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
Maintaining routine immunization services vital during the COVID-19 pandemic – WHO and UNICEF
The COVID-19 pandemic is a stark reminder that infectious diseases know no borders. All countries are vulnerable, regardless of income levels or the strength of their health care systems. Across the European Region, where tens of millions of people have been living in lockdown for weeks, and over 100,000 people have died, the speed and devastation of the novel coronavirus has completely upended lives. The urgent need for a COVID-19 vaccine underscores the pivotal role immunizations play in protecting lives and economies. As scientists around the world work to develop a vaccine against the novel coronavirus and health care capacities are stretched in responding to COVID-19, national routine immunization programmes are more critical than ever before. Governments across the Region must use every opportunity possible to protect people from the many diseases for which vaccines are already available. When routine vaccinations are missed, the risk of disease outbreaks increases. In 2018, approximately 527 000 children missed their first-dose of measles-containing vaccine in the WHO European Region. One year later in 2019, the measles virus exposed immunity gaps in Europe, infecting over 100 000 people, across all age-groups. Protecting children, adolescents and adults from vaccine-preventable diseases through vaccination is a must for the sustainability of health care systems. “We know that vulnerability to infectious diseases anywhere is a threat to public health everywhere,” said Ms. Afshan Khan, UNICEF Regional Director for Europe and Central Asia. “It is critical that routine immunization programmes continue during this crisis, while adequately protecting health workers and individuals receiving vaccinations. Reaching the most vulnerable children who have missed routine immunizations in the past should be prioritized.” If, during these unprecedented times, local COVID-19 response measures cause temporary interruptions of routine immunization services, countries should plan to resume immunization services as quickly as possible after the situation stabilizes. Countries should be prepared to vaccinate those at higher risk and ensure everyone, including the most marginalized, will have equal access to a COVID-19 vaccine when it becomes available. “ We can prevent further impact of COVID-19 on our healthcare systems by assuring that individuals of all ages remain vaccinated according to national schedules. I urge countries to maintain immunization service delivery and drive demand for vaccination, through the life-course even at this difficult time. Prioritizing immunization is one of my four flagship areas and central to WHO’s vision for health in the new European Programme of Work” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. WHO and UNICEF will continue to support governments’ efforts to strengthen their immunization programmes, including through strategic planning for equitable provision of immunization, strengthening vaccine-preventable disease surveillance and community engagement and education. As we step into a new future, vaccines will continue to serve as a foundation for health and wellbeing for all. It is through solidarity, joint action and tireless commitment to leaving no one behind that we can create a healthier future together. #Vaccineswork Georgia immunization UNICEF/UN0326765/Georgia
Statement by UNICEF Executive Director Henrietta Fore on the disruption of immunization and basic health services due to the COVID-19 pandemic
: “Around the world, the COVID-19 pandemic is overstretching health services as health workers are diverted to support the response. “Physical distancing is leading parents to make the difficult decision to defer routine immunization. “Medical goods are in short supply and supply chains are under historic strain due to transport disruptions. Flight cancellations and trade restrictions by countries have severely constrained access to essential medicines, including vaccines. “As the pandemic progresses, critical life-saving services, including immunization, will likely be disrupted, especially in Africa, Asia and the Middle East where they are sorely needed. “At the greatest risk are children from the poorest families in countries affected by conflicts and natural disasters. “We are particularly concerned about countries that are battling measles, cholera or polio outbreaks while responding to COVID-19 cases, such as Afghanistan, the Democratic Republic of Congo, Somalia, the Philippines, Syria and South Sudan. Not only would such outbreaks tax already stretched health services, they could also lead to additional loss of lives and suffering. At a time like this, these countries can ill-afford to face additional outbreaks of vaccine-preventable diseases. “The message is clear: We must not allow lifesaving health interventions to fall victim to our efforts to address COVID-19. “UNICEF is committed to supporting basic health care and immunization needs in the worst affected countries, and to doing so in a way that limits the risk of COVID-19 transmission. We are working hard to ensure adequate vaccine supplies are available in countries that need them. We are in close communication with global vaccine suppliers to ensure production is not disrupted and supply is managed in the best possible manner under these difficult circumstances. We are also providing greater support to governments to continue the supply of vaccines during this pandemic. “In the days to come, governments may have to temporarily postpone preventive mass vaccination campaigns in many places to ensure that the delivery of immunization services does not contribute to COVID-19 spread, and to follow recommendations on physical distancing. “UNICEF strongly recommends that all governments begin rigorous planning now to intensify immunization activities once the COVID -19 pandemic is under control. These vaccination activities must focus on children who will miss vaccine doses during this period of interruption and prioritize the poorest and most vulnerable children. To successfully roll-out vaccines against COVID -19 when they become available, we need to ensure that our immunization programmes remain robust and can reach those that will need these vaccines the most. “Immunization remains a life-saving health intervention. As the world's biggest buyer and supplier of vaccines, UNICEF will continue to play a pivotal role in supporting governments’ current and future immunization efforts.” Nurse Milka Babic performs immunization UNICEF/UNI218376/Pancic
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…
UNICEF reaches almost half of the world’s children with life-saving vaccines
– UNICEF procured 2.5 billion doses of vaccines to children in nearly 100 countries in 2016, reaching almost half of the world’s children under the age of five. The figures, released during World Immunization Week, make UNICEF the largest buyer of vaccines for children in the world. Nigeria, Pakistan and Afghanistan, the three remaining polio-endemic countries, each received more doses of vaccines than any other country, with almost 450 million doses of vaccines procured to children in Nigeria, 395 million in Pakistan and over 150 million in Afghanistan. UNICEF is the lead procurement agency for the Global Polio Eradication Initiative. Access to immunization has led to a dramatic decrease in deaths of children under five from vaccine-preventable diseases, and has brought the world closer to eradicating polio. Between 2000 and 2015, under five deaths due to measles declined by 85 per cent and those due to neonatal tetanus by 83 per cent. A proportion of the 47 per cent reduction in pneumonia deaths and 57 per cent reduction in diarrhea deaths in this time is also attributed to vaccines. Yet an estimated 19.4 million children around the world still miss out on full vaccinations every year. Around two thirds of all unvaccinated children live in conflict-affected countries. Weak health systems, poverty and social inequities also mean that 1 in 5 children under five is still not reached with life-saving vaccines. “All children, no matter where they live or what their circumstances are, have the right to survive and thrive, safe from deadly diseases,” said Dr. Robin Nandy, Chief of Immunization at UNICEF. “Since 1990, immunization has been a major reason for the substantial drop in child mortality, but despite this progress, 1.5 million children still die from vaccine preventable diseases every year.” Inequalities persist between rich and poor children. In countries where 80 per cent of the world’s under-five child deaths occur, over half of the poorest children are not fully vaccinated. Globally, the poorest children are nearly twice as likely to die before the age of five as the richest. “In addition to children living in rural communities where access to services is limited, more and more children living in overcrowded cities and slum dwellings are also missing out on vital vaccinations,” said Nandy. “Overcrowding, poverty, poor hygiene and sanitation as well as inadequate nutrition and health care increase the risk of diseases such as pneumonia, diarrhea and measles in these communities; diseases that are easily preventable with vaccines.” By 2030, an estimated 1 in 4 people will live in urban poor communities, mainly in Africa and Asia, meaning the focus and investment of immunization services must be tailored to the specific needs of these communities and children, UNICEF said.
Record number of infants vaccinated in 2017
: A record 123 million infants were immunized globally in 2017, according to data released today by the World Health Organization and UNICEF. The data shows that: 9 out of every 10 infants received at least one dose of diphtheria-tetanus-pertussis (DTP) vaccine in 2017, gaining protection against these deadly diseases. An additional 4.6 million infants were vaccinated globally with three doses of the diphtheria-tetanus-pertussis vaccine in 2017 compared to 2010, due to global population growth. 167 countries included a second dose of measles vaccine as part of their routine vaccination schedule and 162 countries now use rubella vaccines. As a result, global coverage against rubella increased from 35 per cent in 2010 to 52 per cent. The human papillomavirus (HPV) vaccine was introduced in 80 countries to help protect women against cervical cancer. Newly available vaccines are being added as part of the life-saving vaccination package – such as those to protect against meningitis, malaria and even Ebola. Despite these successes, almost 20 million children did not receive the benefits of full immunization in 2017. Of these, almost 8 million (40 per cent) live in fragile or humanitarian settings, including countries affected by conflict. In addition, a growing share are from middle-income countries, where inequity and marginalization, particularly among the urban poor, prevent many from getting immunized. As populations grow, more countries need to increase their investments in immunization programmes. To reach all children with much-needed vaccines, the world will need to vaccinate an estimated 20 million additional children every year with three doses of the diphtheria-tetanus-pertussis vaccine (DTP3); 45 million with a second dose of measles vaccine; and 76 million children with 3 doses of pneumococcal conjugate vaccine. In support of these efforts, WHO and UNICEF are working to expand access to immunization by: Strengthening the quality, availability and use of vaccine coverage data. Better targeting resources. Planning actions at sub-national levels and Ensuring that vulnerable people can access vaccination services.
More than 117 million children at risk of missing out on measles vaccines, as COVID-19 surges
“As COVID-19 continues to spread globally, over 117 million children in 37 countries may miss out on receiving life-saving measles vaccine. Measles immunization campaigns in 24 countries have already been delayed; more will be postponed. “During this challenging period, the Measles & Rubella Initiative (M&RI) expresses solidarity with families, communities, governments and emergency responders and joins our global immunization and health partners, including those within Gavi, the Vaccine Alliance and the Global Polio Eradication Initiative (GPEI) in our collective focus and fight against the threat of COVID-19. The pandemic sweeping the globe requires a coordinated effort and commitment of resources to ensure frontline health workers around the world are protected, as they face and respond to this new threat. At the same time, we must also champion efforts to protect essential immunization services, now and for the future. “The World Health Organization (WHO) has issued new guidelines endorsed by the Strategic Advisory Group of Experts on Immunization -- to help countries to sustain immunization activities during the COVID-19 pandemic. The guidelines recommend that governments temporarily pause preventive immunization campaigns where there is no active outbreak of a vaccine-preventable disease. M&RI partners, which include the American Red Cross, the U.S. Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation and WHO, strongly agree with these recommendations. We also urge countries to continue routine immunization services, while ensuring the safety of communities and health workers. The recommendations also ask governments to undertake a careful risk-benefit analysis when deciding whether to delay vaccination campaigns in response to outbreaks, with the possibility of postponement where risks of COVID-19 transmission are deemed unacceptably high. “If the difficult choice to pause vaccination is made due to the spread of COVID-19, we urge leaders to intensify efforts to track unvaccinated children, so that the most vulnerable populations can be provided with measles vaccines as soon as it becomes possible to do so. While we know there will be many demands on health systems and frontline workers during and beyond the threat of COVID-19, delivering all immunization services, including measles vaccines, is essential to saving lives that would otherwise be lost to vaccine-preventable diseases. “The M&RI supports the need to protect communities and health workers from COVID-19 through a pause of mass campaigns, where risks of the disease are high. However, this should not mean that children permanently miss out. Urgent efforts must be taken now at local, national, regional and global levels to prepare to close the immunity gaps that the measles virus will exploit, by ensuring that vaccines are available and that they reach children and vulnerable populations, as quickly as possible, to keep them safe. “Despite having a safe and effective vaccine for over 50 years, measles cases surged over recent years and claimed more than 140,000 lives in 2018, mostly of children and babies – all of which were preventable. Against this already dangerous backdrop, preventive and responsive measles vaccination campaigns have now been paused or postponed in 24 countries to help avert further spread of COVID-19. Campaigns expected to take place later in 2020 in an additional 13 countries may not be implemented. Together, more than 117 million children in 37 countries, many of whom live in regions with ongoing measles outbreaks, could be impacted by the suspension of scheduled immunization activities. This staggering number does not include the number of infants that may not be vaccinated because of the effect of COVID-19 on routine immunization services. Children younger than 12 months of age are more likely to die from measles complications, and if the circulation of measles virus is not stopped, their risk of exposure to measles will increase daily. “The M&RI salutes the heroism of health and emergency workers across the globe, and we recognize the vital role they play in delivering clear, trusted information, as well as preventive and supportive care within their communities. We must invest in health workers and ensure they are protected from infection and empowered as part of sustainable and functioning primary health systems. They are the first line of defense against global epidemics. We also recognize the role of parents and caregivers in ensuring their children are vaccinated by following physical distancing recommendations in line with national guidance. Finally, we call on countries and local leaders to implement effective communication strategies to engage communities, ensure supply and demand for vaccination remains strong, and help assure a healthy life for every child especially in this challenging time.” #####