STRICTLY EMBARGOED until 00:01 on 20 April 2023

On 21 September 2022 in Northeast India, Alternate Vaccine Delivery (AVD) worker Dematso Khamblai poses for a photo while crossing a pedestrian suspension bridge spanning a river, as part of a team on its way to a Village Health Nutrition Day event, a mobile medical and immunization intervention. Health workers operating in the area must cross this type of bridge several times each day to shorten their travel time. Dematso, 29, has been working as an AVD person since 2015. Prior to the outbreak of COVID-19, he made seven or eight day-long treks per month to reach villages that are not reachable by road. Since COVID-19 vaccines became available, his workload has increased significantly, and he spends around 20 days per month reaching villages with vaccines. In the eastern mountains of Northeast India, where the sun rises early, Dematso Khamblai’s day of delivering vaccines starts well before dawn. He is a member of the area’s Alternative Vaccine Delivery System. At 3:30 a.m., Dematso leaves his home and heads to the local health centre. There, he stocks up on vaccines, packing them into a grey insulated carrier. By 4:30 a.m., he is on the road, bumping along for as far as a motorbike. When the roads end, he begins his trek over hills, through valleys and across rickety suspended bridges. His mission: to deliver vaccines to villages hidden away in the mountains of this north-east corner of India. “The mountains are steep, and we have to be very careful while hiking,” Dematso said. “It becomes dangerous during the monsoon season as rains make the trek slippery. There are also frequent landslides during the monsoon season, which make the trek tough.” Northeast India, known for its natural beauty and rugged terrain, poses a challenge for health workers striving to ensure that all children receive necessary vaccinations. High mountains, deep gorges, and dense forests, combined with unpredictable weather conditions, make the journey to reach vulnerabl