Safe from harm: immunizing babies and infants
At 8am on Wednesday morning, Donna brings her twelve-day-old daughter, Danica, to Plainview Health Centre in Mandaluyong City, Manila, to receive her vaccination against tuberculosis. The tiny baby is wrapped up to keep her warm. She’s asleep at first but the pain of the needle wakes her up and she starts to cry. Her mother comforts her and in a few minutes she settles back down to sleep.
“I brought Danica here because I wanted her to be protected from diseases and infections,” Donna says. “I’ve also got a two-year-old who was vaccinated here. I’m coming back next week for Danica’s next injection.”
Every Wednesday, mothers – plus grandmothers and other relatives – bring their babies to Plainview Health Centre to receive vaccinations against diseases like diphtheria, pertussis, tetanus, measles, hepatitis B, tuberculosis and polio. The centre’s nurse and midwife also do outreach work, going round the local community with a vaccine box to reach babies whose parents are either unable to bring them in or unaware of the programme.
“Mandaluyong was runner up for the award of most child-friendly city in the Philippine’s this year, which was partly in recognition of our immunisation programme,” Plainview’s Doctor Emily Detaro comments. “It’s free for anyone living in the local barangay. Mothers can bring their babies in between 8 and 12 am every Wednesday and we follow up defaulters with community visits.”
UNICEF is supporting immunization programmes like this throughout the Philippines by assisting the government to procure vaccines, providing equipment for cold storage and transportation and training health workers.
“We support the program at the national, regional and provincial,” Marisa Ricardo, Health and Nutrition Specialist at UNICEF Philippines comments. “We also help ensure that communities participate and empower mothers to attend immunization sessions regularly. With regards to the cold chain, we need to ensure the temperature of the vaccines is maintained from the point of manufacture all the way through to the child being immunized. This requires national and regional cold stores, plus equipment and training.”
The results speak for themselves. “The Philippines has sustained polio eradication status, with no wild polio cases since the year 2000,” Marisa comments. “Deaths from measles are also down from hundreds a year to the point where you can count them on your fingers. Cases of neo-natal tetanus are down to less than one per 1,000 live births.”
The next challenge is measles. Ideally, 95 per cent of all children should get two doses of the measles vaccine but currently in the Philippines they only get one. “Next year, the government will be introducing a combined measles, mumps and rubella vaccination to address this,” Marisa says.
Chain of command
Rolando Garcia runs Metro Manila’s main cold store in Pasig City, where the capital region’s vaccines are stored. Most of the equipment was provided by UNICEF and the German Government. The vaccines are manufactured and transported here from Japan, India and Italy.
An engineer by trade, Rolando is now the Philippines’ leading expert on storing and transporting vaccines. He’s spent the last 21 years ensuring that they’re kept at exactly the right temperature to preserve the delicate biological material inside each tiny vial. He now goes around the country, training other cold chain managers.
“This cold store was built in 2003,” Rolando says. “Before that, we had to use domestic refrigerators in the Department of Health office. It was very difficult – I had to constantly monitor the temperature and adjust the thermostats manually.”
There are now 17 cold stores in the Philippines – one for each region. Each contains specialized equipment to keep all the vaccines at the right temperature. There is also an on-site generator to keep the equipment running in the event of power cuts and an automated system that sends Rolando and his fellow cold chain managers a text message if the temperature ever goes outside the safety range of 2 to 8 degrees C.
“I’ve been texted twice recently when the evaporator had electrical problems,” Rolando says. “Once was at the weekend, while I was at home watching TV.”
There are additional challenges for cold chain managers during emergency situations, like after Tropical Storm Ondoy. Children in evacuation centres are at greater risk of diseases such as measles, which spread rapidly in the over-crowded conditions. They also need Vitamin A to boost their immune systems.
As the need increases, so does the difficulty of getting the vaccines out to the evacuation centres. “This entire area was flooded chest deep,” Rolando explains. “Luckily, the cold store building is slightly raised from the ground so the vaccines weren’t damaged. We prepared the cold boxes for transport but then we had to improvise. First, we took the boxes out along the walkway above the street. Then we loaded them onto military trucks for distribution. In some cases, we ended up using rubber boats to get to the evacuation centres.”
Twenty years ago, the world made a set of promises to all children when it adopted the UN Convention on the Rights of the Child (CRC). While great progress has been made since then, children’s rights are still being denied and much remains to be done. In the Philippines, UNICEF’s support for immunization programmes is one way we can help uphold children like Danica’s right to survive and be healthy.