Call for door-to-door immunisation of children at risk of diseases amid pandemic setback

Afroza Islam has brought her 10-month-old daughter to the Radda MCH-FP Centre in Mirpur-10 for her first dose of the measles and rubella vaccine. The infant was scheduled to receive the vaccine nearly two months ago, but the coronavirus pandemic stood in her way.

The desperate scramble for the coronavirus vaccine has meant that the usual vaccination programme for children has gone neglected. Many children, like Afroza’s daughter, have been unable to receive the routine vaccines at the proper time.

Experts warn that the situation could lead to further outbreaks of disease in the future. A list of all children who have been unable to get their shots should be compiled so that their vaccination can be ensured, they say.

The government’s Extended Programme on Immunization, or EPI, provides children with vaccines for tuberculosis, polio, diphtheria, whooping cough, tetanus, hepatitis-B, haemophilus influenzae-B, pneumococcal pneumonia, measles and rubella.   

Bangladesh’s programme is one of the more successful vaccination campaigns in the world, but even government officials admit that it has received less attention than it should have amid the pandemic.

The programme, like many others, faced setbacks due to the general holidays and other restrictions imposed in the wake of the coronavirus outbreak in Bangladesh in March, 2020. The second wave of infections this year has been another stumbling block.

This year’s child vaccination programme is progressing a bit better than last year’s upheaval, said EPI Programme Manager Moula Baksh Choudhury. But the number of vaccines administered is still significantly lower than normal.

“We are constantly monitoring and supervising the situation from the EPI. We are trying to restore the flow of vaccines to 2019 levels. In 2020, the levels fell below 50 percent, but it isn’t as bad in 2021.”

“The number of cases rose dramatically,” he said, trying to explain the major issues with the vaccination programme.

“Lockdowns have been imposed in various areas. People have been instructed not to leave those areas. This has caused problems, if only a bit, for vaccinations.”

“We survey the situation carefully. Whenever cases fall in an area, we identify those who were left out and vaccinate them in the following month.”

Private institutions involved in vaccination campaigns have also slowed down their operations, he said.

“In my opinion, the flow isn’t there,” Radda MCH-FP Centre Administration and Finance Division Director Ahsan Habib said.

“This has created issues, even if they are small ones… We are calling those who have missed doses and asking them to come to the centre. Many of them are coming.”

But the situation has improved this year, Habib said.

It is better than the situation last April and May, said Nahid Farhana Chowdhury, a medical specialist at the Pallabi branch of the ‘Surjer Hashi’ clinic.

“We are regularly following up to see whether children have received their vaccinations. If anyone doesn’t keep their appointment, we call them on the phone and ask them to come. If they can’t make it to our centre, we ask them to visit one close to them.”

THE DANGERS

Delays in administering routine vaccines could lead to danger, warns public health specialist Benazir Ahmed.

Ahmed worries that if large numbers of children do not receive the appropriate vaccines, we could have new outbreaks and epidemics on our hands. Even those children who received the vaccine could be at risk.

“If children do not get their vaccines on time and many children are excluded from the EPI’s vaccination campaign, then children are at risk from vaccine-preventable diseases. In some cases, there is a risk these diseases may reach epidemic levels.”

Measles is among the diseases that could spread quickly, he warned.

Ahmed brought up the death of several children from the disease in Rangamati last March.

“An investigation in the Rangamati hills found that they had not received the vaccines and the disease spread in the area. In those areas near the border where cases are increasing, mothers may not risk taking their children to get shots. If about 200 to 300 children in an area are not inoculated, it creates a gap that could eventually lead to an outbreak,” he said.

“We have seen many children infected with diphtheria in the Rohingya camps because they did not get vaccines. The problem is that the disease eventually spread among those children who were inoculated and even among adults. It is a serious matter.”

“If we cannot give tetanus shots to pregnant women, as many deliveries take place at home where the conditions are unhealthy, both the mother and newborn are at risk of contracting tetanus.”

WHAT CAN BE DONE?

Benazir Ahmed recommended that lists of unvaccinated children should be made so that there could be an eventual follow-up.

“If a vaccination centre is in an area with rising (coronavirus) infections, the centre could be moved to a neighbouring area so vaccines can be administered in safety.”

We must take steps to vaccinate as soon as cases fall and prioritise those who missed out on their shots, he said.

“As health workers will have to do additional work, there should also be some incentive. That will encourage them to seek out those children who were missed.”

But former IEDCR Principal Scientific Officer Dr Mushtuq Husain believes the situation isn’t at a critical stage yet.

“There is some risk, of course. If an unvaccinated child comes in contact with an infectious disease, they will have an increased risk. That is why the government and expert organisations are stressing that routine vaccines should continue during lockdown.”

“If many children miss their vaccinations at the same time, it would be cause for alarm. But people in Bangladesh are quite aware of vaccine-related matters.”

He said those children who had not received their shots should get them quickly.

“They should get them within a year. If they still do not get their vaccines, they must take them after consulting with child specialists.”

The public health official also called for the introduction of a door-to-door vaccination service.

Standard Operating Procedures, or SOP, have been put in place to conduct the vaccination programme, said Manager Moula Baksh Chaudhury.

The situation is improving, he says after examining the date on the district level.

“The 1 to 2-month-old children who did not receive a vaccine will be put on the list for one in the next session. Our whole monitoring system is quite powerful. We monitor by division. But some children will still be left out and we are planning for that outcome.”

The children who are left unvaccinated will be sought out, listed and given the vaccines around November and December, he said.