Meningitis A, which is a disease spread by a bacterium and causes an acute inflammation of the protective membranes covering the brain, swept through villages in rural Africa. A typical cost for a family to cure this disease (it damages the brain even with cure) is $90, which equals to three to four months’ income, according to study done in Burkina Faso, so it is a scary disease in rural Africa, and it is also the reason why the meningitis A vaccine is required so widely.
However, in Beth Skwarecki’s Breaking the cold chain: Why ditching refrigerators is a big deal for Africa, he described how a health care worker in rural Africa worked during a vaccination campaign: the outreach team can only travel 4-5 hours a day, which makes less people get shot, because they need to return to the district capital, where the refrigerators are functional and they can pick up fresh ice (the vials need to be kept in the cold chain).
Fortunately, in 2012, the meningitis A was granted a new label saying that the vaccination could stay stable and safe even it was kept at warmer temperature (never exceeds 40 degrees C) for up to 4 days. This new label made a huge difference for Africa: over 15000 vaccines were given, and nobody who got the vaccine contracted meningitis that season.
Rural Africa is a poor area where even refrigerators are not normally functional and people have low income. In this case, the primary reason why distributing vaccination being not effective is also a culture and economy reason. Nowadays, even the most scientific research is rooted in the culture, so anthropology plays a huge role in modern public health by providing an alternative reason to disease.