ALL VACCINES MATTER: LGUs asked to prioritize Routine Childhood Immunization alongside COVID-19 operations

Amidst the country’s easing restrictions and progress against COVID-19, a couple of model local government units (LGUs) have been silently championing the country’s flagship program on child immunization against other life-threatening diseases—a program that other LGUs should pay equal attention to as they potentially move forward from COVID-19 operations.

Spearheaded by the Department of Health (DOH), the National Immunization Program (also known as the Expanded Programme on Immunization) is the Philippines’ premiere vaccination program that provides children, infants and their mothers, access to routine vaccines recommended for their age.

Currently, the NIP provides protection against 14 vaccine-preventable diseases (VPDs) from only six when it first began in the 70’s.

LOW ROUTINE IMMUNIZATION   

Dr. Lulu Bravo, pediatric infectious disease expert and the executive director of the Philippine Foundation for Vaccination (PFV), says that the COVID-19 pandemic has caused a disruption on routine immunization especially in the Philippines.

“Regionally, nationally, globally, there has been a disruption in immunization services. At least 70% of the countries in the world have had disruption in immunization [of routine vaccines]. Some countries have rebounded, but unfortunately, for the Philippines, we have yet to go back to the original immunization coverage that we enjoyed in

2015 for example. [Back then,] we had a 93% vaccine confidence that translated to an 80-90% vaccination rate. Now, we only have around 30-40% vaccination rate.

The 2020 Field Health Service Information System annual report states that only 6 out of every 10 Filipino children can be considered fully immunized children (FIC)¹. This was 29.82% below the national program target of 95%. In the past five years, the proportion of FIC has not achieved the desired immunization program coverage and has seen a decline since 2016’s coverage of 80.20%.

NEGLECTED IMMUNIZATION CAN LEAD TO FUTURE OUTBREAKS 

Dr. Bravo warned that unvaccinated children are at high risk of infection which can result in illness, disability or even death. They also pose the risk of causing infectious disease outbreaks in the community, not to mention having an impact to the community’s economy.

“They will have more morbidities and mortalities not just from COVID-19 but also from other diseases. And we will be poor because vaccination improves the economy. The healthier you are, the wealthier you will be. Vaccination is an investment in health and wealth.”

In a PFV podcast with immunization program coordinators, PFV health experts cited the recent reappearance of polio across the globe (a debilitating disease which was thought to be eradicated) as a consequence of low vaccine coverage. In the past years, outbreaks have been spotted in Malawi (2022)⁴, Ukraine (2021)⁵ and in the Philippines (2019).

PFV also cautioned the public to be mindful of other VPDs like measles which are more infectious than COVID-19.

“Alam niyo po ba na ang measles ay mas contagious pa kaysa sa COVID-19. Ang isang batang may measles ay kayang makahwa ng 18 na tao. May bakuna nga sa COVID-19 pero nakalimutan naman iyong routine vaccination sa tigdas. Kapag nagkita-kita uli ang mga bata sa classroom, outbreak na naman ang measles,” says Dr. Tina Alberto.

CHALLENGED IMPLEMENTATION, BUT NOT IMPOSSIBLE 

In the same FHSIS report, it was found that Region 3 (78.75%), Region 1 (76.63%) and CARAGA (75.54%) were the top 3 regions with the highest FIC coverage, while Metro Manila was among the regions below the national average of 65.18% potentially due to the aforementioned interruption brought by COVID-19.

In April 2021, the DOH remarked that many health workers who were supposed to be vaccinators for routine immunization were unavailable after being tapped to help in the country’s pandemic response.⁶

However, despite the interruption in child vaccination services, two LGUs belonging to the top 2 regions with the highest FIC coverage³ have demonstrated that it is possible for communities to prioritize routine immunization alongside COVID-19 operations.

Data from Guagua, Pampanga showed that the case of polio in the province was close to zero while vaccination of babies up to two years old against measles, mumps and rubella was at 97 percent in 2021.

“Maganda ang performance namin.  Hindi ko pinabayaan ang routine vaccination kahit meron tayong pandemya,” said Gapan Mayor Dante D. Torres.  He made sure that every nurse and midwife were the first to be vaccinated against COVID-19 so they could report to the health centers to inoculate babies.  Extra allowances were also given to health workers to keep them motivated.  Torres said communication is crucial so they educate parents on the importance of routine vaccination through a radio program in a local station.

Meanwhile, Gondelina Balanay, Expanded Program on Immunization (EPI) coordinator in Ilocos Norte, said that the anticipated surge in pregnancies brought by the pandemic meant that they needed to ensure accessibility, availability and continuity of the NIP especially as young children had no protection against COVID-19.

“Noong pandemya po, maraming nabuntis. Nakakatuwa ito kasi in the past years, mababa po talaga ang deliveries sa Iloco Norte. Kaya naman sinabihan ko ang mga public health nurses at midwives namin sa health centers na vulnerable ang mga bata sa COVID-19 kaya dapat mas igihan iyong pagtutok sa kanila kasi wala silang protection sa virus, so ang best protection lang po na maibibigay namin ay ang mga available na bakuna o iyong mga routine vaccines.”

In their community, barangay health workers diligently log mothers who gave birth in a target client lit (TCL) so that they can keep track and follow-up whenever a baby is due for vaccination. This is supported by an effective referral system which is made possible by close coordination among different hospitals and government units.

Gondelina also gave instructions to accommodate visiting mothers even when it was outside the dedicated vaccination day for child immunization. According to IATF resolution no. 141, LGUs are strongly enjoined to fasttrack routine immunization by shifting COVID-19 vaccinators to child immunization services every Wednesday (called Bakuna Wednesdays).²

As a result of their consistent and best practices, Gondelina shared that FIC coverage in their community increased from 73 percent in 2020 to 77.57 percent in 2021.

“All these efforts and accomplishments show a very strong leadership and dedication of health personnel and of course the continued supply of vaccines by DOH – ito ang nag-momotivate sa amin. Importante din ang sustainability of vaccines na galing sa DOH. We are thankful na regular kaming nabibigyan,” Balanay added.

SCALE UP VACCINE COVERAGE

Dr. Bravo lauded the efforts of LGUs who prioritize health and can still pay attention to routine vaccination, while calling for a healthy competition to raise vaccine awareness.

“I am glad to know that there are LGUs who continue to prioritize routine vaccination of children and infants in their communities. In fact, every LGU should compete with one another in making health and vaccination a priority because vaccines are there. As an LGU, you can do a lot of things to improve your constituents, to improve your province. If you are a good leader, it should be your goal to make vaccine-preventable diseases zero!”

To strengthen efforts on routine immunization amidst the COVID-19 pandemic, the Philippine Foundation for Vaccination has partnered with GlaxoSmithKline Philippines, Inc. to launch “Vax My Baby”—a year-long, multisectoral vaccine mobilization campaign that aims to mobilize target LGUs in revamping routine immunization services in the community as well as educate parents about the importance of routine vaccines and how to safely access them in the community.

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[1] FIC – children who have received at least one dose of BCG, three doses each of OPV, DPT and Hepatitis B vaccines and one dose of measles vaccine before reaching 1 year of age. 

https://doh.gov.ph/sites/default/files/publications/FHSIS%202020%20Annual%20Report.pdf                                                                                                        

[2] https://www.officialgazette.gov.ph/downloads/2021/09sept/20210930-IATF-141-RRD.pdf  

[3], [4] Polio Makes a Comeback in Pampanga – Region 3 (78.75% FIC coverage); Ilocos Norte (Ukraine as War Halts Vaccination Campaign. Jefferey Kluger,TIME76.63%). https://time.com/6155963/polio-ukraine-war/ 

[5] Wild poliovirus type 1 (WPV1) – Malawi. WHO. https://www.who.int/emergencies/disease-outbreak-news/item/wild-poliovirus-type-1-(WPV1)-malawi  

[6]Pandemic causes drop in routine immunizations in Philippines. Christian Depiarine, Philistar.  https://www.philstar.com/headlines/2021/04/26/2093940/pandemiccausesdrop-routine-immunizations-philippines