Participants speak at the Annual EPI (Expanded Program on Immunization) Managers Meeting for East and Southern African Countries

By Asmait Futsumbrhan

Key fact: Immunization prevents illness, disability and death from vaccine-preventable diseases. As Africa made improvements regarding immunization, Eritrea has been applauded for its effective 95% immunization coverage throughout the country. From 18th to 20th March, the annual EPI meeting was held at Hotel Asmara Palace, where the Eastern and Southern African countries shared their experiences and challenges on vaccination programs.

-Mr. Tedros, Director of the National Immunization Program at the Ministry of Health, Eritrea

“Eritrea has controlled almost all vaccine-preventable diseases such as polio and tetanus, including in rural areas. As a result, child death rate has dropped tremendously. The only reason Eritrea was able to achieve such results is the unconditional commitment of the Government and the community. The Government of Eritrea gives vaccination programs priority. Nonetheless, the Ministry of Health works with several partners who are also committed to reaching the desired goal in vaccination.

However, just because Eritrea is succeeding doesn’t mean we don’t need to push harder. We need to interact with other countries and share experiences and help one another.”

– Dr. Annet Kisakje, WHO office in Uganda EPI Focal Person

“This is an annual meeting which brings together the EPI family, an opportunity to exchange experience from one another. What I saw here in this meeting is that there are several things Uganda can relate to Eritrea.

Nevertheless, what struck me was the community’s commitment. How can Uganda learn from that? By the end of this meeting, every country representative should work on motivating its community to have the same commitment as the Eritreans. That is something we need to go back as a team and be motivated to work on. The thing that Eritrea has accomplished relies on the community commitment. In Uganda we have the village teams, but have we used them properly to support the immunization program? If not, what else can we do to reach the children who haven’t been vaccinated in the village? That is what we learn from Eritrea”

-Dr. Josephine Namboze, WHO Representative for Eritrea

“There are four categories to where the countries are divided. Countries in Number one category are those with no infrastructure or are in unstable political situations which are having challenges with their own immunization program. Second category countries have challenges to reach children with the right vaccines. In the third category are countries that couldn’t reach the desired percentage of immunization coverage, which is 90%. The fourth category includes countries which were able to reach the goal, which is what every country is trying to be at. Looking at the example of Eritrea, other countries’ challenges can be the community involvement. Eritrea holds good community participation and, therefore, was able to mobilize communities to participate in the immunization program. When you have that as the key, it is easy for any country to overcome the issues of geographical access.”

-Dr. Shaya Ibrahim Asindua, Deputy Representative of UNICEF

“We are delighted that it is being hosted by Eritrea. This meeting dwells on issues of sharing experiences, new technologies and innovations. Eritrea has good experience to share; it has very high performance in covering the immunization over 95% for almost all vaccines. It has well-developed and maintained chain of vaccine management systems. Its effectiveness has been proven. This is one of the areas that other countries could really learn from Eritrea. Not all countries have the same record of high immunization coverage like the country. One of the biggest issues other countries are facing could be data collection. They need to focus on insuring in providing good quality and collection of data. Besides, another big issue is the unreached children; every child needs to be reached with immunization as it is their right. And this is an area that all countries need to focus on.

-Dr. Fitsum Daniel, WHO cluster lead for the Immunization and Vaccination Development Progress of Eastern and Southern Countries

“It is great to see that this year Eritrea and Rwanda have been singled out for their outstanding achievements in immunization. It added a great feeling to the meeting as Eritrea is hosting. There are 20 countries from east and southern Africa participating at this year’s annual meeting. We have divided the meeting in two sessions, one where all the countries take part to share the experiences and another parallel session where we have the scientific topics where we discuss practices and challenges. We will be coming up with the EPI program managers’ recommendation for 2019 which will be in a frame work and we will monitor it every six months.”

-Christopher Kamugisha, Horn of Africa Polio outbreak Response coordinator

“Previously we had a big case of polio type2 which happened in November 2017 in Somalia. We intensified surveillance to ensure where cases were coming from. We started having campaigns and divided the ten countries into three zones — Somalia, part of Ethiopia bordering Somalia, and another part in Kenya bordering the Somali area. This problem became a regional outbreak as people were shedding the virus with the constant population movement. As this problem continued in Nairobi, it was declared that the problem needs joint effort polio eradication by WHO. While we were dealing with type2 we also got type3 polio outbreak again in the same region. We needed to double our efforts to fight the challenge.

Previously we stopped using oral vaccine of type 2 in those regions, so we had to come up with only e monovalent vaccine so that we could stop the transmission. The challenge we are t facing now is the population movement in those areas. So far we haven’t had other cases from this area. It seems like we are doing better but we need to continue to make efforts. 

Regarding immunization in Eritrea it is one of the few countries which have achieved greatly. I feel like Eritrea is the best country we have in the region. However, the way for the future is to increase surveillance, and then we can decrease the rate of child death.

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Reportage

EPI Managers’ Meeting for the Eastern and Southern Africa

By Habtom Tesfamichael

The annual EPI managers’ meeting for the eastern and southern Africa was held from 18 to 20 March at Hotel Asmara Palace, here in the capital of Eritrea, Asmara, under the theme “Protected together, Vaccines Work”. The meeting was attended by delegates from more than 20 countries and representatives of NGO’S and IGO’S.

The aim of the conference was to create a platform for countries to share information and experience that will help improve access to immunization and immunization coverage in the region.

In her opening address, Ms. Amina Nurhusien, Minister of Health of Eritrea, said that with the prevailing peace and friendship between Eritrea and Ethiopia and the lifting of the unfair and unjust sanctions that had been imposed on Eritrea, the year 2018 ushered in historic changes in Eritrea and the region, and brought about a sense of renewed hope for cooperation in health, economic growth and social development.

EPI managers of the region convene annually in one of the states of the region. Minister Amina highlighted that EPI managers’ meetings are golden occasions that provide a forum for the exchange of experiences among countries in order to improve key health outcomes for the populations, especially children.

Minister Amina added that vaccination is probably the most cost effective form of health intervention. It yields maximum benefits for the relatively minimum investments one can make. It prevents child mortality and averts lifelong disability.

As a case in point, the Expanded Program on Immunization has been remarkably successful in Eritrea, achieving 98% immunization coverage. As a result, on October 17th 2009, Eritrea was awarded by the Global Alliance for Vaccination (GAVI) in Hanoi, Vietnam, for its high and sustained immunization coverage. Eritrea was also awarded by UNICEF Eastern and Southern Africa regional office in 2016 in recognition of its outstanding achievements in vaccine stokes management. “In this regard we are very grateful for the support of the government and all partners,” Minister Amina said.

She reminded the participants that despite all these achievements, more efforts from different stakeholders are still needed both to reach the unreached with the available vaccines and to continue developing and providing new vaccinations.

Ms. Amina said that governments and departments need to continue to focus on supporting vaccinations and related child health interventions in order to speed-up the attainment of the SDG’ s target on reducing child mortality to no more than 25 per 1000 live births by 2030. This will mark real progress and development. On its part Eritrea is committed to attaining the SDGs as it did with the MDGs.

Currently Eritrea is revising its National Health Policy. At the center of the revision of the national Health Policy is Universal Health Coverage (UHC) through strengthening the health systems.

In Eritrea, regarding the first mechanisms of UHC, namely identifying the uncovered population and extending the services to those not covered, with RED — Reaching Every District — and other EPI strategies for reaching the unreached, immunization coverage continuously increased to virtually Universal Coverage, 98%.

Regarding the second mechanism, namely continuously identifying the services that are covered and continuing filling the gaps or adding the services that are missing, immunization program started with six antigens and constantly increased to a dozen antigens in routine immunization in Eritrea, which is expected to keep increasing.

Regarding the third mechanism, namely financial protection, immunization is provided totally free of charge, with a perfect financial protection.

The aim of the Ministry of Health is to follow these footsteps in immunization programs with proven effectiveness to deliver essential integrated health services package in order to achieve UHC and thereby SDG-3.

Dr. Piere Ngom, UNINCEF country representative at the EPI Mangers Meeting for East and Southern Africa, said that Eritrea has a high performing immunization program that is among the best in Sub-Saharan Africa.

Eritrea has recently introduced the Measles-Rubella vaccine as part of the routine immunization, following a very successful campaign that reached over 97 per cent of eligible children aged 6 months to 15 years. This is just one of the many achievements of the program.

Dr. Ngom indicated that Eritrea’s cold chain and vaccine management systems are well established and are able to handle the country’s current needs, including new vaccines such as the Meningitis vaccine that is due to be introduced this year. The Effective Vaccine Management Assessment (EVMA) conducted in 2017 with composite indicators that included cold chain capacity and effectiveness of vaccine management achieved a score of 81 per cent above the cut-off point of 80 per cent.

The EVMA score has to be maintained above the cut-off point if the program is to sustain the successes thus far. Dr. Ngom assured the participants that UNICEF, with funding support from GAVI, Japan, and other partners will continue to support the procurement and the delivery to the country of all vaccines and cold chain supplies. “For the past few years, UNICEF has had to charter planes twice each year to deliver vaccines to the country because of the UN imposed sanctions and the related absence of commercial cargo planes coming to the country,” he said. These efforts have helped avoid vaccine stock outs in the country. He said that they are optimistic this situation will improve soon as the cost of chartering a plane to deliver vaccines is quite high and will no more be a problem.

Dr. Ngom underscored that “immunization is a right that every child deserves”. He added, however, that despite the high immunization coverage that Eritrea enjoys, there are still a good number of children that are missed. Regional data indicates that in 2017 Eritrea had as many as 7750 un-immunized children out of 3.7 million in the East and Central Africa region.

As Eritrea moves towards UHC in contribution to the SDGs, it needs to reach out with the life-saving vaccines to all these children, most of whom live in hard to reach communities. UNICEF currently provides logistic support to the Ministry of Health to reach 41 of these communities that are hardest to reach through mobile clinics. The mobile clinics provide an integrated package of essential health care services that the children and women in these communities wouldn’t usually have access to.

Dr. Ngom acknowledged and commended the tremendous contribution the communities continue to provide to immunization and other health and nutrition services. Without such contribution, it would not have been possible to achieve and sustain the high coverage. So far, there are no known objectors to immunization as seen in a number of other countries in the region. The Immunization Equity Assessment of 2018 identified the main barriers as geographical access, seasonal mobility of some populations such as pastoralists and mothers and caregivers not being aware of when to return for next immunization schedule. The Ministry of Health gave assurance that strategies are in place to address these barriers.

Dr. Ngom applauded the ownership and commitment of the Government of Eritrea in meeting its co-financing obligations consistently and in a timely manner. As more new vaccines and technologies are introduced in the country, he expressed his hope that the Government of Eritrea will continue to set its budgetary priorities to meet the increasing co-financing obligations.

Ms. Susan N. Ngongi, UN resident coordinator, on her part said that as Eritrea integrates more closely with the region, and the world as a whole, there will inevitably be an increase in human population movements across national borders.

“With this increased mobility, however, it’s up on Eritrea and all of us to ensure that there is minimum exposure to cross-border disease transmission. Our systems and capacities must rise to meet this increased risk in close collaboration with all our neighbors,” she said.

Ms. Ngongi highlighted that immunization is one of the most effective means of preventing and controlling the transmission of disease, ranging from measles and rubella to polio, meningitis and yellow fever, across borders. Prevention calls for increased vigilance and surveillance, early detection and appropriate control. This necessarily calls for cross-border platforms that would enable effective collaboration for prevention and control. Eritrea’s Expanded Program on Immunization is robust and one of the best in the region. It is on track towards the control, elimination and eradication of several vaccine-preventable diseases.

Ms. Suasn underscored that a fully immunized child is a healthy child and a fully immunized nation is a healthy nation. The robustness of Eritrea’s immunization program was undisputedly a major contributor to its MDG success and no doubt will be an important contributor towards SDG-3 goals. These achievements need to be backed up with reliable and accessible data and should be properly documented so that they can all learn from the past and inform the future.

Dr. Josephnie Nambose, WHO representative in Eritrea, said that the scope of the immunization program is changing and is becoming more complex to manage. As governments endeavor to save more lives from vaccine preventable diseases, more vaccines are being added to the national immunization schedule, with more on the pipeline.

The Eritrea Immunization Program has worked tirelessly to ensure there is consistent high immunization coverage in the country. For the past few years Eritrea’s high coverage can be attested by the results achieved: polio eradication, maternal and neonatal tetanus elimination and measles are on the course of elimination. Surveillance activities, too, have been intensified so that no case is missed, including GIS mapping.

Dr. Josephine added that Eritrea has been recognized several times for its excellent supply chain systems. It is right now graded as a country with mature immunization systems within the WHO Immunization Maturity Gird matrix and this attests to Eritrea’s commitment and implementation capacity in achieving the set national and global development goals.

Eritrea has developed a five-year health sector strategic plan, 2017-2021, anchored on SDG’s, especially SDG 3 on UHC. This has paved the way for the country to transition from basic health care to essential health care package that focus on people-centered delivery of services.

The political leadership and commitment were applauded for the life-saving interventions in Eritrea which was instrumental in coordinating stakeholder and partner participation not only in immunization and other child survival activities but also in other health interventions.

The EPI managers from 20 countries presented their respective countries report and experience. The participants of the conference deliberated on regional strategies to increase immunization for diseases, the status of regional immunization programs, expanding the coverage of immunization and its challenges, the role of community participation in the sustainability of immunization, introducing new immunization programs and maintaining the progress achieved so far.

The EPI managers also gave presentations on the progress of immunization coverage and equity work in Ethiopia, vaccination in conflict affected areas such as South Sudan, Ebola vaccinations in Uganda, the preparation to introduce Malaria vaccinations in Malawi, success achieved in polio outbreak prevention, measles epidemic in Madagascar, Rota virus in Botswana and Yellow Fever in Ethiopia.

At the end of the conference, the participants agreed on recommendations for improved, effective and efficient implementation of immunization programs in the region that would ensure better health conditions of the populations.