Missed vaccine shots: Go for innovative strategies to address zero-dose, say experts

Beyond being at risk, children who have;not received a vaccine of any kind also become a population that harbours diseases and can transmit them to others
Involving the communities more in their health services through civil societies, community-based organisations and other community structures can help address the issue. Representative photo: iStock.
Involving the communities more in their health services through civil societies, community-based organisations and other community structures can help address the issue. Representative photo: iStock.

The COVID-19 pandemic and related disruptions have weakened health systems, with 25 million children not receiving vaccination in 2021, 5.9 million more compared to 2019 figures and the highest number since 2009, according to the World Health Organization (WHO).

Though the pandemic has had a devastating effect on services for health and immunisation worldwide, one in eight children was zero-dose — not received a vaccine of any kind — even before. An estimated 19.7 million children under the age of one year did not receive basic vaccines, according to 2019 WHO figures.

To go deeper into the causes and probable solutions of zero-dose children, this reporter had exclusive conversations with Ndadilnasiya Endie Waziri, chair of the Gavi CSO steering committee for immunisation and stronger health systems and Dr Sheila Shawa, senior technical and partnership specialist, Health, Humanitarian Affairs Directorate at the African Union Commission. The experts were interviewed at the fifth edition of the Africa Health Agenda International Conference.

Endie emphasised that reaching every child with lifesaving vaccines is important because they protect children from several diseases, including tuberculosis, diarrheal diseases, polio, etc. If the children are not protected against those diseases, they will either die as children or be unable to have a good quality of life when they grow up, she said.

“We have countries that contribute to the huge population of zero children in the world. You look at countries like India, then when you come down to Africa, you look at Nigeria, you look at Ethiopia. They have huge population of children that have not been reached with vaccines,” she said.

So, they become a population at risk of diseases, but beyond being at risk, they also become a population that harbours those diseases and can transmit them to others, she added.

Endie pointed out a couple of sides to the causes of the problem. An issue around demand and supply is one among them.

“The communities are not aware of the vaccines, they do not know the importance of the vaccines. So, they need to be educated so that they can create a demand. The parents need to know the essence of the why they are vaccinating their children,” she said. 

Endie told this reporter:

But there’s also an issue of supply. When you generate demand from the communities, you must ensure these vaccines are available to all children. You must have trained healthcare workers to administer the vaccines; you must have strategies to reach children wherever they are, which is also a huge problem.

Furthermore, she stressed the issue of accessibility. “We have a lot of hard-to-reach areas; we have conflict areas, we have areas with humanitarian crises, we have fragile settings where it’s difficult for vaccines or vaccination programs to reach,” she said.

So, it is important to reach those communities with innovative strategies to ensure access to vaccination and other primary healthcare services, she added.

However, Dr Sheila argued that apart from the issue of nomadic communities, people are not aware, are not educated enough and don’t understand why they’re getting vaccinated. 

Sheila told this reporter:

When you don’t understand, it’s very difficult for you to find yourself involved in that activity. Second, it is about the nomadic population. A number of our populations move about in Africa. So, it’s difficult to catch them because they’ll be moving, looking for grazing for their cattle. Third is about when we have so many emergencies as well as the issue of financial capacity. You may want to vaccinate the whole country, but you have countries with a huge populations and might not be able to.

The pandemic diverted services, especially those related to vaccination, she added. Among the strategies, Endie complimented Zipline, a service that uses drones to deliver vaccines in flooded areas and settings with humanitarian crises.

She suggested involving the communities more in their health services through civil societies, community-based organisations and other community structures.

Endie strongly recommended letting communities drive the health system and its programs so that they know the essence and why they need it. To best engage the communities, she suggested using traditional systems such as community leaders, getting people from communities as immunisation vanguards and religious structures since some people have so much confidence in whatever they say, among others.

Dr Sheilla believes that the 2016 Addis Ababa declaration on immunisation, which the African Union has adopted, can bring positive changes. She thinks all that is needed is to support its implementation because the document covers a lot of activities that can be put in place.

“If we implement that document, most of these challenges would be addressed,” she said.

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