In Focus: Immunization
Immunization is one of the world’s most cost-effective public health interventions, saving millions of lives each year, and protecting children from illness and disability. Vaccines have helped to halve the number of child deaths worldwide since 1990 and represent a sound financial investment: every $1 spent on childhood immunizations returns an estimated $44 in economic and social benefits. Despite the achievements of immunization programmes in the Europe and Central Asia Region in recent decades, reported immunization rates are uneven across countries — from as high as 98 percent in Albania to as low as 19 percent in Ukraine. The regional average for Eastern Europe and Central Asia stands at 92 percent, still not high enough to protect all children from preventable diseases. What’s more, there was no improvement in coverage between 2014 and 2016. At national levels, disparities can be shocking, with the most vulnerable children often missing out on immunization. Across the Region, more than half a million children have missed out on their routine measles vaccination, and many countries continue to face outbreaks of vaccine-preventable diseases that threaten the lives and well-being of children. Challenges to immunization include weak political commitment and health systems, ‘vaccine hesitancy,’ and concerns about the financial sustainability of national immunization programmes in middle-income countries. UNICEF knows that the whole Region benefits when ALL countries achieve and maintain high vaccine coverage at both national and sub-national levels. Download file (PDF, 981,23 KB) July 2018
Interpersonal Communication for Immunization
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Research in ECA has shown that health workers do not always engage with caregivers in an open and supportive way, often using a patronizing and top-down approach in communication. As a result of time constraints and limited communication capacities, they often fail to understand the immunization-related concerns, fears and expectations of caregivers and fail to identify and address vaccine hesitancy. To help strengthen the communication and community engagement skills of front-line workers, the UNICEF Regional Office for Europe and Central Asia (ECARO) has developed this interactive and evidence-based training package to identify and address their own biases and misconceptions and to equip them with the essential knowledge, skills, and attitudes they need for positive and meaningful interpersonal communication. It consist of a Facilitator Guide, Participant Manual and a set of Presentations. Options Available options Facilitator guide Participant manual Presentation Download file (PDF, 5,62 MB) (PDF, 5,57 MB) (PDF, 11,88 MB) November 2019
Interpersonal Communication for Immunization. Presentation
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Download file (PDF, 11,88 MB) November 2018
Interpersonal Communication for Immunization. Participant manual
Good interpersonal communication can mean the difference between a child being fully immunized or not at all. This Interpersonal Communication for Immunization Participant manual seeks to help health workers value, acquire, and consistently use the knowledge, skills, and attitudes needed to communicate effectively with caregivers and communities about childhood immunization. Interpersonal communication for immunization capacity development is critical. Almost every study of health worker practices in the region finds that interpersonal communication for immunization overall is weak. Yet, at the same time, the vast majority of caregivers of young children cite health workers as their primary source of information about immunization. Health workers and health services must close this gap if nations and the world are to achieve universal immunization. Download file (PDF, 5,57 MB) November 2019
Interpersonal Communication for Immunization. Facilitator Guide
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Research in ECA has shown that health workers do not always engage with caregivers in an open and supportive way, often using a patronizing and top-down approach in communication. As a result of time constraints and limited communication capacities, they often fail to understand the immuni-zation-related concerns, fears and expectations of caregivers and fail to identify and address vaccine hesitancy. To help strengthen the communication and community engagement skills of front-line workers, the UNICEF Regional Office for Europe and Central Asia (ECARO) has developed this interactive and evidence-based training package to identify and address their own biases and misconceptions and to equip them with the essential knowledge, skills, and attitudes they need for positive and meaningful interpersonal communication. Download file (PDF, 5,62 MB) November 2019
Saving lives one dose at a time - Immunization across Europe and Central Asia
Vaccines protect children against disease and death, saving up to 3 million lives globally every year, and are one of the most cost-effective child survival interventions. In short, #VaccinesWork. The Europe and Central Asia Region continues to enjoy overall high childhood immunization coverage and is polio-free. The benefits of vaccines, however, are spread unevenly. Too many children are still missing the protection they deserve. A mother in Serbia holds her baby during her free vaccination as part of the Serbia's national immunization plan. A mother in Serbia holds her baby during her free vaccination as part of the Serbia's national immunization plan. Of particular concern is a rebounding of measles in the region, despite a record-low of new cases in 2016, causing over 33,000 cases and 79 deaths. The largest current outbreaks have been in Romania (12,368 cases and 49 deaths including 46 children), Ukraine (16,500 cases, 13 deaths including nine children) and Serbia. Although Serbia has a long and successful tradition in child-health protection, it is currently facing a measles outbreak with nearly 5,000 cases (as of 24 April 2018) which have resulted in 15 fatalities. UNICEF is working with the Ministry of Health to support its response and to improve records of immunization in the future. A little boy cries as he receives a routine vaccination at a clinic in Moldova. A little boy cries as he receives a routine vaccination at a clinic in Moldova. Due to universal vaccinations of newborns in Moldova, cases of Hepatis B have dropped from 682 in 1994 to only four in 2015. However, only 89 percent of all children are immunized against all preventable diseases and UNICEF has been working with the government to precure more vaccine doses to ensure all children have access to immunizations. A young boy puts on a brave face as he receives his second dose of the MMR vaccine in Kyiv, Ukraine. A young boy puts on a brave face as he receives his second dose of the MMR vaccine in Kyiv, Ukraine. Two-thirds of the world’s unvaccinated children live in fragile countries or countries affected by armed conflict. Between 2010 and 2016, conflict-affected eastern Ukraine had the world’s second lowest coverage rate of children fully immunized against diphtheria, pertussis, and tetanus. The country also had the third lowest coverage rate in the world for MMR vaccine in 2016. A plane with a crate of UNICEF-labelled MMR vaccines next to it. On the 26 February, 220,000 doses of the MMR vaccine arrived in Ukraine facilitated by UNICEF. UNICEF in Ukraine is helping to fast-track the delivery of MMR vaccines, assisting the Ministry of Health to respond to the recent measles outbreak in which 14,500 people have been infected – killing 13 people including nine children. Nine-month-old Sasha gets a kiss from his mother, after receiving the diphtheria, pertussis, tetanus (DTP) vaccine in Kyiv. Nine-month-old Sasha gets a kiss from his mother, after receiving the diphtheria, pertussis, tetanus (DTP) vaccine in Kyiv. Vaccine hesitancy has also become an issue in Ukraine but UNICEF is working to change attitudes and educate people on the dangers of not vaccinating their children. “Before his birth, we decided we would give our child all the necessary vaccinations,” says Sasha's father. “When my grandmother was a child, she got polio and, although she recovered from the illness, she was disabled for life. As caring parents, we want to protect Sasha from all sorts of infections.” In Turkey, a boy receives a dose of the Oral Polio Vaccine (OPV). In Turkey, a boy receives a dose of the Oral Polio Vaccine (OPV). UNICEF Turkey is supporting a vaccination program, led by the Ministry of Health. The campaign has included nine rounds of polio campaigns reaching 1.4 million refugee and migrant children and Turkish children in remote provinces between 2013-2015, and the provision of additional doses of MMR, Hepatitis B, Diphtheria, Tetanus, Pertussis, Polio and Haemophilus in 2017. A health worker vaccinates a one-year-old Syrian refugee boy at a neighbourhood health centre in Gaziantep, Turkey. A health worker vaccinates a one-year-old Syrian refugee boy at a neighbourhood health centre in Gaziantep, Turkey. UNICEF has also helped produce and disseminate information materials, in both Turkish and Arabic, to raise awareness about the importance of being immunized. A young baby receives her vaccination injection in Uzbekistan. In Uzbekistan, four-month-old Ziyoda receives a dose of the new polio vaccine - 'Inactivated Polio Vaccine’ (IPV) - which is designed to help stop polio globally. Despite Uzbekistan having an almost 99 percent coverage rate of the Polio vaccine, UNICEF continues to work with the Government to ensure that no child is left unimmunized in the future. A group of women wait for their children to be vaccinated at a village clinic in Uzbekistan. A group of women wait for their children to be vaccinated at a village clinic in Uzbekistan. Ensuring vaccination levels are high in every country across the region is essential. UNICEF is working to ensure all children are protected against the spread of vaccine-preventable childhood diseases and the best defence is a vaccine-protected population and a strong and responsive health system. The whole region benefits when ALL countries achieve and maintain high vaccine coverage at both national and subnational levels.
Protecting young children from vaccine-preventable diseases
Vaccination is one of the world’s safest and most cost-effective public health interventions. Yet growing distrust in science, coupled with misinformation, means that vaccination coverage rates are declining in some countries and communities, resulting in an upsurge of vaccine-preventable diseases. Research shows that those caring for children…
Tracking anti-vaccination sentiment in Eastern European social media networks
This UNICEF working paper aims to track and analyse online anti-vaccination sentiment in social media networks by examining conversations across social media in English, Russian, Romanian and Polish. The findings support the assumption that parents actively use social networks and blogs to inform their decisions on vaccinating their children. The…
Frontline social workers provide vital support to improve health
Yura has been a social worker for many years. “When I started working in social services, I was mainly interested in family therapy,” she says . “In time, I found out that supporting communities to become resilient and self-reliant is an extremely rewarding experience.” A year ago, she joined the Council of Refugee Women in Bulgaria (CRWB) – a civil society organization created in 2003 to support the integration of refugees and migrants. “Guiding through people from refugee and migrant backgrounds on health-related procedures in their host country is a way to empower them to find solutions to health issues,” explains Yura. And this is particularly vital for those fleeing from armed conflicts and humanitarian crises. As they search for safety and better life opportunities, both adults and children go through many traumatic experiences as a result of often prolonged stays in refugee camps, limited access to health care, and the dangers they face as they travel through volatile areas. By the time they finally reach a safe destination, they are often in very bad physical and psychological shape. “In Bulgaria, refugee children arrive with their parents or – in some cases – unaccompanied. Psychological problems, infectious diseases, medically unobserved pregnancies and, in particular, a lack of immunization, are common problems that have a negative impact on their health and wellbeing.” Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB The CRWB partners with UNICEF Bulgaria to provide general health checks and referrals, as well as life-saving vaccines in line with children’s immunization schedules, and equips parents with information on health risks, entitlements and how to access medical services. “As part of the ‘Strengthening Refugee and Migrant Children’s Health Status in Southern and South-Eastern Europe’ (RM Child-Health) project co-funded by the European Union’s Health Programme, we work with our partners to ensure that children can follow immunization plans and that their vaccination status is updated in their immunization documents. These are crucial steps in ensuring good health . ” Diana Yovcheva, Programme Officer with UNICEF Bulgaria Working directly with refugees, Yura consults families that want to access health services. “Some cases are easier than others”, she says, recalling a consultation with Ahmed*, a 45-year-old father of six children, who fled Syria in 2020 and received humanitarian status in Bulgaria. A chef by profession, Ahmed settled quite well in the host country, found a job in a restaurant and, after some time, managed to reunite with his wife, his four sons and two daughters. “Ahmed was referred to the CRWB by friends and he came in for a consultation on the immunization process with his youngest baby girl, Yasmina, only one year old” explains Yura. During their meeting, the social worker provided information about the health system in Bulgaria, the role of a general practitioner, and how people with refugee status can access medical services including vaccinations for their children. Although Ahmed’s baby girl had been vaccinated before her arrival in Bulgaria and had an immunization passport, the father urgently needed to update her vaccination status to synchronize her vaccinations with the recommendations of the national immunization calendar. “I contacted the Regional Health Inspectorate and helped Ahmed to provide the necessary documents and find a translator, as the documents were in Turkish”, says Yura. Subsequently, she helped Ahmed schedule an appointment with a medical doctor and Yasmina received her next vaccine. Parents often lack the necessary vaccination documents. According to Yura, “Sometimes children have not had any vaccinations, or they have been vaccinated in their country of origin, but their immunization cards have been lost or destroyed.” Such cases require additional consultations, research and coordination, as well as testing for antibodies and immune responses when it is not clear whether the child has been vaccinated. “By empowering parents to familiarize themselves with the immunization plans and procedures we help them become proactive in following up on their children’s health." Yura, Social worker To address the COVID-19 restrictions and keep active communication with refugees and migrants, the CRWB and UNICEF developed leaflets in Bulgarian, Arabic and Farsi with details about the health system in Bulgaria and the importance of vaccinations, and regularly provide health-related information via social media. “The role of communication in immunization is essential. Our frontline staff interact on a daily basis with beneficiaries, but we have also used other means [such as a Facebook group dedicated to health-related topics] to keep the information flow going, particularly during the COVID-19 pandemic . ” Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB Logo - Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe This story is part of the Project Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe, co-funded by the Health Programme of the European Union (the ‘RM Child-Health’ initiative). The content of this story represents the views of the author only and is her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the European Health and Digital Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains .
Breastfeeding: the best gift a mother can give her child
Breastmilk saves lives, protects babies and mothers against deadly diseases, and leads to better IQ and educational outcomes, yet rates of breastfeeding in Europe and Central Asia are low, with only 23 percent of the wealthiest families and 31 percent of the poorest breastfeeding up to the recommended age of two. Empowering and enabling women to breastfeed needs to be at the heart of countries’ efforts to keep every child alive and to build healthy, smart and productive societies. “Breastfeeding is the best gift a mother, rich or poor, can give her child, as well as herself,” said Shahida Azfar, UNICEF’s Deputy Executive Director. “We must give the world’s mothers the support they need to breastfeed.” A mother breasfeeds her baby at a maternity centre in Tashkent region, Uzbekistan. A mother breasfeeds her baby at a maternity centre in Tashkent region, Uzbekistan. The early initiation of breastfeeding – putting newborns to the breast within the first hour of life – safeguards infants from dying during the most vulnerable time in their lives. Immediate skin-to skin contact and starting breastfeeding early keeps a baby warm, builds his or her immune system, promotes bonding, boosts a mother’s milk supply and increases the chances that she will be able to continue exclusive breastfeeding. A mother learns to breastfeed her baby at a maternity hospital in Fergana, Uzbekistan. A mother learns to breastfeed her baby at a maternity hospital in Fergana, Uzbekistan. Breastmilk is safe as it is the right temperature, requires no preparation, and is available even in environments with poor sanitation and unsafe drinking water. It’s also more than just food for babies – breastmilk is a potent medicine for disease prevention that is tailored to the needs of each child. The ‘first milk’ – or colostrum – is rich in antibodies to protect babies from disease and death. A patronage nurse teachers a mother how to breastfeed in Kyzylorda city, Kazakhstan. A patronage nurse teachers a mother how to breastfeed in Kyzylorda city, Kazakhstan. In Kazakhstan, UNICEF has been working with patronage nurses to support mothers to breastfeed their children. The project has been running for several years and includes two visits during pregnancy and nine visits until the child reaches the age of three. As a result, there was a 14 percent increase in the number of children who were exclusively breastfed in the pilot region. A patronage nurse visits a family in Kyzylorda city, Kazakhstan. A patronage nurse visits a family in Kyzylorda city, Kazakhstan. There are several reasons why a mother may not be able to breastfeed, or does not wish to do so. Reasons include low awareness of the importance of breastfeeding and long-term impacts, as well as not knowing how to breastfeed properly which can subsequently cause the mother a lot of pain. Patronage nurses work with mothers to try to overcome these obstacles. A mother breastfeeds her baby, while the father and the older son support them. Mother Jovana breastfeeds her son Aleksa (two-months-old) while older son Ognjen (18-months-old) and husband Nikola support her at a clinic in Serbia. Breastfeeding is not a one-woman job. Women who choose to breastfeed need support from their governments, health systems, workplaces, communities and families to make it work. UNICEF urges governments, the private sector and civil society to create more enabling environments for breastfeeding mothers including arming mothers with the knowledge to make informed decisions, and providing them with the support they need from their families, communities, workplaces and healthcare systems to make exclusive breastfeeding for the first six months happen. Smiling parents watch as their baby breastfeeds at a maternity unit in Armenia. Smiling parents watch as their baby breastfeeds at a maternity unit in Armenia. In Armenia, UNICEF, together with the ministry of health and local health authorities, have created a sustainable parental education system at maternity and primary health-care facilities across the country to encourage breastfeeding and provide support to parents. In a UNICEF-supported space for refugee and migrant families, two mothers breastfeed their babies. In a UNICEF-supported space for refugee and migrant families in Serbia, two mothers breastfeed their babies. During the refugee and migrant crisis in Europe, UNICEF stepped in to provide support for children and mothers. Support included providing private spaces for breastfeeding mothers, nutritional guidance and breastfeeding support. UNICEF supports action to improve infant and young child nutrition across Europe and Central Asia, aiming to ensure that every child has the best possible nutritional start in life. Through its global campaign, Every Child ALIVE , which demands solutions on behalf of the world’s newborns, UNICEF urges governments, the private sector and civil society to: Increase funding and awareness to raise breastfeeding rates from birth through the age of two. Put in place strong legal measures to regulate the marketing of infant formula and other breastmilk substitutes as well as bottles and teats. Enact paid family leave and put in place workplace breastfeeding policies, including paid breastfeeding breaks. Implement the ten steps to successful breastfeeding in maternity facilities, and provide breastmilk for sick newborns. Ensure that mothers receive skilled breastfeeding counselling at health facilities and in the first week after delivery. Strengthen links between health facilities and communities, so that mothers are ensured of continued support for breastfeeding. Improve monitoring systems to track improvements in breastfeeding policies, programmes and practices.