"If these vaccines didn't exist, we would have had to invent them!"

Youssouf Diarra lives in Diamarabougou, a village in the Markala Health District in the central region of Ségou. He has been a vaccinator in the community health centre for over 20 years.

" l found my first year on the job very difficult because the villagers were afraid of side effects and didn't trust vaccines. Today, twenty years later, I can tell you that not only have things changed, but it is the parents themselves who come to me to asking for the vaccination schedule, just to make sure that their children do not miss their vaccination," recounts Youssouf as he head out on his rounds.

Since the second dose of the measles vaccine (VAR2) was introduced into the Expanded Programme of Immunization of Mali late 2019, Youssouf makes sure that all children aged 15 to 23 months have received their second dose of VAR,  whenever he visits families. This second dose of the vaccine was introduced to further boost immunity and give the child an added protection against measles.

During his rounds, he makes a stop to see the family of 4-year-old Aminata Farota. She received an additional dose of VAR during the vaccine response to a measles outbreak in her health district, Markala. This was just before the introduction of VAR2 into the routine Expanded Programme for Immunization (EPI). Despite having received a first dose of VAR before her first birthday, Aminata developed measles.

"One day her body temperature started to rise, then some spots showed up on her face.  She was not eating much and started losing weight, just like her three brothers," says Boubacar, Aminata's father. "When Youssouf came around, he immediately asked us to take them to the Community Health Centre.  After the tests, the doctor told us that they had contracted measles. The next day Youssouf and his team began to vaccinate all the children in the neighborhood.  Aminata and her other brothers in the family were also vaccinated," conclude Boubacar the fisherman confidently, now happy to see his daughter Aminata in perfect health. Youssouf, has no doubt that vaccines are safe, effective and that they save lives. "The second dose of VAR which was added to routine EPI is really necessary. It gives the child a second chance to be protected against measles," he insists.

Health systems around the world are being strained, and the longer this COVID-19 pandemic lasts, the more it will disrupt the functioning of essential health services such as immunization. In a country like Mali, one that has been affected by humanitarian and security crises and has caused the displacement of more than 300,000 people (over half of whom are children) COVID-19 has further weakened an already complex situation.  

The COVID-19 pandemic has slowed the distribution of vaccines against deadly and highly contagious diseases such as measles and polio. Nonetheless, Mali UNICEF is supporting the Government which is also working hard to ensure that essential services such as immunization continue to be available.  "In 2019, before the introduction of VAR 2 in Markala Health District, 9 cases of measles had been confirmed, notwithstanding our earlier vaccination campaigns. Some of the children had even received their first dose of VAR," explains Bouare Lalla Sidibe, EPI manager in Markala health district. "Since we introduced the second dose, we are starting to notice a marked improvement.  In 2020 we had only 2 confirmed cases and these were children from parents who move frequently. That is why the children are not up to date with their vaccination schedule.”

In Mali, the immunization coverage rates increased from 39% in 2013 to 87% in 2020 among children aged 12 to 23 months. This was as a result of new and innovative approaches such as:

• The creation of digital registers for vaccinated children,
• The use of ambulant immunization teams to get to populations living in hard-to-reach areas,
• The use of solar fridges to keep vaccines at an optimal temperature,
• The setting up of vaccination sessions in places with large gatherings of people (markets, schools, mosques, and main bus stations) as well as,
• The use of mobile phones to remind parents of their children's vaccination schedules.

The introduction of VAR 2 into routine EPI activities is an initiative supported by the GAVI Alliance and implemented by the Government of Mali with UNICEF’s support. Since its inception, the number of measles cases has decreased in Markala district, from 9 confirmed cases in 2019 to 2 cases in 2020. This is largely due to the commitment and mobilization of vaccinators like Youssouf, who, despite his modest income, is more determined than ever to make that every child in their community survives and develops. " It is an honor for me to vaccinate the children of my community.  I feel more pride when I see how far we have come over these last decades, getting vaccines accepted in our communities."

The COVID-19 pandemic revealing the magnitude of the challenges communities face when they do not benefit from vaccination protection against a vaccine-preventable disease. " Where they are available, vaccines are the most effective tool to prevent the spread of any disease that has the potential to become an epidemic. This is why it is more important than ever to ensure the continuity of essential and vital services such as vaccination," says Dr Abdoulaye BAGAYOKO, Immunization Officer for UNICEF in Mopti and Ségou regions, here during a vaccination session in Socoura IDP camp at Mopti.

The scientific evidence is clear. Vaccines are safe, effective and save lives by preventing disease outbreaks.  There is also no doubt for Boubacar, Aminata's father: "If these vaccines didn't exist, we would have had to invent them. They protect our children from disease, what’s more, they are free. Our parents were not so lucky, so let's take advantage and vaccinate our children," he concludes.