Funding and “public hesitancy” key challenges for continuing successful immunisation program

Some 95 percent of the target population of the Maldives’ national inoculation program have received their recommended vaccinations, despite declining state funding for such initiatives and growing public reticence, health authorities have said.

While ongoing commitments by Maldives authorities to protect the public against preventable diseases were praised this month by international experts, sources within the Ministry of Health have said maintaining high immunisation coverage across the country remains challenging.

Aishath Thimna Latheef, Public Health Program Manager for the Expanded Program on Immunisation (EPI) at the Ministry of Health told Minivan News that a lack of funding for additional training and supervision were among crucial challenges facing national inoculation efforts.

Other issues included a growing number of parents opting against having their children inoculated, and need for improved coordination with private schools.

The World Health Organisation (WHO) reviewed the Maldives EPI and vaccine preventable disease (VPD) surveillance programs between January 27 and February 3 this year, and praised the country’s efforts.

Representatives from the Ministry of Health, UNICEF, the Centre for Communicable Diseases, Atlanta (CDC) and experts from Indonesia, India, Nepal, Myanmar, Thailand and Sri Lanka conducted the review, according to the WHO.

“The government is ensuring immunisation against 10 vaccine preventable diseases. Furthermore, steps are being undertaken for the introduction of pentavalent vaccines into routine immunisation schedules,” said the WHO.

“The team verified that more than 95 percent of the target population have received all the recommended vaccines and immunisation service delivery functions, including vaccine distribution and cold chain management. Effective partnership with the government, WHO, UNICEF and other stakeholders have contributed to these achievements.”

The review was the first study of its kind to be conducted in the country since 2006, following previous research carried out in 1994 and 1988.

“Basic right”

Immunisation Program Manager Thimna maintained that immunisation was a “basic right” of Maldives children under successive governments.

“The government regards children as one of the most important assets of the nation and therefore every effort should be made without discrimination of person’s gender and socio-economic status to promote welfare and full development of their potential for a useful and quality of life,” she said.

“This policy has not changed. Immunisation in the Maldives is 100-percent government funded. But over the years the funds for immunisation have gradually declined, limited now to only the purchase of vaccines and vaccine consumables. Training, supportive supervision and IEC developments are not funded any more. From a programmatic perspective, this is a serious concern for us.”

According to Thimna, the reduced funding was a direct result of economic difficulties experienced in recent years that had resulted in continued calls to cut state expenditure both from within parliament and by international organisations like the International Monetary Fund (IMF).

Beyond financial challenges, authorities indicated that education was another area needing review in order to ensure that all children and young people were being included in national inoculation plans.

According to Thimna, in 1994 the government introduced a policy whereby each schoolchild studying at a public institution was included in a state immunisation program.

However, she contended that with a growing number of public schools in the country, some of these institutions were not following state policies such as the inoculation program.

Without greater collaboration between the state and private education providers, Thimna claimed that a growing number of young people faced being excluded from the national immunisation program if fewer schools signed up.

Anther potential concern identified by authorities was a small but growing number of parents who were opting not to have their children immunised, for unspecified reasons.

Thimna said while only a small number of children were not receiving inoculations recommended by the state as a result of “vaccine hesitancy” among parents, the issue was growing and could potentially become a “huge concern” for authorities in the future if not addressed.

However, she stressed that recent amendments to national legislation did grant health authorities power under the law to give vaccinations to children – even if parents refused – on the grounds of public health.

“The most recent change is the passing of Public Health Act in December 17, 2012. This has given some power to the program to address issues of vaccine hesitancy. But this will only be in action after the rules and regulations and  developed and  incorporated and a new immunisation policy is developed,” Thimna added.

Polio prevention

Addressing the potential risk of a re-emergence  of the polio virus, Thimna said the country was always at risk of importation of such threats.  According to official statistics, the last reported indigenous case of the virus in the Maldives was 1982, however the last imported case of the polio virus was in 1994.

“As a tourist destination, the Maldives is always at risk of importation like any other country in the world. We need to have stringent active and passive Acute Flaccid Paralysis (AFP) surveillance to detect and investigate any case of suspected polio. This is something which we already do but needs to be strengthened,” Thimna said.

“The only thing that would perhaps work in our favour if  an importation occurs is the high level of  hygiene and sanitation in the Maldives.”

In an open editorial piece last month, Regional Director for the WHO in the South-East Asia region, Dr Samlee Plianbangchang, stressed a need for vigilance to eradicate the virus from the region.

With India having recorded a second consecutive year without a reported case of polio virus, Dr Plianbangchang called for sustained efforts to combat potential spreads of the disease, particularly across international borders.

“Although not all countries face the same risk, most countries in the region remain at a risk of polio resurgence through a distant or cross border importation of the wild polio virus from countries where it continues to circulate,” he wrote.

“As India completes two years without any cases of wild polio virus, WHO’s South-East Asia Region is firmly on-track for polio-free certification in early 2014. The South-East Asia Region will be the fourth WHO Region to be certified as polio free, the first Region in more than 12 years after the European Region was certified in 2002.”