Vaccine acceptance: Understanding and addressing barriers
In the wake of the recent measles outbreak in Nepal’s west, UNICEF, local authorities and partners are working to not just ensure availability of the vaccine, but also to build vaccine confidence and uptake in the community
Banke, Nepal: Meena Thapa had suspected early on that her first child, a little girl, was not developing quite at the same pace as other children her age. Where other toddlers may have started to walk, Deepshika could not yet sit or stand properly.
“We took her to different hospitals, but nothing worked,” Meena, a resident of the Khajura Rural Municipality in Banke District in Nepal’s west, says of the family’s harrowing experience seeking treatment. “It was only after we went to India, where she got nerve surgery two times, that she was able to stand with some help.”
Deepshika is now 10 years of age. While she is still unable to walk or speak, the little girl is lively and cheerful. To take care of her and their other children, Meena – who used to work at a micro-finance company – had decided to give up her job and stay home, while her husband migrated to India to earn for the family.
Though Meena says she has made peace with her eldest daughter’s condition, there are still a great number of challenges in their daily lives, Deepshika’s mobility being key among them.
“It’s been difficult to send her to school or anywhere because the commute is too hard for her,” Meena says.
This was one of the reasons that when there was a measles outbreak in several communities in the district in January 2023, Deepshika was among those children suspected of not having yet received the complete dose of the measles-rubella or MR vaccine.
Starting first from two wards in the Nepalgunj sub-metropolitan city, the outbreak quickly spread to all 23 wards, as well as parts of other nearby municipalities.
In response, an Outbreak Response Immunization campaign was launched to vaccinate all eligible children between 6 months to 15 years of age in the affected area. UNICEF – together with local authorities and partners – supported the delivery of the MR vaccine to health facilities across Nepalgunj.
In addition to safety delivering vaccines, UNICEF, in partnership with the Behavioral Science Center (BSC), has also been working to provide life-saving information to communities and increase vaccine uptake.
The BSC was established by the Kathmandu University School of Medical Sciences (KUSMS) in collaboration with UNICEF-Nepal and JSl in 2022. The center comprises core members from the Ministry of Health and Population, the Department of Health Services, the National Health Education, Information and Communication Center, the Family Welfare Division, academia, research experts, social scientists and civil society organizations.
In Nepalgunj, the team – in coordination with health authorities – conduced a rapid inquiry in select areas to understand the social and behavioral barriers that were discouraging vaccination, an approach that is key to the success of any vaccine drive.
“We also identified and engaged different community influencers who could help encourage vaccine uptake in communities,” says Anjali Joshi. “That was followed by door-to-door outreach to identify possible cases of unvaccinated children, counsel their caregivers and guide them to the health facilities.”
It was under this household outreach that the BSC team had learned of Deepshika’s condition, and sought to find the little girl. Anjali that it was initially difficult to locate them, given that the child was not enrolled in any schools. “Finally, we found a student who was related to Meena’s family, and she showed us the way to their home,” Anjali says.
Following a personal counselling session where Meena was informed about the dangers that measles pose to unvaccinated children, and a discussion about how vaccines contribute to children’s health and futures, the young mother was persuaded to take both her girls to get the vaccine.
With Deepshika secured to the back of her bicycle and her younger daughter in the front, the trio made their way to the vaccination center, where the two girls were vaccinated.
Meena says that she is glad her daughters have now received all the vaccines that are part of the national vaccination schedule, and feels that she understand the importance of immunization better.
“Vaccines are necessary to protect children from disease,” she says simply.