaccination] in my community, and to encourage people to get vaccinated.”

In the beginning, she would raise awareness in a personalized manner.

“Each time I saw someone I always created a context to discuss and provide advice to persuade them to be vaccinated. I used the death of my brother, and my own vaccination, as testimony,” she says.

These days, Justine no longer waits for people to come to her. Instead, she goes “door-to-door” to raise awareness in her community. For her, there are prerequisites for vaccination.

“We must first educate the community about the real existence of the disease and the vaccine’s effectiveness before hoping that people will get vaccinated en masse,” she suggests. “It’s both an honour for me and a duty to others.”

“Madame Justine is like a mother to me. She has assisted me from the pregnancy of my first child, who is now 16, to today as I’m carrying my fifth,” says Ravaonirina, one of the people Justine reached out to about the COVID-19 vaccination. “She managed to convince me of the effectiveness of the vaccine, so I got vaccinated.

“Now, I’m carrying a pregnancy – contrary to the rumours that claim the vaccine makes you sterile,” she adds.

False rumours such as these, claiming that the vaccine causes sterility or makes you weak and thus vulnerable to other diseases, persist despite the work of community mobilizers like Justine. To refute them, she organizes discussion and experience-sharing sessions featuring health workers and vaccinated people to testify about their vaccination and post-vaccination experiences, highlighting in each case that the rumours are unfounded.

Since her involvement as a community mobilizer, Justine says she has convinced more than 250 people to get vaccinated. “Patience and diplomacy smooth the way,” she says.

In Madagascar, vaccination against COVID-19 began in May 2021. By the beginning of September 2022, 1.4 million people had received their first dose of vaccine, or 5.4% of the total population against a target of 51% by 2023.

Ambatondrazaka district is outperforming the national average, with a vaccination coverage rate of nearly 14%, a percentage attributable in part to efforts of community workers like Justine.

“Justine is a great support for our community. She uses her influence to help us reach the target population to be vaccinated. We owe our progress so far to her and to the other community workers,” declares Dr Sylvie Rabearizoa, a health inspector in Ambatondrazaka. “She is an influencer to be encouraged. Despite her age and people’s reluctance, she doesn’t hesitate to go door to door.”