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European Immunisation Week in BiH

Press Conference on EIW in Federal Public Health Institute

The European Immunisation Week in Bosnia and Herzegovina was marked from 27th April to 2nd May 2009., under the slogan “Immunisation – a great achievement of the civilisation”. It began with a Round Table discussion on immunisation , followed by the training on crisis communication for health professionals. The European Immunisation Week was established in 2004, and was marked for the first time in BiH in 2006.

The event was organized by the Public Health Institute of the Federation of Bosnia and Herzegovina and the Health Protection Institute of the Republika Srpska with the support of the World Health Organization and UNICEF. The objective was to underline the importance of Immunisation following the drop in child immunisation rates recorded last year. The immunisation rates rose from some 60 percent in 1995 to around 75 percent in 2002, and were increased to some 90 percent in 2008 across BiH owing to the efforts of health professionals.

However, director of the SOS telephone Jagoda Savić leveled accusations against entity institutes and UNICEF, as the supplier of vaccines, stating that the supplied dozes included excessive amounts of mercury, which had a negative impact on children’s health. While these allegations were never proven and UNICEF provided evidence such as WHO certificates and certificates of vaccine quality issued by the Belgrade-based Torlak Institute, this event has significantly contributed to a drop in the rate of vaccinated children.
“This pressure caused doubts to appear even among the physicians who were carrying out immunisation and also among parents”, said Jelena Ravlija, EPI Coordinator with the Federal Public Health Institute, during the round table discussion on this issue.

This was one of the main reasons to organize training on public relations in crisis situations for Cantonal and regional coordinators. Following an introduction by Zlatko Vučina, the Director of the Public Health Institute, during which he expressed gratitude for UNICEF’s support in organizing the Immunisation Week, and following presentations by Dr. Ravlija and Mitar Tešanović, an epidemiologist with the RS Health Protection Institute, while the journalist Alema Kazazić held a training on public relations in crisis situations.
“When talking to the media, you need to be clear, to present the information you have and to explain key measures you are taking”, Ms. Kazazić told the participants.

In the discussion that followed, physician Amira Skaka, who is a member of the House of Representatives of the Federation Parliament, related that on average, one pediatrician covers some 1,300 patients in his/her area. She suggested that the purchase of vaccines be made conditional on selecting the same vaccines as used in the vendor country. She illustrated the importance of immunisation using an illuminating example from the wartime.
“Early in the war, in 1992, our immunisation rate was 99 percent, and during the war we did not have a single epidemic”, Skaka related.

Smail Zubčević PhD, a neuro-pediatrician of the Clinical Center in Sarajevo, believed that the increasing lack of trust in immunisation among parents was to a great extent a responsibility of the pediatricians.
“The issue is a lack of communication between the pediatrician and the parents. Due to the reforms in the primary health care sector and the introduction of family physicians, the number of primary care pediatricians in health centers in FBiH was dramatically reduced, which ultimately resulted in an increased workload for the remaining pediatricians. Thus, pediatricians today have a hundred patients per day who are waiting for some form of health

Round table - Immunisation - a great achievement of the civilisation

service. This means they merely have three and a half minutes for each patient, which is certainly not enough to have a discussion with the parent”, Zubčević said.

“The times we live in have changed in many ways and are different from the times we grew up in”, said an RTRS reporter, Jelena Lugonja-Kisić. “In my time, there was no question that my parents would take me to the nearest pediatrician for vaccination without having any second thoughts. Today, however, we as parents are exposed to a great number of conflicting information in favor and against vaccines on the one hand, while on the other hand we have lost the support that the pediatrician provided to the parents in the past. It is quite logical that I, as a young mother, and any other parent for that matter, will think twice before I take my child for a vaccine after I read some articles against vaccines. I am definitely FOR the immunisation, but this requires a change in the attitude of physicians toward parents. We cannot expect their relationship to remain the same passive physician-patient relationship that was prevailing some twenty years ago. It is time now to make certain adjustments so that physicians are more proactive and are reaching to parents to provide appropriate information. Today, our society has a great need for a continued parent education”, Lugonja-Kisić added.

Marin Kvaternik, an epidemiologist with the Regional Health Protection Institute in Doboj and the former RS Minister of Health, noted that most of the credit for assistance in immunisation was due to UNICEF. In addition, he expressed his surprise at the fragility of the immunisation system in our country.
“Just when I thought we had a strong immunisation base, several cases convinced me that this base is actually more like a house of cards. People are not aware of the significance of vaccination and of the dangers posed by diseases they are vaccine preventable. We immunise people against diseases that are never actually visible precisely because of the vaccine. There have to be some reserves regarding vaccines – but we cannot say we will stop using electricity because it can kill”, Kvaternik said.

He underlined that the immunisation awareness campaigns “could sensitize the general public”, adding that maternity wards were excellent places because young mothers were most receptive to information concerning the child.

Zlatko Vučina, Director of the Public Health Institute of FBiH, described the activities during the Immunisation Week organized with UNICEF’s support, which were aimed at informing the parents and health professionals. To this end, educational materials for parents were developed including detailed information on immunisation and vaccination schedule for the first 12 months of child’s life. Posters were also developed carrying the same information. These materials will be distributed in all maternity wards across the country and in all facilities where children are immunized. Furthermore, materials for health professionals and reporters were also developed, including frequently asked questions regarding immunisation. “The aim of this latter material,” said Zlatko Vučina, “is to ensure consistency in the communication between health professionals and reporters and to improve the quality of reporting on immunisation.”

Experiences related by health professionals who participated in the round table discussion indicated that there was an emergence of immunisation opponents in BiH who argued that the vaccination was expensive. A 2003 study conducted in 11 countries showed that the costs of measles treatment in Europe were between 209 and 480 Euro, while the costs of the measles vaccine were only 0.17 to 0.97 Euro per child. This saves 36 million Euro annually in measles treatment in Europe.

The round table conclusion was that the anti-vaccine movement was just forming in BiH. In developed countries, this movement has become an integral part of the Immunisation system. In 1970s, due to public concern regarding possible harmful neurological effects, Japan had to suspend Immunisation against pertussis-whooping cough. To this date, France has a low vaccination rate against Hepatitis B.

Patrick Olin of the World Health Organization stated that our country was going through a process that the countries of Western European experienced earlier.
“Each country has its own schedule. This has already happened in the European Union. Following similar concerns, vaccination rates used to drop to as little as 70 percent; however, virtually everyone vaccinates their children today”, said Olin, adding that a progress was made at the round table discussion.
“Some issues were put to the table, and the next time these issues are raised this experience will prove useful. We have to maintain a continuous progress and communication with health professionals. The important thing is what is going to happen in the coming days in the Cantons and entities. I am quite convinced that people there are professionals and will do a good job”, Olin said, adding that “this is a matter that should be supported and coordinated by a large international institution. I believe that UNICEF plays an excellent supporting role”.

Vaccination is mandatory for all children in BiH, covering ten diseases: tuberculosis, diphtheria, tetanus, whooping cough, disease caused by hemophilus influenza type b, infectious hepatitis b, child paralysis, measles, mumps and rubella. It has been proven scientifically that vaccination strengthens child’s immune system.

UNICEF has been supplying vaccines to BiH exclusively from the producers listed by the World Health Organization, which are required to pass rigorous controls every six months and a full evaluation every two years. In addition, the Drug Commission tests and approves each vaccine imported to BiH.

The annual average of 0.01 reported vaccination side effects, or 43 cases in 420,000 vaccine dozes administered, is another indication that the supplied vaccines are in good order. Reporters who took part in the round table discussion were told that vaccines were rather different from other medicines and had much fewer side effects.

Immunisation success stories include the eradication of smallpox in 1987. This disease used to take some five million lives annually across the globe, and today the same number of children is saved from paralysis annually thanks to vaccines. The North and South Americas are measles-free regions, while only 20 years earlier this disease took 10,000 lives there.

The first working day of the European Immunisation Week was ended with a press conference at which discussion conclusions were presented and the rest of activities in the Immunisation Week were announced.

Semir Mujkic



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