A mother of a child with zero-dose vaccination testifies about the efforts to leave no one behind

Hodan Abdi, an Internally Displaced Person (IDP) living in Tulu Gulled Woreda, Fafan Zone of Somali Region, went through painful, prolonged, and unbearable labor whilst giving birth to her baby boy, Mudasir.

Tulu Gulled is 660 kilometers from Addis Ababa, the capital of Ethiopia, and 30 kilometers from Jigjiga, the capital of the Somali Region. More than 75,000 people inhabit Tulu Gulled Woreda, which also hosts many IDPs sheltered in three IDP sites, namely Tulu-Gulled, Darami, and Gabagabo. In the past, the host community and the IDPs had been receiving essential health services from three health centers and one health post that is in the Woreda. 

The woreda recently had a severe drought that caused food shortages resulting in acute malnutrition. Outbreaks of cholera and other vaccine-preventable diseases, such as measles, have also persisted in the woreda. These problems have been further fueled by the COVID-19 pandemic and recurring conflicts in the woreda, which caused disruption of essential health services including immunization, and also made it risky to travel back to their villages and health facilities to seek care.

Due to the afore mentioned situation, her son Mudasir had gone for three long months without receiving even a single dose of life-saving vaccines recommended for his age. Children with stories like Mudassir’s are common in Ethiopia. Several African countries, including Ethiopia, have recorded a significant backslide in routine immunization coverage and quality. In Ethiopia, measles Supplementary Immunisation Activities (SIAs) have been delayed for several months, and routine immunization coverage has declined during the initial phase of the pandemic. 

There has been a rise in the number of children in Africa who have never received a single dose of a life-saving vaccine from 7.7 million in 2020 to over 12 million in 2022.

"Routine immunization coverage rates have declined in Africa, and the recurrence of outbreaks of vaccine-preventable diseases, mainly measles, has increased significantly. This crisis could translate into high child morbidity and mortality across Africa and the globe," Dr. Matshidiso Moeti, Director of the WHO Regional Office for Africa, spoke at the high-level meeting held in Addis Ababa on the sidelines of the 36th African Union Summit conducted during 18-19 February 2023.

Adding to this, Dr. Nonhlanhla Dlamini, WHO Acting Representative to Ethiopia, stated that "all countries must take action to address critical immunity gaps and backsliding on immunization."

In recognition of the effects of the COVID-19 pandemic and conflicts, and as continuation of the concerted efforts, the Ministry of Health, WHO, and other partners are making big efforts to reinstate immunization services and increase coverage in the country. Thus, the picture is now changing, and the negative impacts are being reversed.

Health partners in Ethiopia are determined to leave no one behind, and hence to track and vaccinate all children, like Mudassir and other children who missed vaccines. The various strategies to vaccinate zero-dose and under-immunized children include routine immunization, catch-up immunization, periodic intensified routine immunization, SIAs, and integration of immunization with other maternal and child health services.

Accordingly, using the opportunity of the nationwide measles SIA, which was conducted between December 2022 and January 2023, routine immunization has been integrated for children below one year who were zero- dose or under-vaccinated. During this time, hundreds of thousands of children in the country received their missed vaccines as appropriate for their age; and these children were urged to continue with their routine vaccinations if they had not yet completed as per the national schedule. In the Somali Region, the integrated measles SIA was conducted from 26 December 2022 to 04 January 2023, and during this time health workers finally tracked and vaccinated Mudasir and his age mates with the life-saving routine vaccines which they had missed, as appropriate for their ages.

Similarly, throughout the country, a total of 109,984 zero-dose children were identified and vaccinated during the recent Integrated Measles SIA, which was over 10% of the total 1.1 million zero-dose children estimated in the country as indicated in the Ethiopian Mini-Demographic Health Survey (Mini-EDHS) 2019.

“I greatly appreciate the efforts made by the health workers and other humanitarian staff involved in this vaccination campaign to provide these live-saving interventions for our children," said Hodan.

The efforts to reach and vaccinate zero-dose and under-vaccinated children will continue for the next three years with the support of GAVI Full Portfolio Plan (FPP) and other partners, including WHO, and the country is now ready to address zero-dose and under-immunized children. In line with this, 447 woredas have been selected nationwide based on the criteria for dealing with these missed children. Ethiopia has an ambitious plan and set a target to reduce zero dose children by 50% by 2025.

WHO has joined its global partners, including Gavi - the Vaccine Alliance, the Bill & Melinda Gates Foundation, and UNICEF, to reach zero-dose and under-vaccinated children in any part of the world. This global effort aims to reduce the number of zero-dose children by 25% by 2025 and to halve it by 2030.