1 million babies in the Philippines have not had a single routine vaccine, exposing them to diseases
The country is at high risk of polio and measles outbreaks, threatening children’s health
Jamila could see them from afar.
The hazy figure of PPE-clad nurses toting vaccine carriers coming over the hill meant only one thing for the first-time mother—her baby Jonaila was going to get vaccinated.
Unlike most towns in the Philippines where patients go to the clinics, government nurses in Marantao, Lanao del Sur, go from house to house to deliver routine immunization services for infants. And unlike most towns, many people in Marantao have a different reaction to the sight of ghost-like figures walking in the village.
“I took my baby and ran away. Others would shut their windows. We were afraid of the COVID vaccine because it was new, and we were worried that they would sneak it into the routine vaccines for children. I was scared that something bad would happen to my baby,” said Jamila.
For over a year, her baby Jonaila would remain a zero dose child—an infant that has never received a single immunization for any vaccine-preventable disease.
UNICEF and health workers finally convinced Jamila to get her daughter her first shots at 13 months old—an age when she should have been finished with all seven essential immunizations for babies.
Rise in zero dose children
Jamila and Jonaila’s case reflects a disturbing increase in the number of unimmunized children, among those born during the COVID pandemic.
According to UNICEF Immunization Officer Dr. Amador Catacutan, these children are particularly at risk for vaccine-preventable diseases like polio and measles.
“As they would be under 2 years old, their immune systems would still be maturing. Mortality is high in that population, especially when there are complications,” he said.
As of October 2022, the Philippines is the fifth-ranked country in the world with the most zero dose children, with up to 1 million unimmunized as of December 2021. That figure is only about half of the annual birth cohort, and almost double the number of zero dose children in 2020.
A large contributor to that figure is Jamila and baby Jonaila’s own home region, the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM)—an area historically plagued by poverty, access issues, and armed conflict.
BARMM, a Muslim-majority region in the country, also houses a passionately religious and tight-knit population. Many, like Jamila, value the advice of their own family and community members over that of medical experts—a dynamic exacerbated by the fear of COVID-19.
The ideal vaccination target is 95% of all children, but according to the 2021 Field Health Services Information System of the Department of Health, BARMM only managed to fully vaccinate about 61% of its eligible children, lower than the national average of 63%.
BARMM had already been lagging in vaccination rates even prior to the pandemic. The situation came to a head in 2019, when the province of Lanao Del Sur saw outbreaks of both polio and measles—two severe yet easily preventable diseases covered under the seven vaccines of the routine National Immunization Program for children.
Dr. Alinader Minalang, Health Officer III of the Integrated Provincial Health Office of Lanao Del Sur, says that the outbreaks were “not surprising,” given the issues in the province.
“Our previous cold chain facility was not very ideal. We only had refrigerators, and storage was limited and improperly organized.”
“We experience a lot of power outages—especially in our more remote communities—so the vaccines have to be properly monitored, because outages can affect the temperature and therefore the potency of our vaccines.”
Minalang also cites religious and cultural factors. “There is the religious belief that every one of us has that predestined fate. So some of our constituents believe that with or without vaccines, it’s still the same, because the destiny of man is predetermined.”
In response to the outbreaks, UNICEF and the BARMM’s Ministry of Health (MoH) launched special immunization activities aimed at reaching 95% vaccination coverage. This involved health workers going from house to house and the entire community coming together, including local NGOs, mayors, barangay captains and religious leaders.
To address the logistical gaps, Dr. Catacutan says: “We distributed solar refrigerators, especially to the far-flung areas. We also facilitated installation of walk-in cold rooms to ensure vaccines remain potent.”
Of utmost importance, according to Catacutan, was the help of the most important influencers in the Muslim community. In 2019, UNICEF worked with the Bangsamoro Government to create a compilation of Fatwa, or Islamic Rulings on Immunization based on passages from the Koran.
One such influencer is Imam Alim Abdulrahman Poli, who preaches in support of vaccines at the Mutilan Mosque in Marawi City. Poli cites that “The Prophet Mohammad said every illness has a cure. Vaccines aren’t haram (forbidden). They’re medicine.”
“While we have the concept of ‘Qadar’ or fate, you have to do your part first, and in this case, that means getting vaccinated. What happens after is fate.”
Dr. Catacutan credits the success of the 2019 outbreak response to a true “multi-sectoral effort”—a campaign that needs to be sustained to combat the rise in zero dose children.
“Most people think this is only an issue for the health sector, but this isn’t true.”
“Sometimes we need the Department of Social Welfare and Development to give financial assistance or sacks of rice as an incentive to vaccinate.”
Dr. Catacutan adds, “the police and army have the transportation to reach the remote areas, and the private sector has helped with manpower augmentation.”
“In a resource poor country like ours, we need other sectors to step in.”