Zero-dose children in Angola are being protected through a nationwide vaccination campaign

How the initiative is reaching babies in a nation with a high number of unvaccinated children.

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UNICEF
23 May 2023

After decades of civil war, Angola achieved peace in 2002. But in the past two decades, despite the end of the conflict, the country has struggled to reach every child with lifesaving vaccines.  

Even before the COVID-19 pandemic 30 per cent of children in Angola were identified as zero-dose, leaving them vulnerable to a range of preventable and potentially deadly diseases. The COVID-19 pandemic made the situation even worse as it disrupted health care services across the country.

Angola was one of 10 countries with the highest number of unvaccinated children in 2022.

Nine-month-old Lwisani is held by her mother, Lidia Francisco, prior to receiving a dose of a measles and rubella vaccine at Catambor Health Centre in Luanda.
UNICEF/U.S. CDC/UN0828426/Karel Prinsloo Nine-month-old Lwisani is held by her mother, Lidia Francisco, prior to receiving a dose of a measles and rubella vaccine at Catambor Health Centre in Luanda.

But through a partnership between the Angolan government, UNICEF and other partners, the tide is beginning to turn. A nationwide immunization campaign is underway with the aim of rebounding from years of struggle and the exacerbating impact of the pandemic. 

Kailane is held by her father, Wilson Abreu, while Nurse Quénia Pinto administers a vaccine.
UNICEF/U.S. CDC/UN0828195/Karel Prinsloo Kailane is held by her father, Wilson Abreu, while Nurse Quénia Pinto administers a vaccine.

Two-month-old twins Kailane and Kaio are benefiting from the initiative. Their father Wilson took them to a clinic for a regular checkup and to get their routine immunizations. They received oral vaccines against polio and rotavirus, as well as two injections with the pneumococcal and pentavalent vaccines. Wilson says he personally felt the pain for his babies when they received the injections but reflects that he’s incredibly happy and relieved that his daughters are now protected.

Wilson Abreu carries his 2-month-old daughter, Kailane, while his sister, Seovima Abeur, carries Kailane’s twin sister, Kaio.
UNICEF/U.S. CDC/UN0828196/Karel Prinsloo Wilson Abreu carries his 2-month-old daughter, Kailane, while his sister, Seovima Abeur, carries Kailane’s twin sister, Kaio.

Children like Kailane and Kaio can receive these vaccinations thanks to the incredible work of health workers like Quenia Pinto. She’s a 28-year-old nurse who has worked at the Catambor Health Centre for four years now.

Parents and caregivers wait for their children to receive routine immunizations at Catambor Health Centre
Nurse Quénia Pinto

“I like vaccinating children, even if they cry. I know it is for their good,” Pinto says. “I vaccinate between 40 to 50 kids every day. I feel as if I am always on duty. When I am home in the community, people always come and ask me questions and for advice.” 

At the clinic Pinto works, dozens of caregivers in the waiting room listen attentively to her as she guides them through a presentation about basic health practices for their babies, including breastfeeding. She’ll talk to them about the importance of immunization, reminding the parents that vaccines are safe and provide essential protection against diseases like measles, pneumonia, polio and tetanus. The infants are also weighed and measured to track their growth and detect any signs of malnutrition.

Four-month-old Nhairi Lwini is held by her mother, Fatima Domingos, while her measurements are taken during a medical checkup.
UNICEF/U.S. CDC/UN0828179/Karel Prinsloo Four-month-old Nhairi Lwini is held by her mother, Fatima Domingos, while her measurements are taken during a medical checkup.
Joao Correia carries his 8-month-old son Tacio during a routine checkup.
UNICEF/U.S. CDC/UN0828205/Karel Prinsloo Joao Correia carries his 8-month-old son Tacio during a routine checkup.

Through this campaign, immunization is becoming an important part of primary health care for children at a very young age. That’s essential in Angola, which is a country that has the second-highest fertility rate in the world, with an average of 5.9 children per mother. 

Angola has the second-highest fertility rate in the world.

Pregnant women wait to receive antenatal care at Benfica Maternal and Child Health Centre in Luanda.
UNICEF/U.S. CDC/UN0828222/Karel Prinsloo Pregnant women wait to receive antenatal care at Benfica Maternal and Child Health Centre in Luanda.

One of the reasons behind the past lower rates of childhood immunization in Angola was insufficient cold chain infrastructure, which helps to store vaccines at the appropriate temperatures. That’s being addressed in this partnership between Angola’s Health Ministry and UNICEF.

Head Nurse Nsingui Pedro Cardosa inspects vaccines in the Benfica Maternal and Child Health Centre’s cold storage facility.
UNICEF/U.S. CDC/UN0828240/Karel Prinsloo Head Nurse Nsingui Pedro Cardosa inspects vaccines in the Benfica Maternal and Child Health Centre’s cold storage facility.
Logistics Manager Tshiyaze Martin monitors the temperature inside a cold storage room.
UNICEF/U.S. CDC/UN0828245/Karel Prinsloo Logistics Manager Tshiyaze Martin monitors the temperature inside a cold storage room.

UNICEF is helping to roll out a nationwide remote temperature monitoring system, so that health managers can consistently monitor the temperatures of the vaccines being stored. During the storage period, if for whatever reason the vaccine is exposed to temperatures that are unsafe, health managers receive an alarm. As a result, they can take timely and appropriate action to ensure that only safely stored vaccines are delivered to the child. 

Health worker Nelson Franco Domingos walks with lorida Manuel, as she brings her 5-month-old baby daughter Pascaulina to be immunized at a mobile vaccination post.
UNICEF/U.S. CDC/UN0828477/Karel Prinsloo Health worker Nelson Franco Domingos walks with lorida Manuel, as she brings her 5-month-old baby daughter Pascaulina to be immunized at a mobile vaccination post.

Thanks to the improving cold chain infrastructure, health workers are now able to travel more easily and reach children and their caregivers in their own communities rather than at regional hospitals. That includes Francesca Da Silva and her 10-month-old daughter Malena. Because Francesca is blind, it makes it very challenging for her to travel long distances to access the health care she needs for her daughter. But today, thanks to an outreach campaign in her community, her daughter Malena has been vaccinated.

Francesca Da Silva holds her 10-month-old daughter, Malena, at home after she was immunized at a mobile vaccination post in the Macuia neighbourhood of Luanda.

“My day went well,” says Francesca. “I have not vaccinated my daughter before as there is nobody to take me to the hospital to vaccinate her. It is good for the health of the babies. I feel very happy that my baby is vaccinated.”

Reaching every child in Angola depends not only on effective cold chain storage, but also passionate community health workers who work tirelessly to serve their communities. Nelson Franco Domingos is among those. He’s carried a table and cold storage boxes with vaccines to the Macuia neighborhood of Angola’s capital, Luanda, to set up a mobile vaccination post.

Eighteen-month-old Fernando is held by his mother Madele Easebia, while receiving a pentavalent and oral polio vaccines.
Eighteen-month-old Fernando is held by his mother Madele Easebia, while receiving a pentavalent and oral polio vaccines.

“We normally vaccinate between 200 to 300 people per day. There are so many children coming here who are zero-dose,” says Nelson, referring to children who have not received their first diphtheria-pertussis-tetanus vaccine (DTP1). “Their mothers forgot to take them to the hospital the first time. The most important thing doing this work is my love for the people.”

There’s still much more to be done to reduce the large number of zero-dose children in Angola. But through this initiative, the country has managed to catch-up and return to pre-pandemic levels of immunization coverage. That means that more and more babies in Angola can grow up healthy and have the chance to thrive.