Protecting immunisation for every child during the disruptions of COVID-19

COVID-19 is disrupting healthcare around the world, including immunization programmes. UNICEF is working closely with the Royal Government of Cambodia to protect these essential services.

Lydia Darby and Jaime Gill
©UNICEF Cambodia/2020/Nayheak Khun
UNICEF Cambodia/2020/Nayheak Khun
01 October 2020

"We cannot trade one health crisis for another", warned UNICEF Executive Director Henrietta Fore in July of this year, speaking out on the importance of maintaining vaccination programmes for other diseases even as the world combats COVID-19. Globally, immunisation saves at least three million children lives every year by protecting them from deadly diseases like measles, pneumonia, cholera, and diphtheria. Missing out on routine immunizations could in fact harm children’s health more than COVID-19.

Fortunately, the picture in Cambodia is a more encouraging one, and immunisation levels have been maintained even during the crisis.

How did Cambodia manage to keep immunization going despite a global crisis?

In the early stages of the COVID-19 pandemic, Cambodia's Ministry of Health (MoH), with support from UNICEF Cambodia and the World Health Organisation (WHO), issued interim guidelines for health workers. These guidelines supported frontline health workers in delivering essential health and outreach activities safely, including vaccinations. They promoted and provided instructions for the routine disinfection of health facilities and strict maintenance of patient social distancing.

Once health workers were prepared, MoH and UNICEF launched a nationwide immunization campaign, encouraging parents and caregivers to continue using vaccination services. Social media messages, TV and radio spots addressed concerns parents may have about COVID-19 transmission while also stressing the importance of immunity from other diseases.

These interventions could only work if vaccines were available.  With travel restrictions imposed by COVID-19, traditional shipment routes for supplies of vaccines were badly affected. UNICEF's global operational capacity worked hand in hand with UNICEF Cambodia to bring sufficient and timely essential vaccines into Cambodia. This has been supported by the Government's national budget and funding from GAVI, the Vaccine Alliance.

As a result of these efforts, the MoH estimated that 95% of 363,739 pregnant women and 357,095 children under the age of one were immunised between January and July 2020. Vaccinations were delivered throughout the country's 1,352 health care centres and hospitals, as well as through outreach visits in remote areas. This means that the number of children immunised against tuberculosis, measles and five other life-threatening diseases in the first half of 2020 is comparable to the first half of 2019. This is a testament to the exceptional efforts made by the Royal Government of Cambodia, UNICEF, and many partners. 

"It is vital to work closely with the Government, even more so during this difficult time, so we can ensure supplies of lifesaving vaccines and immunisation reach all children in need,” said Navy Kieng, a UNICEF Health Field Officer in Kratie. “Starting to miss out on vaccines now would be dangerous for children's health in Cambodia because they would become vulnerable to diseases, compounding the impact that COVID-19 is likely to have on this generation of children."

Unfortunately, there remain high-risk communities and geographical areas in Cambodia where vaccination coverage against childhood diseases is still low. Persistently low coverage in these areas has contributed to recurring outbreaks of measles since 2018 and threatens the progress made on reducing child mortality over the past decades.

To improve universal coverage of immunisation, WHO and UNICEF - with additional funding from GAVI - are supporting MoH to improve local targeting, planning and data analysis, while strengthening community mobilisation and engagement in order to reach every child. Periodic "catch up" immunization activities are conducted, including for children who began programmes but failed to complete the full course because they dropped out. 

The delivery and the administration of vaccines has all been made possible by a remarkable effort by health workers from the national level down to community-located service points where children are given their injections. UNICEF thanks them all.