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
What you need to know about COVID-19 vaccines
Vaccines save millions of lives each year and a COVID-19 vaccine could save yours. The COVID-19 vaccines are safe and effective, providing strong protection against serious illness and death. WHO reports that unvaccinated people have at least 10 times higher risk of death from COVID-19 than someone who has been vaccinated. There is also evidence that being vaccinated can help prevent you from spreading the virus, so it protects people around you. It is important to be vaccinated as soon as it’s your turn, even if you already had COVID-19. Vaccines offer more reliable protection than natural immunity. Getting vaccinated is a safer way for you to develop immunity from COVID-19 than getting infected. The COVID-19 vaccines are highly effective, but no vaccine provides 100 per cent protection. Some people will still get ill from COVID-19 after vaccination or pass the virus onto someone else. Therefore, it is important to continue practicing safety precautions to protect yourself and others, including avoiding crowded spaces, physical distancing, hand washing and wearing a mask.
Vaccinations with a smile in Uzbekistan
Baby Imona is visiting the clinic, but there is no fear or tension, because Nurse Aziza Abduazimova knows how to put her and her parents at ease. Aziza’s open face and sweet, cheerful manner make all of the children she meets comfortable. “I always meet babies with a smile. Then I answer all of the parents’ questions about vaccinations so that they feel they can trust me with their child’s health. I make the child comfortable, and chat and play with them. I use toys to create a relationship before vaccinating them.” Aziza has been immunising children at Polyclinic #47 in Tashkent, Uzbekistan for six years now. She says that she loves her job. “I’m a mother myself. I have three sons aged 15, 12 and 10 years old who are all vaccinated and growing up healthy. I didn’t have a moment’s hesitation in getting my children vaccinated, and I am happy to help other mothers raise strong and healthy kids.” Aziza believes that it’s much better to vaccinate a child and prevent a disease than treat the sometimes-serious consequences of an illness. “Polio can cause permanent paralysis. Mumps, a common childhood disease, can make boys infertile, and measles can be fatal. It’s not just the consequences for the individual, either. A child who hasn’t been vaccinated is putting everyone else at risk, including babies and unvaccinated adults.” Nurse Aziza Abduazimova administers the polio vaccine to baby Imona. Nurse Aziza Abduazimova administers the polio vaccine to baby Imona. However, despite all the evidence about the safety of vaccines to prevent serious disease, some parents are still hesitant. “It’s a natural urge for a mother to protect her baby, and some mothers are scared to cause their baby the pain of an injection,” Aziza says. “Believe me, when I first started this job, I used to cry along with the babies, but then I realised that by causing this brief moment of pain, I’m preventing a lot of future suffering.” Some parents read things on the internet that scare them. Aziza says, “I follow a lot of discussions on the web and I often post evidence to prove that they needn’t worry. All the vaccines used in Uzbekistan meet international standards.” Aziza recalls a young mother who didn’t vaccinate her first son. “He got every childhood disease, one after the other, including Hepatitis A. With my encouragement she decided to vaccinate her younger son. He has grown up very healthy. Now when people see them together, they assume the younger one is older because he wasn’t sick as often, he’s so much taller and stronger than his brother. His mother tells everyone her story. She says, ‘If I’d had my older son vaccinated, I wouldn’t have gone through all these troubles.’” Aziza helps parents who have concerns about vaccinations to meet mothers and fathers with children who have been fully immunised. “Peer to peer conversations are really helpful because parents trust fellow parents and they can see the results.” She believes being a good vaccinator isn’t just about following procedures but having the right attitude: “There was one lady who came from outside our clinic’s catchment area. She was surprised to find me so cheerful and friendly. In her previous experiences staff had been professional, but she told me my friendliness has made such a difference to her children; now they feel at ease during and after vaccinations. It makes such a difference how you treat people." "Children pick up a lot from how you deal with them—they connect with a smile.” - adds Aziza. Nurse Aziza puts baby Imona at ease with a toy after administering a vaccine. With toys and smiles, baby Imona is at ease after receiving a vaccine. “My main message to parents would be to follow the vaccination calendar. Don’t wait or delay; it has been developed to protect against the most common diseases in this country and vaccinating on time gives your child the best protection.” Aziza gives baby Imona a last cuddle. She smiles, “Parents share the hope that their child will grow up healthy. In my work as a vaccinator, I can help make that happen.” UNICEF in Uzbekistan trains health professionals across the country to vaccinate children and works closely with the Government to ensure the vaccine system is safe and can reach all children with life-saving immunizations.
Protecting children against measles in Romania
Parents living in Strehaia, a Roma community in South-West Romania, nod and smile in relief after watching a short video shown by their local physician on the benefits of immunizing their children. The physician answers questions from the parents before they gather their children and move to the next room where all of the children are vaccinated. The children range in age from young toddlers to 18 years old. The young ones hold their mothers’ hands tightly, but the older ones laugh and ask to watch the film again. The film is part of UNICEF Romania’s ongoing support to the Ministry of Health’s efforts to increase immunization coverage and prevent the spread of measles. Vaccination coverage in Romania has declined since 2000. In 2017, only 75 per cent of children had received two doses of Measles, Mumps and Rubella (MMR) vaccine – a coverage rate far below the recommended 95 per cent needed to protect all children. As a result of low immunization coverage, Romania has experienced a measles outbreak, with over 15,000 people affected since 2016. This includes 59 deaths, the majority being children. As part of ongoing efforts to increase immunization coverage, in July 2018 Romania’s Ministry of Health launched a door-to-door catch up campaign to vaccinate children who missed their vaccinations. In support, UNICEF developed a series of materials to provide parents with easy to understand, factual information about the benefits and process of children being immunized. These materials include the short film watched by families in Strehaia. The film is shown to parents and families in the most vulnerable communities in Romania - people living in hard to reach areas, those affected by poverty, and Roma communities. These communities often have children with the lowest rates of immunization. The film talks about the necessity and benefits of vaccination and, at the same time, addresses the most common vaccine-related questions from parents: Is it safe to vaccinate my child? What if she/he catches another disease? What if my child gets sick after the vaccination? Is the vaccine free of charge? A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. “In the beginning parents did not want to vaccinate their children, but then they put their trust in us. We told them vaccines are good and we encouraged them to ask the doctor all the questions they have during the campaign. So they were able to have a clear picture on the benefit of vaccination,” said Gabriela Stan, a health mediator in the town of Buhuși, in Eastern Romania. Gabriela was part of the team that went door-to-door to inform parents from vulnerable communities about the benefits of vaccination. Although there have been positive developments in reaching vulnerable children with lifesaving MMR immunizations over the past few months in Romania, until the coverage rate reaches 95 per cent, children will remain at risk.
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…
Vaccination drive ongoing to protect children from deadly measles outbreak in Ukraine
Uliana Dziuba, 36, is holding the hands of her two young children as they wait to receive their vaccination against measles, mumps and rubella (MMR). Unlike her brother Volodia, nine-year-old Maryana is anxious, but Uliana knows how important today is. “I used to refuse to vaccinate the children against measles,” she says. “Once, I refused because they were sick at the time. Another time, there was a very powerful anti-vaccination campaign on social media. But Maryana got measles at age three and now I’m very worried that my son will get sick. I am vaccinating both of them for the first time today.” The pair are among thousands of children now being vaccinated in Lviv region, Ukraine, after the Ministry of Health with support from UNICEF launched an immunization drive. It is using a combined approach: teams of mobile doctors are working to reach school-age children while local clinics are increasing their ability to vaccinate more children. The drive is happening as UNICEF warns that global cases of measles have surged to alarmingly high levels – including in countries that had previously been declared measles free – eroding progress against this highly preventable, but potentially deadly disease. Maryana Dzuba, 9, receives her first dose of MMR vaccine on 21 February 2019 in the medical centre of the Lapaivka village school, Lviv region, Ukraine, as part of a three-week long catch-up vaccination campaign to increase MMR coverage among school aged children in the region. Maryana Dzuba, 9, receives her first dose of MMR vaccine on 21 February 2019 in the medical centre of the Lapaivka village school, Lviv region, Ukraine, as part of a three-week long catch-up vaccination campaign to increase MMR coverage among school aged children in the region. In Ukraine alone, according to Government data, there were more than 53,000 cases of measles in 2018. Another 24,000 people were infected just in the first two months of this year. The situation in Lviv region is particularly dangerous, with approximately 11,000 measles cases in 2018, and up to 50,000 unvaccinated children in the region. Of the 634 children attending Volodia and Maryana’s school in Lviv, only 13 remain unvaccinated due to the ongoing immunization drive. During the first two days, a total of 2,030 children were vaccinated. For many it was the first time. The vaccination drive also helps combat negative attitudes towards vaccination, as well as shortages in vaccine supply through 2009-2015. “Teachers and medical professionals have been campaigning for vaccinations,” says school headteacher Tetiana Malieryk. “We held all-school meetings and parent-teacher conferences, where the danger of measles was explained. Now fewer parents are refusing vaccinations and those children who did not receive vaccinations because of their parents’ beliefs are being vaccinated.” Next in line for vaccinations at the school in Lviv are six-year-old twins Vitalina and Yuliana. The girls and their mother Olesia Kechur, 37, are dressed in traditional embroidered clothing. This will be their second vaccination against measles. Twins Vitalina and Yuliana Kechur, 6, are given a check-up by the doctor before receiving MMR vaccination on 21 February 2019 in the medical centre of the Lapaivka village school, Lviv region, western Ukraine. Twins Vitalina and Yuliana Kechur, 6, are given a check-up by the doctor before receiving MMR vaccination on 21 February 2019 in the medical centre of the Lapaivka village school, Lviv region, western Ukraine. “The mother is very responsible about vaccinations,” reports Halyna Narolska, their doctor. “They get all of them and don’t miss anything.” Narolska has been a doctor for over 30 years. During this time, she says, she has not seen a single complication from an MMR vaccine. “Temperature may increase and there may be rash on day four, but neither has happened to a single child that we have vaccinated,” she says. “The only way to stop the outbreak is to vaccinate all children.” “There is a measles outbreak all over the world,” remarked Ukraine’s Deputy Minister for Healthcare Olha Stefanyshyna, during a recent visit to Lviv. “However, Ukraine is sadly a leader among the European countries. This is why we need to take extraordinary measures. I would like to say that this campaign is aimed primarily at children who missed their vaccination against measles, mumps, and rubella in the past. Today, we have better coverage of children who are born now.” UNICEF and its partners are supporting governments to reach millions of children in countries around the globe with life-saving immunization. However, stronger commitment and actions to vaccinate more children and protect them from preventable diseases is critical – including in Ukraine.
#VaccinesWork to protect children in Ukraine, amid measles outbreak
As a mother of two young children, Natalia was once told by her doctor that vaccinations were unnecessary. Now – with a measles outbreak gripping Ukraine –Natalia is glad she chose to ignore the doctor’s advice and instead vaccinate her children. This recent national outbreak has affected 16,500 people and killed 13, including nine children. According to a UNICEF poll taken in 2016, 16 percent of parents in Ukraine have refused vaccinations for their children. Natalia with her two children in a park in Kyiv. Natalia, with her two young children in a park in Kyiv. “Many parents I know still refuse to vaccinate their children,” says Natalia, whose children received the MMR vaccine against measles, mumps and rubella. “They say the vaccines are bad, that they have adverse effects. My children are fine and I think their health is more important.” Ukraine’s Ministry of Health has been leading the outbreak response since 2017 with support from UNICEF and other partners. While less than half of all children in the country were vaccinated against measles as part of routine immunization in 2016 (via the MMR vaccine), the number more than doubled in 2017 to over 90 percent, according to the Ministry. Valentyna Ginzburg, a doctor who heads Kyiv’s state healthcare department, says she and her team have been working to combat the measles outbreak since first being alerted to a rise in infections following the New Year and Orthodox Christmas celebrations in 2018. “We received information on the incidence rates of measles in Kyiv,” Dr. Ginzburg says. “We knew we needed to take rapid action to prevent a situation similar to other regions, such as Odesa, where there had already been fatalities amongst both adults and children from the illness.” Measles is one of the most contagious diseases around and we understood that if we were not proactive and did not control it, it would have not been long before we had the same situation as in other regions. Dr. Ginzburg Dr. Ginzburg explains how she and her colleagues had to act quickly to stop the spread of the disease in Kyiv. UNICEF/2018/Krepkih Dr. Ginzburg explains how she and her colleagues had to act quickly to stop the spread of the disease in Kyiv. In the four days that followed, 11,000 children were vaccinated in Kyiv. Around 48,000 children were immunized from January to March, a tally that would normally take 12 months to reach. Following national recommendations on outbreak response, authorities in Kyiv launched a ‘situation room’ to collect the latest information and coordinate response actions. Being vaccinated was also made a pre-condition for children attending schools and preschools to help stop the spread. The city administration also encouraged medical specialists to visit schools and raise awareness of vaccination among both teachers and parents. Maryna Stefanenko, a pediatrician at a clinic on the left bank of Kyiv, gives more details. “We had a lot of people coming in, even those who normally go to private clinics,” she says. Dr Stefanenko’s clinic usually administers around 80 vaccines per day, but during the outbreak they were immunizing around 1,200 people each day. On the other side of the city, in Obolon district, another clinic rushed to meet demand. A pediatrician there, Dr Natalia Yatsenko, explained that as part of her job, she must sign the paperwork for parents who refuse to vaccinate their children. She says she spends a lot of time explaining the benefits of vaccination, as well as the risks for children who do not receive their shot. Before the measles outbreak, she managed to talk some 10 per cent of objectors into changing their mind. However, during the outbreak, she did not even have to persuade them – many parents who were once against vaccinations were very keen to bring their children to the clinic. A young boy receives several vaccines at a time at Dr Natalia Yatsenko clinic in Kyiv. A young boy receives several vaccines at a time at Dr Natalia Yatsenko clinic in Kyiv. Another factor in the response? The effects of armed conflict in eastern Ukraine. “We had some internally displaced people from the eastern regions who came to our clinic,” says Yatsenko. “They told us that their children’s vaccination records had been falsified, and now they wanted to vaccinate them for real. So we vaccinated them.” “We also vaccinated some parents,” adds Stefanenko. “The parents bought the vaccines for themselves from the pharmacy then brought them to us and we administered the shots.” Dr. Ginzburg also advocated with the Kyiv authorities to address one of the biggest issues the country is struggling with - access to vaccines for adults and health workers. “All health workers had to be checked and those who required vaccination had to be immunized,” she says. “Then we were sure that, no matter what, the doctors wouldn’t be incapacitated.” The city administration also made sure the municipal pharmacy chain had measles vaccines available for adults. Artem, six, receives his second dose of the MMR (mumps, measles, rubella) vaccine in Kyiv. Artem, six, receives his second dose of the MMR (mumps, measles, rubella) vaccine in Kyiv. Although vaccines for children were available in 2017, increased demand had depleted stocks in some regions. To help replenish stocks, a new expedited supply of MMR vaccines was delivered by UNICEF at the request of the Ministry of Health at the end of February 2018, and another 800,000 doses are due this month, to ensure sufficient vaccines for both routine immunization of children and those who may have missed their immunizations in previous years. Significant progress has been made in reaching more children with vaccines, yet still an estimated 1.5 million children die globally from vaccine preventable diseases every year and an estimated half a million children in the region are still not immunized. Millions of lives can be saved by extending basic health services like routine immunization to the most vulnerable and disadvantaged, and UNICEF is on the ground immunizing millions of children each year . Vaccines protect children against disease and death, saving up to three million lives every year. In short, #VaccinesWork.