From Door-to-Door: Reaching Out to Every Family with Vaccination During COVID-19

Lao PDR’s immunization programme has a long history of achievements and is widely regarded as one of the country’s most successful public health programmes. Launched in 1979, the programme established a system of outreach that can deliver vaccinations and other preventive interventions to children and women in every village nationwide. 

Thanks to the generous contributions from donors such as the Japan Committee, and Vaccines for the World’s Children, the Immunization programme has successfully eradicated diseases such as Smallpox and Polio in past.

2021 was another feather in the cap for the immunization programme, as Lao PDR rolled out the COVID-19 vaccination and made significant progress in vaccinating its population. By 19 December, about 4.4 million people or 60 per cent of the population had received at least one dose, while 3.4 million or about 46 per cent had been vaccinated with all recommended doses, getting closer to the goal of vaccinating 70 per cent of the population.  

To support the people of Lao PDR, UNICEF is leading the procurement of and supplying COVID-19 vaccines as part of the COVAX Facility, led by GAVI, the Vaccine Alliance, and supported the facilitation of bilateral vaccine contributions. UNICEF is also supporting the Government in strengthening the country’s cold chain capacity.

So far, 340 fridges to health facilities and installed 5 cold rooms to expand the subnational storage capacities. Moreover, UNICEF provided 688 cold chain equipment funded by Government of Japan emergency funding in December 2021.

However, these achievements were also filled with numerous challenges such as the country’s difficult geographic terrain, nationwide lockdown enforced due to the COVID-19 outbreak, travel restrictions and maintaining high vaccination coverage.

Although the Government lists immunization of infants and pregnant women as a high on its priority, a significant drop in childhood routine immunization services was observed due to services being disrupted.

In Lao PDR, Measles and Rubella vaccine coverage has stalled since 2013 and never reached 90 per cent. A wide degree of variation of MR immunization coverage from January to June 2021 was observed across the country by province, with the lowest MR 1 coverage of 50 per cent in Xaysomboun province and 59 per cent in Vientiane Capital, and the highest coverage of 91 per cent in Champassak and 90 per cent Saravane provinces.

A large segment of population remained unreached despite the ongoing efforts and special outreach programs designed to reach this section and maintain equity of services.  To tackle this issue, the National Immunization Programme (EPI) team combined COVID-19 vaccination and routine vaccination for children to achieve both targets together.

For this, local Governments have taken the leadership to conduct out-reach clinic sessions at remote and inaccessible villages ensuring live saving vaccines reach every child. This programme has also mobilized local leaders at grassroot level.

Mr Long Yang is a Village Chief at Phonkeo Village of Xiengkhoung Province. He is currently busy coordinating with health officials and village residents to bounce back the routine immunization with COVID-19 vaccination.

“Most people in my village belong to the ethnic group, the Hmong community, who are farmers by occupation. As they spend most of their time in the farm, they often miss appointments for regular and special rounds of vaccination services,” shares Long.

However, Long is determined to get every child vaccinated. Whenever vaccine services are scheduled, Long personally gives a phone call to villagers to inform. Health officials are also grateful for his leadership in supporting them to reach target groups.

While the National Immunization Programme (NIP) has recorded several milestones and achievements, new and urgent challenges have emerged. The COVID-19 pandemic poses a significant threat to the gains made in past as the country is undergoing an unprecedented level of macroeconomic stress.

To ensure children are not deprived of routine immunization, more support is required to upgrade the existing cold chain system and procure vaccines such as Measles and Rubella, and vaccination devices to maintain the constant availability of the vaccine and vaccination supplies until Lao PDR becomes self-sufficient in vaccine procurement.